Synthetic opioids mixed with animal tranquilizers that block overdose reversal drugs are reshaping the US addiction crisis, even as overall overdose deaths decline from their 2022 peak.
Fentanyl, a man-made opioid 50 to 100 times more potent than heroin, now dominates street supplies. But dealers increasingly add xylazine and medetomidine, both synthetic animal tranquilizers referred to as "tranq," which prolong the high while slowing breathing. Critically, naloxone (Narcan), the nasal spray that reverses opioid overdoses, does not counteract these tranquilizers. Xylazine also causes necrotic skin ulcers that can reach bone and are difficult to treat.
The shift has transformed the overdose landscape. Overdose deaths peaked at 110,000 Americans in 2022 but dropped to around 70,000 last year, according to the BBC report. Yet the crisis persists in new form. In Franklin County, Ohio (Columbus), 78 percent of fatal overdoses in the last 12 months involved stimulants, according to Scott Sanders, who runs Hope Dealers, a recovery group. Many users purchasing crack cocaine unknowingly receive fentanyl or opioid cocktails instead, creating what street users call a "hot dose."
Overdose deaths among Black men in Ohio are increasing, Sanders said. His organization partners with the Centers for Disease Control and Prevention on drug sampling, sending swabs from user needles and pipes to the CDC laboratory in North Carolina for analysis.
One user profiled in the report, a 48-year-old Army veteran in Columbus named Mike, unknowingly smoked multiple synthetics mixed into fentanyl. Testing confirmed medetomidine in his samples. He described the drug's hold: "This drug will damn near make you do anything, unfortunately."
At recovery meetings like those held at Glenwood Church in Columbus, survivors share accounts of overdoses that required multiple naloxone doses to reverse or nearly proved fatal. One man survived after paramedics gave naloxone three times before a fourth dose worked. Another attendee, Tonya, overdosed on crack cocaine laced with fentanyl while her nephew died from the same contaminated supply nearby.
Sanders described the scale of the problem plainly: "The drug supply in 2026 is this: we think we are buying crack but we're not, we're buying a number of different things. Today it is mixed, not just cut."