02/01/2026
This is a long post, so heads up! The downward trend in F-OD’s you’ve been hearing about is REAL thankfully, & it started to show up in national data around mid‑2023 into 2024, with a significant drop in F-OD’s reported compared to the year before. That’s GREAT, & it looks like it might be connected to changes in the drug supply itself, not just more naloxone/HR out there or treatment access improvements. (Though I do personally believe these absolutely helped)
One big piece of that supply change is what’s happening with fentanyl purity. For the first time in years, local drug checking programs & forensic data are showing that the unregulated, illegal fentanyl market isn’t as pure or as potent as it used to be, which seems to be one of the factors contributing to fewer immediate F-OD’s. PA Groundhogs’ report shows a STEEP decrease of fentanyl purity samples, particularly starting in Oct, 2023, indicating ✨something✨ happened on supply side. It could be that precursors are harder to get, so organizations are stretching supply, or a supposed ban by the Sinola Cartel to make/sell Fentanyl (of course this can never be confirmed- but it’s been repeated several times in online forums & those in the know) Regardless, something happened. It could have been both, along with a combination of other things, too.
But here’s the part that most people aren’t talking about enough: The supply isn’t just less pure fent, which isn’t always a “win:” it’s extremely chaotic & unpredictable currently, & that’s dangerous in its own way.
Tranq (xylazine) - an exclusively JUST animal sedative that was mixed with fentanyl for years before anybody knew & took notice. It was first seen being used in He**in in Puerto Rico in the early 2000’s according to my own research. It made the jump to mainland US at some point, & really started to make itself known in the later 2010’s. Known for its necrotic wounds that can leads to amputations, tranq has been dropping in many supply’s, especially in the NE coast like Philadelphia & Baltimore, partly because states like PA banned it. It used to be everywhere & made OD’s harder to reverse because Narcan doesn’t touch it as it’s not an opioid. It also has its own WD- high BP & anxiety rates being common. Traditional MOUD (MAT medications for OUD) meds don’t address it, so it’s important to note this if starting a medication. They can recommend comfort meds you can get OTC to help.
Medetomidine - a stronger sedative, though it does have a human version too, that’s been increasingly replacing xylazine, especially after tranq became harder to get due to bans, has now become the dominant adulterant in the illicit opioid supply in many areas. It’s now the more dominant of the two cuts, though you will see both show up sometimes. It’s 10‑20x more potent than xylazine, & like xylazine, it doesn’t respond to Narcan. So far, we’re not seeing necrotic wounds directly from it, but it’s WD is extremely severe- many reporting ER visits. Again: High BP & anxiety like tranq, but more extreme.
People exposed to medetomidine can become deeply sedated with slow heart rate & breathing, & when they quit, WD can be extremely intense, with very high blood pressure, rapid heart rate, vomiting, tremors, & symptoms that can require hospital care. This isn’t the “mild” feeling some folks associate with sedative withdrawal, as it truly can be life threatening.
& it doesn’t stop there…. I’ll be combining these next things into one category;
🧪 Benzodiazepines, benzo analogues, & pressed pills: We’ve also seen more designer benzos (like flualprazolam, etizolam, etc.) & other depressants showing up in illicit pills & substances sold on the street. These aren’t reversed by Narcan either & intensify respiratory depression when combined with fentanyl, fent analogues, or any opioids. Some counterfeit pressed pills sold as Xanax or oxycodone actually contain unknown doses of fentanyl or benzo analogues &/or both, & people don’t know what they’re getting. This is why using test strips, if you’re actively using, is always important, as well as never using alone. There are hotlines you can call: Never Use Alone
NOTE: (The first 2 Penn North, Baltimore Mass OD events were brought on by a benzo analogue, one similar to Klonopin- so it had a very long half life. The 3rd & last mass OD event in the neighborhood was blamed on Medetimine. Thankfully, there were 0 ☠️’s from all 3 events- showing just how quickly first responders, outreach workers, & those out there worked to help people. It’s because of them that nobody lost their lives.
So while F-OD numbers maybe dipping for now, the unregulated supply remains wildly unpredictable, with new chemicals, new risks, new cuts, & new withdrawal challenges are cropping up all the time.
Here’s some important life‑saving info to know. Narcan may not be enough these days, sadly; What to do if someone OD’s on opioids, sedatives, tranq, or benzodiazepine analogues:
📞 1. Call 911 immediately.
You don’t have time to guess what’s in the substances taken, emergency help is critical. This is ALWAYS your first step no matter what.
💉 2. Give naloxone (Narcan) if you suspect an opioid is involved. Heck- Even if you don’t know, it can’t hurt honestly. Just give it. It can’t hurt, & only help! Narcan can reverse opioid respiratory depression (including fentanyl) but does NOT reverse xylazine, medetomidine, benzos, or other sedatives, as again: Narcan ONLY works on opioids.
🫁 3. Start rescue breathing if breathing is slow or absent:
• Tilt the person’s head back slightly
• Pinch their nose
• Give one breath every 5 seconds (about 12 breaths per minute)
• Watch for their chest to rise: that means air is getting in
This keeps oxygen going to the brain until help arrives. With sedatives & benzos, getting oxygen in can be the difference between life, brain damage, or ☠️, because Narcan won’t wake someone up from deep sedation on its own, as again- it only works on opioids.
💤 4. Put them in the “recovery position” once they’re breathing regularly: on their side with their top knee bent forward to keep the airway clear, just in case they vomit.
So YES, F-OD’s are trending downward, that’s good. BUT the chaotic supply with Medetomidine/Xylazine, benzodiazepine/ analogues, pressed pills of unknown composition, & other surprises means the risk is still very real. One mistake, one unexpected chemical, & someone can go from “fine” to fatal in minutes.
Carry Narcan. Learn rescue breathing. Stay with your people & don’t let temporary positive trends make you forget that the supply is still dangerous & unpredictable!
If you’re in the PA area, close to it, or just find the data interesting, I highly recommend following PA Groundhogs, & the work they do. Because they do quantitative analysis on substances, we’re able to see in real time exactly the makeup of different substances, & it’s very interesting seeing the variety of substances found, & how they differ from block to block, or even from week to week. The last 2 images, the graphs, is from their data & report.
