A report from the Office of the Chief Medical Examiner has confirmed that fluorofentanyl and isotonitazene or "ISO," two types of opioids more powerful than fentanyl, have infiltrated the streets of San Francisco. Xylazine, commonly known as "tranq," is also on the list. (Related: Fentanyl narcotic blamed for another mysterious death in Oklahoma City.)
According to the report, a retest conducted in 617 out of 647 overdose deaths from 2022 revealed that xylazine was found in 15 cases, while fluorofentanyl was present in 48 others. The report also indicated that fluorofentanyl was the sole opioid detected in some cases where stimulants like methamphetamine and cocaine were present.
Keith Humphreys, a Stanford professor and former drug policy advisor to the Obama administration, stated that fluorofentanyl is made by black market chemists, has never been intended for medical procedures and lacks approval for any legitimate use.
"In all my years working in medical institutions, I have never come across any reports of fluorofentanyl being used for medical purposes, not even in veterinary medicine," Humphreys stated.
Chelsea Shover, a respected epidemiology professor from the University of California, Los Angeles (UCLA), emphasized that xylazine appears to be more popular than fentanyl and ISO.
Xylazine, when mixed with fentanyl, becomes a more probable cause of death, but it does not appear in standard post-mortem drug exams unless specifically tested for.
Shover stated that xylazine users are prone to skin disease and may experience prolonged periods of unconsciousness, making homeless users susceptible to assault and robbery. Furthermore, xylazine is not an opioid, which makes it resistant to Narcan, a common opioid antidote.
Narcan (naloxone) works on ISO, but the extreme potency of the drug gives responders less time to administer the antidote and reverse the overdose successfully. "When we're talking about synthetic opioids in particular, it's sometimes the case that people require more than one dose," Shover said.
New street drugs in San Francisco are becoming Narcan-resistant
The arrival of new drugs in the streets of San Francisco is spreading rapidly to drug users who rely on Narcan for overdose reversal. However, these drugs are becoming Narcan-resistant.
Joey, a man found smoking fentanyl in a SoMa alleyway, recounted an experience when he accidentally overdosed on ISO. Thanks to the timely intervention of emergency responders armed with Narcan and a shot of adrenaline, Joey was revived from the brink of death.
"I woke up, and there was a group of people around me saying, 'Oh my god, you were gone,'" Joey stated.
The Department of Public Health and the local Drug Enforcement Agency are currently investigating the presence of ISO in the city. While they claim not to have found any traces of the substance, drug users insist that they can taste a discernible difference between ISO and their usual cuts of fentanyl.
According to those familiar with the street drug scene, ISO is marketed as a premium version of fentanyl, boasting higher purity levels and potentially more intense effects.
John Ostwalt, a long-term resident of the streets of San Francisco, shared tragic experiences with ISO. After smoking the drug, he collapsed while walking down the street, injuring himself and suffering a black eye from falling into a car window.
Ostwalt revealed that five of his friends overdosed on ISO in a single day. He then started to criticize the decision of the city to close a safe consumption site, the Tenderloin Center, which had successfully reversed over 300 overdoses during its operation.
However, others still remain skeptical about the ISO wave. Frank, a drug user, dismissed the uproar as mere rumors perpetuated by cunning drug dealers. He contended that ISO is likely just a different cut of fentanyl rather than a separate substance.