Waging a war on drugs is like playing a game of Whac-A-Mole.

In 2005 Congress addressed the “meth crisis” by passing the Combat Methamphetamine Epidemic Act that, among other things, made the popular decongestant Sudafed, used by homegrown labs to make meth, a behind-the-counter drug and restricted its sale to patients. It didn’t take long for Mexican drug cartels to fill the void created by the crackdown on domestic meth labs, and to find other and better ways to manufacture meth. Now the Centers for Disease Control and Prevention report methamphetamine-related deaths at record high levels.

Reacting to the fact that the synthetic opioid fentanyl and its analogs— largely made and smuggled into the U.S. by labs in China—is responsible for up to 75 percent of opioid-related deaths, the Trump administration persuaded China to impose a ban on the production of fentanyl and its analogs in April 2019. By the fall of 2019 a new synthetic opioid, isotonitazene, made its debut in U.S. and Canadian black markets. The drug, which is not a derivative of fentanyl but equally as potent, is legal to export from China and is not banned in North America or Europe.

In March of this year Vice gave a detailed report on how this synthetic opioid has been found in counterfeit Dilaudid tablets sold on the streets in Nova Scotia, mixed with heroin sold in the U.S., and is sold in underground markets in Europe.

Research by the University of Pittsburgh shows that overdose deaths from licit and illicit drugs have been increasing exponentially since at least the late 1970s and show no signs of slowing. The drug that predominates as the cause of death has changed over the years, but the trend continues. In the beginning of this century prescription opioids that were diverted to the street were predominant. As prescriptions of opioids dropped, non-medical users migrated to heroin. Soon thereafter fentanyl and its analogs emerged on the scene, and now make up the bulk of opioid-related overdose deaths.

As efforts are underway to crack down on illicit fentanyl, don’t be surprised if isotonitazene is the next big thing.