Synthetic drug mixtures reshape US overdose crisis, BBC reports

The Big Picture

The United States has seen a substantial decline in overdose deaths since their 2022 peak, but a changing illicit drug supply continues to pose serious risks, according to a BBC News report published Sunday.

About 110,000 Americans were dying from overdoses at the peak in 2022, mostly from opioids, the BBC reported. That total fell to around 70,000 in 2025. The report said the decline does not mean the crisis has ended, as fentanyl is increasingly found in mixtures with synthetic animal tranquilizers, stimulants and other chemicals.

Fentanyl is a fully synthetic opioid estimated to be 50 to 100 times more potent than heroin, according to the BBC. Its prevalence has transformed the drug market, the report said, particularly when it is combined with substances that can complicate emergency treatment.

What Happened

BBC reporters spent time in Columbus, Ohio, where they met Mike, a 48-year-old Army veteran who said he had lived with opioid addiction for 20 years. Mike told the BBC he was smoking fentanyl that cost three or four dollars per hit and believed it had been mixed with xylazine and medetomidine.

Both substances are synthetic animal tranquilizers, sometimes referred to as tranq, the BBC reported. They can prolong fentanyl's effects and slow breathing. Naloxone, also known by the brand name Narcan, reverses opioid overdoses but does not reverse the effects of xylazine or medetomidine.

The BBC reported that a drug kit Mike brought to a sampling program operated by the Hope Dealer Community in partnership with the Centers for Disease Control and Prevention tested positive for medetomidine. Under the program, participants' needles or pipes are swabbed, with samples sent to a CDC laboratory in North Carolina.

Xylazine can also cause necrotic skin ulcers that may extend to the bone and can be difficult to treat, the BBC reported.

Why It Matters

The changing supply can place people at risk even when they do not intend to take opioids. Scott Sanders, who runs the Hope Dealer Community in Columbus, told the BBC that people seeking crack cocaine may instead receive crack mixed with fentanyl or other opioid combinations.

Sanders said 78% of fatal overdoses in Franklin County, Ohio, during the preceding 12 months involved stimulants. He also said overdose deaths among Black men in Ohio were rising. Those claims were reported by the BBC and were not accompanied in the report by underlying county or state data.

The BBC said it heard in both Columbus and Chicago about crack cocaine users who died after using products that contained fentanyl. On the street, an unexpectedly fentanyl-contaminated supply can be called a “hot dose,” the report said.

Background

Naloxone has become widely available in the United States and has helped reduce fatal opioid overdoses, according to the BBC. The nasal medication can quickly reverse an opioid overdose, but the presence of non-opioid sedatives means patients may remain at risk after naloxone is administered.

At a Hope Dealer Community meeting, one man described surviving a July 2022 overdose after paramedics administered naloxone multiple times, with the final attempt reviving him, the BBC reported. Another participant, Tonya, said her nephew died of an overdose while she was overdosing on crack cocaine that had been spiked with fentanyl.

Those accounts underscore a central challenge for first responders and recovery groups: illicit substances may contain several drugs, and users may have little reliable information about their contents.

What Happens Next

Drug-sampling efforts such as the CDC-linked program in Columbus may provide local officials and community organizations with more information about emerging substances, including medetomidine, the BBC reported.

But Sanders told the BBC that the present supply is defined by mixtures rather than single drugs, describing chemicals made in basements and combined with fentanyl, methamphetamine and other substances. The report also included an interview with an unidentified Chicago fentanyl dealer who said he sold for Mexican cartels and acknowledged that his work was wrong.

The decline in overdose deaths offers an important measure of progress, but the BBC's reporting suggests that prevention, treatment and overdose response efforts are confronting a more volatile and difficult-to-identify supply.