N-Desethyl Isotonitazene is classified as a novel opioid of the 2-benzyl benzimidazole sub-class and is structurally dissimilar from fentanyl. Novel opioids have been reported to cause psychoactive effects similar to heroin, fentanyl, and other opioids. Novel opioids have also caused adverse events, including death, as described in the literature. N-Desethyl Isotonitazene is a known metabolite of isotonitazene; however, it is now being manufactured and distributed as a parent drug on its own, which has been observed through sales on online gray market sites and demonstrated through the detection of this drug without isotonitazene in drug materials. Etonitazene and its analogue synthetic opioids were first synthesized and reported in the literature in the 1950s. Data suggest that this group of analogues can have potency similar to or greater than fentanyl. In vitro data shows that N-desethyl isotonitazene is similar in potency to etonitazene, and approximately 20 times more potent than fentanyl.4 Structurally similar drugs include isotonitazene and other nitazene analogues.