Community Drug Alerts

Find information on overdose prevention and naloxone, harm reduction supplies and community supports.

Active community drug alerts

September 18, 2026: The Overdose Monitoring Alert and Response System (OMARS) is issuing an Community Drug Alert for Waterloo Region. 

There were 48 suspected overdoses/ drug poisonings and 1 suspected drug-related death in Waterloo Region from September 14 to September 17.

The street drug supply is highly toxic: street drugs may be different than expected and may cause unexpected reactions.

People who use unregulated (street) fentanyl may be at greater risk for overdose/ drug poisoning. Sanguen’s Drug Checking Program found:

Fentanyl with high amounts of Medetomidine. Drugs may not be evenly mixed, so some parts may have much higher amounts of medetomidine than others (hotspots).
Fentanyl mixed with other opioids (Para-fluorofentanyl)
Fentanyl is stronger than expected
Yellow as colour of concern. Be cautious using yellow powdered drugs.

There are reports of:

Very strong sedation happening very quickly after using drugs (ex: after one inhale) and needing more naloxone.
Concerns with cocaine: Being unresponsive, very slow breathing, and pinpoint pupils after using cocaine.
Complex overdoses. Signs to go to the hospital:

Deep sleepiness (very heavily sedated) and really hard to wake up
Very low heart rate

Complex withdrawal leading to hospitalization. Signs to go to the hospital:

Throwing up a lot
Chest pain
Going in and out of awareness
Very high heart rate and blood pressure

Read tips on how to stay safe if using drugs.

See the full printable version of the alert

Drugs of concern

Drugs found through Sanguen Health Centre’s Drug Checking Program

The drugs below were found unexpectedly in fentanyl samples. People who use unregulated (street) fentanyl may be at greater risk. Opioids, tranquilizers, or benzodiazepine mixed with any of these drugs increases risk for overdose/ drug poisoning because their dangerous effects become stronger when they are together.

Medetomidine

What is it? A strong sedative, like xylazine but much stronger. Not an opioid.
Effects: Last a long time (90 minutes or several hours). Deep sleepiness (on the nod, heavily sedated).

Passing out. People may be hard to wake up.
Slow breathing, heart rate, and blood pressure.
May cause hallucinations or confusion.
Dizziness, nausea, vomiting.

Medetomidine Withdrawal: Can start quickly and be very serious. Signs to go to the hospital:

can’t stop throwing up.
chest pain.
going in and out of awareness

Para-fluorofentanyl 

What is it? Unregulated fentanyl-like drug (opioid).

Test your drugs with fentanyl test strips. A positive result could mean para-fluorofentanyl or other types of fentanyl are in your drugs.

Effects:

Deep sleepiness (on the nod, heavily sedated). 
Passing out. People may be hard to wake up. 
Slow breathing, heart rate, and blood pressure

Fentanyl

What is it? A strong opioid.
Test your drugs with fentanyl test strips. A positive result could mean fentanyl is in your drugs. 
Fentanyl was found to be stronger than expected. People who use unregulated (street) fentanyl may be at greater risk for overdose/ drug poisoning.

Effects:

Slows breathing and heart rate.
People may be hard to wake up (heavily sedated). 
Memory loss.
Feeling of a stiff or tight chest.

What to do:

Stay with anyone on the nod and watch for signs of an overdose.
Follow the 5 steps to respond to an opioid overdose:

Shout their name and shake their shoulders.
Call 911 if they won’t wake up or if breathing is very slow or not at all.
Give naloxone.

Fentanyl and para-fluorofentanyl are opioids. Naloxone will work on these drugs.
Medetomidine is not an opioid. Naloxone cannot stop the effects of medetomidine. Give naloxone because it will work on opioids that may be mixed in the drugs.

Check that the person is breathing regularly. They may not wake up right away. Perform rescue breathing or give oxygen if you can.
Additional doses of naloxone may be needed. Give another dose every 2-3 minutes until breathing is back to normal.

If they are very sedated (sleepy) but still breathing, encourage them to keep breathing.
Stay with them until help arrives.

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About community drug alerts

The OMARS (Overdose Monitoring, Alert and Response System) Committee monitors data and information about overdoses in Waterloo Region. OMARS issues community drug alerts to warn people who use drugs and service providers when there is a higher risk of overdose in Waterloo Region because of,

A sudden spike in 911 calls for overdoses in a short time
A sudden spike in suspected drug-related deaths in a short time
Unexpected drugs found in the local unregulated supply
Unexpected reactions to drugs in the local unregulated supply

The unregulated drug supply is highly toxic. Anyone who uses these drugs is at risk of harms including overdose and death. For more safety information while using drugs, see our drug page.

If you have had an unexpected reaction to street drugs, or an overdose, OMARS encourages you to talk with a harm reduction worker.

Resources

Free naloxone kits and harm reduction supplies are available throughout Waterloo Region. For details see our drug page.
Toronto’s Drug Checking Service drug dictionary has information about drugs found in the unregulated drug supply.
The Opioid Overdose/Drug Poisoning Dashboard shows data on overdoses and deaths in Waterloo Region.
Test your drugs with the Sanguen Health Centre Drug Checking Program to know what is in your drugs.
For more information, email harmreduction@regionofwaterloo.ca

Past alerts

August 18, 2026: Alert extension was issued because there were 25 suspected overdoses/drug poisonings and 3 suspected drug-related deaths in Waterloo Region from August 14 to August 17. Sanguen’s Drug Checking Program found:
- Fentanyl with high amounts of Medetomidine and other opioids (Para-fluorofentanyl and suspected Nitazenes)
- Fentanyl with long-acting benzodiazepines (Flubromazepam and Gidazepam)
- Fentanyl was stronger than expected
August 4, 2026: Alert was issued because there were 37 suspected overdoses/ drug poisonings and 1 suspected drug-related death in Waterloo Region from July 30 to August 3. There were reports that fentanyl is stronger than expected.
July 3, 2026: Alert was issued because there were 44 suspected overdoses/ drug poisonings and 1 suspected drug-related death in Waterloo Region from June 28 to July 2. The street drug supply is highly toxic. Unexpected drugs may be mixed in to any type of street drug without people knowing. Sanguen’s Drug Checking Program found:
- Fentanyl with high amounts of non-opioids (medetomidine) and opioids (parafluorofentanyl).
- Fentanyl is stronger than expected.
June 1, 2026: Alert was issued because there were 38 suspected overdoses/ drug poisonings and 2 suspected drug related deaths in Waterloo Region from May 27 to May 31. Sanguen’s Drug Checking Program found:
- Fentanyl with high amounts of non-opioids (medetomidine and benzodiazepines) and opioids (carfentanil and nitazenes).
- Fentanyl with a new non-opioid, Nefopam. Nefopam is a non-opioid pain-relieving drug, which can cause some sedation. It is currently not approved for use in Canada.
- Meth mixed with Xylazine.
April 7, 2026: Alert extension was issued because there were 45 suspected overdoses/ drug poisonings and 1 suspected drug related death in Waterloo Region from April 3 to April 6. This was the second extension of the alert issued on March 16 (previously extended on March 25). Sanguen’s Drug Checking Program found fentanyl samples that had non-opioids (medetomidine, benzodiazepines and nitazenes) and opioids (carfentanil and parafluorofentanyl) unexpectedly mixed in.
March 25, 2026: Alert extension was issued because there were 27 suspected overdoses/ drug poisonings and 3 suspected drug-related deaths from March 20 to March 24. This was an extension of the alert issued March 16. Sanguen’s Drug Checking Program found fentanyl samples that have medetomidine, benzodiazepines, nitazenes, carfentanil, and parafluorofentanyl unexpectedly mixed in.
March 16, 2026: Alert was issued because there was 32 suspected overdoses/ drug poisonings and 2 suspected drug-related deaths from March 10 to March 15. Sanguen’s Drug Checking Program found fentanyl samples that had nitazenes, carfentanil, parafluorofentanyl, medetomidine, and benzodiazepines unexpectedly mixed in.
February 26, 2026: Alert was issued because there was 35 suspected overdoses/ drug poisonings and 1 suspected drug-related death from February 21 to February 25. Sanguen’s Drug Checking Program found fentanyl samples that had medetomidine, benzodiazepines, xylazine, and nitazenes unexpectedly mixed in. There were reports of memory loss, confusion, and being very sleepy (sedation) after using drugs.
January 15, 2026: Alert was issued because there were 3 suspected drug-related deaths from January 13 to January 14. Sanguen’s Drug Checking Program found fentanyl samples containing medetomidine and benzodiazepines.

November 25, 2025: Alert extension was issued because there were 3 suspected drug-related deaths from November 17 to November 25. Sanguen’s Drug Checking Program found fentanyl samples are stronger than expected, have fentanyl analogues including para-fluorofentanyl and continue to have Medetomidine/dexmedetomidine in them. Some people were very drowsy right after using.
November 13, 2025: Alert was issued because there were 3 suspected drug-related deaths from November 10 to November 12. Sanguen’s Drug Checking Program found fentanyl samples are stronger than expected, have fentanyl analogues including para-fluorofentanyl and continue to have Medetomidine/dexmedetomidine in them.
October 22, 2025: Alert was issued because there were 3 suspected drug-related deaths since October 16. Sanguen’s Drug Checking Program detected Medetomidine/dexmedetomidine. There were reports of confusion, disorientation, and memory gaps.
May 20, 2025: Alert extension was issued because there were 3 suspected drug-related deaths from May 14 to May 16. Concerns were raised about potential unpredictability in the cocaine supply.
May 5, 2025: Alert was issued because there were 5 suspected drug-related deaths between May 1 and May 3.

November 15, 2024: Alert extension was issued because there were 3 suspected overdose/drug poisoning related deaths from November 11 to November 14, 2024. Sanguen’s Drug Checking Program detected Medetomidine/dexmedetomidine, fentanyl Analogues, Xylazine, and Oxazepam. Concerns were raised by community members about the unpredictability of the meth supply which may cause unexpected reactions.
November 6, 2024: Alert was issued because there were 35 reported overdoses from October 31 to November 5. Sanguen’s Drug Checking Program detected Medetomidine/dexmedetomidine, fentanyl Analogues, Xylazine, and Oxazepam. Concerns were raised by community members about the unpredictability of the meth supply, which may cause unexpected reactions.
October 22, 2024: Alert was issued because there were 5 suspected drug-related deaths from October 11 to October 21. Sanguen’s Drug Checking Program found high potency fentanyl, Para-fluorofentanyl, Oxazepam, Flubromazolam AKA “Liquid Xanax”, fentanyl Analogues, Medetomidine/dexmedetomidine, Bromazolam in samples.
October 1, 2024: Alert extension was issued because there were 3 suspected drug-related deaths from September 29 to September 30. Sanguen’s Drug Checking Program found high potency fentanyl, Oxazepam, Dexmedetomidine, and Paraflurofentanyl in samples.
September 24, 2024: Alert was issued because there were 3 suspected drug-related deaths and 41 reported overdoses from September 17 to September 30. Sanguen’s Drug Checking Program found high potency fentanyl with Oxazepam. Dexmedetomidine, fentanyl, Paraflurofentanyl, and Bromazolam were also found in samples.
September 3, 2024: Alert was issued because there were 2 suspected drug-related deaths and 43 reported overdoses from August 28 to September 2. Sanguen’s Drug Checking Program found nitazenes in fentanyl samples. Flubromazolam AKA “Liquid Xanax,” Bromazolam, and paraflurofentanyl were also found.
July 5, 2024: Alert was issued because there were 4 suspected drug-related deaths and 41 reported overdoses from June 28 to July 4. Sanguen’s Drug Checking Program found Flubromazolam AKA “Liquid Xanax”, Xylazine, fentanyl Analogues, Medetomidine/dexmedetomidine, Bromazolam.
June 18, 2024: Alert was issued because there were 5 suspected drug-related deaths from June 12 to June 17.
June 3, 2024: Alert extension was issued because there were 4 suspected drug-related deaths and 50 reported overdoses from May 23 to June 2. Sanguen’s Drug Checking Program found fentanyl analogues, Benzodiazepines (including Bromazolam and Xanax), and Xylazine in fentanyl samples.
May 28, 2024: Alert was issued because there were 2 suspected drug-related deaths and 35 reported overdoses from May 23 to May 26. Sanguen’s Drug Checking Program found Fentanyl analogues, Benzodiazepines (including Bromazolam and Xanax), and Xylazine in fentanyl samples.
May 15, 2024: Alert was issued because there were 3 suspected drug-related deaths from May 11 to May 13. Sanguen’s Drug Checking Program found fentanyl analogues, Bromazolam, Xylazine, Medetomidine/ Dexmedetomidine and Parafluorofentanyl in fentanyl samples.
April 5, 2024: Alert extension was issued because there were 5 suspected drug-related deaths from March 28 to April 5. Sanguen’s Drug Checking Program found fentanyl analogues, Bromazolam, Xylazine, Medetomidine/ Dexmedetomidine and parafluorofentanyl in fentanyl samples.
March 27, 2024: Alert was issued because there were 3 suspected drug-related deaths from March 19 to March 26. Sanguen’s Drug Checking Program found new fentanyl analogues, Bromazolam, Xylazine, and Medetomidine/Dexmedetomidine in fentanyl samples.
January 22, 2024: Alert was issued because there were 6 suspected drug-related deaths from January 10 to January 22. Sanguen’s Drug Checking Program detected Para-fluorofentanyl, Bromazolam, and Xylazine in fentanyl samples.