How a wave of homemade synthetic drugs sweeps the US and deepens the crisis

A changing drug supply

Mike, a former army veteran with a 20-year opioid addiction, guided reporters through neighbourhood back streets. He said he was smoking fentanyl, but one of his drug kits later tested positive for medetomidine.

Fentanyl is 50 to 100 times more powerful than heroin, the report says. It is increasingly mixed with synthetic tranquillisers, which can prolong its effects and make it harder to revive people who overdose.

The report describes these mixtures as homemade, with synthetic substances produced in American basements and bathtubs. It also says Mike believed his drugs contained xylazine and another substance he could not name.

Limits of overdose reversal

Naloxone, sold under the brand name Narcan, is a nasal spray that reverses opioid overdoses. Reporters carried it in case anyone on their team encountered fentanyl or someone nearby overdosed.

But naloxone does not work against sedatives such as xylazine. Xylazine can slow breathing and cause deep skin ulcers that are difficult to treat, making mixtures containing it especially dangerous.

At a weekly meeting of the Hope Dealer Community at Glenwood Church, one man described surviving an overdose in July 2022. After three doses of naloxone failed, a paramedic tried once more, and that final attempt saved his life.

Overdoses across communities

In Columbus and later in Chicago, reporters heard of people who used crack cocaine and died after their drugs contained fentanyl. On the street, this is known as a “hot dose.” Scott, who is almost 10 years sober, said overdose deaths among Black men in Ohio are increasing. When he asked the recovery group who had overdosed, most people raised their hands.

Supply still reaches users

The report links basement-made synthetic drugs to a sharp increase in overdose deaths in Illinois. It also describes a person challenged over his role in the opioid crisis, in which 50,000 people die each year. Asked whether the Trump administration’s targeting of boats suspected of carrying traffickers had made a difference, he said his product was still arriving from Mexico.