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  • Writer's pictureDr. Harold Pierre

Deadly New Street Drugs in 2023

Updated: Nov 29, 2023

Deadly New Street Drugs Like Fentanyl Mixed with Xylazine, Designer Drugs, and Tianeptine

Deadly New Street Drugs Like Fentanyl Mixed with Xylazine

The human urge to alter consciousness is ancient and universal, but the methods for achieving this transcendence continue to evolve. Once limited to plant derivatives like opium and coca, chemists have unleashed a Pandora’s Box of potent new intoxicants. The Drug Enforcement Administration list several other concerning drugs that have emerged over the years. These emerging street drugs like fentanyl mixed with Xylazine, fentanyl-laced street drugs, bath salts, flakka, kratom are known too well by the bodies of drug overdose deaths.

syringe on the ground indication that it has been used.

Take the bizarre mixture dubbed “tranq” on the streets - a blend of the tranquilizer xylazine and the synthetic opioid fentanyl. Though developed for veterinary medicine, tranq has tragically found its way into the veins of addicted souls seeking a high. It's made a dangerous behavior even more deadly. The first cases left physicians puzzled, but before long, this exotic formula was linked to many overdose deaths.

Sadly, this is but one concoction in an exploding street pharmacy of new psychoactive substances. This has become much bigger than the opioid crisis. Home labs churn out synthetic cousins of MDMA, LSD, and cannabis to skirt the law. Rogue chemists synthesize deadly fentanyl analogues far stronger than morphine. Even with regulations, the illicit drug market adapts quickly, ever engineering new ways to deliver dazzling highs and addictive hooks.

Curiosity has always driven humans to sample altered states of mind. But modern chemistry has opened a Pandora’s Box of intoxicating products of unknown effect. We must grapple with this complicated desire, balance compassion for the addicted with protecting the innocent. Through this blog post, I hope to expand your understanding of these emerging street drugs.

Why Are New Street Drugs Like Xylazine (Tranq) So Dangerous?

The reason these new street drugs are so dangerous is because of their extreme potency coupled with their unpredictable effects. Let's break down the two main components found in these drug mixtures:

Fentanyl - A Synthetic Opioid 50 Times Stronger Than Heroin

  • Fentanyl is a synthetic opioid designed for pain management.

  • It's roughly 50 times more potent than heroin

  • It's estimated to be 100 times more potent than morphine.

  • It is trafficked as fentanyl powder

  • Even small amounts can be lethal.

  • It has flooded the street drug market in recent years

  • It is mixed with or sold as heroin, oxycodone, meth, and cocaine without users' knowledge.

  • Fentanyl-laced drugs has driven surges in overdose deaths across North America.

  • Fentanyl's high potency means it can rapidly stop a user's breathing even in experienced opioid users.

  • It's potency makes overdoses very hard to reverse.

Xylazine - An Animal Tranquilizer With Sedative Effects

  • Xylazine is a veterinary tranquilizer and sedative commonly used for animal surgeries. It has no approved medical uses in humans.

  • When mixed with opioids like fentanyl, xylazine also enhances their depressive effects.

  • It makes opioids last longer while also slowing down breathing.

  • Xylazine cannot be treated with naloxone, the emergency overdose reversal drug used for opioids. There is no antidote for xylazine overdoses.

The Rise of Xylazine as a New Street Drug

While xylazine has been detected in drug supplies for over a decade. Its presence has grown enormously in recent years according to the DEA. Between 2020-2021, the DEA found xylazine in fentanyl mixtures in 48 of 50 states tested. It's often mixed with fentanyl or heroin without users' knowledge [1].

Some key facts about the rise of this veterinary tranquilizer as a street drug:

  • Poison control calls for human xylazine exposure grew by 260% from 2015 to 2019 across the United States. This indicates increasing misuse.

  • Deaths involving Xylazine was about 7% of all overdose deaths nationwide in 2020, up from just 0.36% in 2015 [3].

  • States like Pennsylvania, Maryland, and Connecticut have seen xylazine present in 20-30% of overdose deaths, showing growing regional impacts [4].

  • Like fentanyl, xylazine is readily available online without a prescription and distributed through the same overseas drug networks. It can be easily and cheaply obtained as a cutting agent.

This rapid growth shows that we are dealing with a new public health threat that requires urgent attention. Both awareness and evidence-based harm reduction strategies will be key to tackling this crisis.

The Dangers of Fentanyl Mixed with Xylazine

While xylazine alone can be dangerous due to its sedative effects, combining it with fentanyl creates an even higher risk of overdose and death. Here are some of the hazards of using fentanyl-xylazine mixtures:

  • Extreme respiratory depression - Both substances depress breathing. Together they compound this effect, drastically raising the likelihood of stopping breathing.

  • Difficulty reversing overdoses - Xylazine overdoses can't be treated with naloxone. Higher or repeated doses of naloxone may be needed to manage the fentanyl, but the xylazine effects continue unchecked.

  • Prolonged sedation - Xylazine makes fentanyl's effects last longer, increasing the time the user is incapacitated and vulnerable. This also prolongs overdose risk after naloxone wears off.

  • Higher risk of death - With both a potent opioid and a sedative tranquilizer, even a small dose of a fentanyl-xylazine mixture can rapidly cause life-threatening overdose.

  • Skin and tissue damage - Xylazine constricts blood vessels and can cause skin wounds that lead to infection, necrosis, and lead to amputations.

Using any street drugs laced with unknown substances comes with severe risks. But the combination of xylazine and fentanyl appears to be particularly lethal based on the recent rise in deaths across multiple states. Recognizing this growing threat is the first step to being able to reduce these preventable losses in our communities through both policy and public health action.

Synthetic Cannabinoids

Synthetic cannabinoids refer to human-made chemicals that aim to mimic the effects of cannabis by acting on the same cannabinoid receptors CB1 and CB2. They are commonly sold as smokable herbal mixtures marketed as "synthetic marijuana" under names like K2 and Spice [1].

  • First appeared in the early 2000s as an alternative to marijuana, often purchased online from overseas labs.

  • Now banned, but chemists continually tweak molecular structures to create new unregulated analogs. Over 200 different synthetic cannabinoids have been identified so far [2].

  • Can be 100 times more potent than THC, producing stronger psychoactive effects.

  • Use has been linked to kidney damage, heart attacks, seizures, psychosis, violence, and deaths due to the unpredictable strength [3].

  • Not detected on typical workplace drug tests, making use appealing to some users.

  • Prevalence declined after 2015 peak, but remains an evolving public health threat with continuing development of new variants [4].

Synthetic Cathinones (Bath Salts)

Synthetic cathinones, also known as "bath salts," refer to stimulants chemically related to the khat plant but made entirely in labs. They are marketed under names like Flakka and Bloom and sold online or in head shops.

  • Gained popularity in the late 2000s as replacements for drugs like cocaine and MDMA once they were banned.

  • DEA banned many common synthetic cathinones, but chemists keep producing new unregulated analogs by slightly modifying molecular structures.

  • Desired for their energizing and euphoric effects, but can also cause paranoia, agitation, seizures, hyperthermia, self-harm, kidney/liver failure, and death.

  • Highly addictive with no approved medical treatment. Withdrawal includes depression, anxiety, tremors, fatigue, and drug cravings.

  • Variably detected by drug tests for amphetamines depending on the analog. Testing can help identify involved cathinones to improve treatment.

  • Use and harms declined since peaking around 2011-2012, but new variants continue appearing unpredictably.

Synthetic Opioids

Bottle with pills in gradient blue background. Presentation of synthetic opioid

Synthetic opioids like fentanyl are made entirely in a lab rather than derived from opium poppy plant products like morphine and heroin. They include:

  • Prescription synthetic opioids, including fentanyl, methadone, and tramadol, approved for pain relief.

  • Illicitly manufactured fentanyl, carfentanil, and novel analogs like U-47700, made in underground labs and trafficked through the same routes as heroin and cocaine.

  • Extremely potent, with just 2 mg of fentanyl being potentially lethal—minimal amounts needed to lace heroin or make counterfeit pills.

  • High likelihood of overdose death due to potency and variability in illicit production and mixing. Overdoses increased over 15-fold from 2013 to 2019.

  • Difficult to identify due to the endless stream of new structural analogs invented by traffickers to skirt regulations. Immunoassays and chromatography tests help screen samples.

  • Besides death, exposure to these strong opioids causes breathing to slow, unconsciousness, hypoxia, and permanent neurological damages like Parkinsonism.

Designer Benzodiazepines

Benzodiazepines or "benzos" like alprazolam (Xanax) and diazepam (Valium) are prescribed for anxiety, insomnia and other conditions. Non-approved designer versions have appeared on the illicit drug market [13].

  • Structural analogs like clonazolam, flualprazolam, and etizolam, made by underground chemists and trafficked online or through existing drug trade routes.

  • Desired for relaxation and anxiety relief. 10-20 times more potent than commercial benzos with higher blackout and addiction risk.

  • Overdoses cause sedation, slurred speech, confusion, slowed breathing, coma, and can be lethal, especially mixed with other depressants like opioids.

  • Withdrawal includes insomnia, tremors, seizures, panic attacks, and can be life-threatening. Long-acting benzos may be used medically to wean users off safely.

  • Specialized urine tests help detect the presence of designer benzos, but most standard screens will miss them.


Phenibut is a central nervous system depressant developed in Russia in the 1960s and currently sold online as an unregulated "dietary supplement".

  • Purported to reduce anxiety, improve sleep and cognitive function. However, little evidence of benefits.

  • Acts on GABA-B receptors similarly to baclofen and gabapentin. Also metabolizes into GHB, giving it addictive, sedative properties.

  • Recreational use at high doses causes euphoria, but can produce unpredictable effects like loss of consciousness, seizures, arrhythmias, and psychosis.

  • Withdrawal symptoms include anxiety, tremors, racing heart, and insomnia. Can be medically managed by slowly tapering with baclofen.

  • Not detected on standard drug tests. Specialized urine, blood, or hair tests required to identify phenibut overdoses, which have been rising.


Kratom is a plant native to Southeast Asia whose leaves are consumed for their stimulant and opioid-like effects. It is also used to self-treat pain and opioid withdrawal.

  • Main active compounds are mitragynine and 7-hydroxymitragynine, which act as partial opioid receptor agonists with high addiction and abuse potential.

  • Desired effects include euphoria, relaxation, sociability and analgesia. Side effects include nausea, drowsiness, seizures, liver damage, psychosis, and respiratory depression [19].

  • Withdrawal produces drug cravings, anxiety, insomnia, pain, diarrhea, and muscle spasms, managed via slow tapering.

  • Being discussed for a possible regulatory drug scheduling in the US. Currently banned in Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin.

  • Not detected on typical drug tests. Specialized urine, blood or hair tests required to confirm kratom toxicity.


Tianeptine (Zaza Red) is an antidepressant drug approved in Europe, Asia, and Latin America, but not FDA approved. It has opioid-like effects and is used recreationally.

  • Enhances serotonin uptake but also acts on MOR as a full agonist, unlike other antidepressants. Hence, high addiction and abuse potential.

  • Recreationally used for its anxiolytic, sedative, and euphoric effects at high doses well beyond medical use.

  • Overdoses cause extreme drowsiness, seizures, confusion, kidney failure and death, especially when mixed with other depressants.

  • Withdrawal symptoms resemble opioid withdrawal - anxiety, sweating, nausea, diarrhea, insomnia, and body aches. Can be managed by tapering with buprenorphine.

  • Being monitored by the DEA but not currently a scheduled controlled substance. Specialized urine or blood tests help identify overdoses.

How Can We Address This Emerging Drug Threat?

With street drugs getting more dangerous, efforts are needed on multiple fronts to address this public safety crisis. Some measures that can help counteract the spread of drugs like xylazine-laced fentanyl include:

  • Improved monitoring & data sharing - We need more timely nationwide data to track the spread of these drugs and deploy resources. Crime labs, medical examiners, Centers for Disease Control, and law enforcement should coordinate data to identify emerging threats.

  • Alert systems - Early public safety alerts when new substances appear in communities can alert users, outreach workers, first responders, and hospitals to increase safety measures.

  • Expanded naloxone access - More naloxone kits and training for handlers, first responders, drug users, and bystanders are vital to reverse more overdoses. Higher doses may be needed.

  • Outreach and education - Public health messaging about new drug threats should especially target at-risk communities and youth. Harm reduction groups require additional resources to reduce deaths.

  • Supporting substance use treatment - Greater access to evidence-based treatment, especially medications for opioid use disorder, provides an alternative to dangerous street drugs.

  • Regulatory measures - Policy options like tighter controls on synthetic opioid production and distribution may help restrict availability alongside public health approaches.

Times of crisis require decisive action. While deaths continue rising, all levels of government and health authorities must come together to enact measures that can mitigate the harms of ever-changing illicit drugs. With stronger surveillance, community supports, addiction care, and harm reduction, we can curb preventable losses.

The Takeaway: Stay Informed, Be Prepared

The key lessons around the emergence of novel, highly potent street drugs are:

  • Understand the risks - Know that today's illicit drug supply is increasingly unpredictable and dangerous. No drug use is truly safe, especially with opioids.

  • Stay informed - Be aware of what new drugs are appearing in your area and how to reduce your risk of overdose.

  • Don't use alone - Having someone with you to administer naloxone can save your life in an overdose emergency.

  • Carry naloxone - Make sure you and your loved ones have this emergency medication on hand to reverse opioid overdoses.

  • Know the signs - Recognize overdose symptoms like slowed breathing, blue lips, clammy skin. Call 911 immediately and give naloxone.

  • Seek help - If you have a substance use disorder, seek medical care and treatment options. Recovery is possible.

  • Support harm reduction - Back policies and programs that reduce health risks and provide help without stigma.

The emergence of xylazine mixed with fentanyl and other novel street drugs underscores the need for enhanced vigilance, safety precautions, and public health strategies. As existing illegal drugs get banned or become scarce, underground chemists synthesize new structural analogs to skirt laws and meet user demand. While risks are rising, we have opportunities to prevent deaths and improve lives through evidence-based interventions and addiction recovery.

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About the author:

Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.

This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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