These drugs 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. 
  • Very low or no pulse.     
  • 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. 
  • Having chest pain. 
  • Going in and out of responding or being aware, even while awake

Benzodiazepine (“benzo”)  

• What is it? A strong sedative. Not an opioid.   
• Gidazepam is a long-acting benzodiazepine. Effects may not be as strong as other benzodiazepines but last a lot longer.
• Effects:
• Deep sleepiness (on the nod, heavily sedated).
• Passing out. People may be hard to wake up.
• Slow breathing, heart rate, and blood pressure.
• Blackouts (memory loss).
• Slurred speech, trouble focusing eyes, poor balance. 

Nitazenes  

• What is it? A very strong unregulated opioid.
• Test your drugs with nitazene test strips. A positive result could mean Nitazenes 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. 
• Very low or no pulse.     

Carfentanil 

• What is it? A strong unregulated opioid, stronger than fentanyl. 
• Effects: 
• Deep sleepiness (on the nod, heavily sedated).  
• Passing out. People may be hard to wake up.  
• Slow breathing, heart rate, and blood pressure.  
• Very low or no pulse.      

Parafluorofentanyl   

• What it is: Unregulated fentanyl-like drug (opioid).  
• Test your drugs with fentanyl test strips. A positive result could mean parafluorofentanyl 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. 

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: 
1. Shout their name and shake their shoulders.  
2. Call 911 if they won’t wake up or if breathing is very slow or not at all. 
3. Give naloxone. 
• Nitazens, carfentanil, and parafluorofentanyl are opioids. Naloxone will work on nitazenes, carfentanil, and parafluorofentanyl.
• Medetomidine and Benzodiazepines (Gidazepam and Ethylbromazolam) and medetomidine are not opioids. Naloxone cannot stop the effects of medetomidine and benzodiazepines. Give naloxone because it will work on opioids that may be mixed in the drugs. 
4. Check that the person is breathing regularly. They may not wake up right away. Perform rescue breathing or give oxygen if you can. 
5. Additional doses of naloxone may be needed. Give another dose every 2-3 minutes until breathing returns to normal. 
• If they are very sedated (sleepy) but still breathing, encourage them to keep breathing.   
• Stay with them until help arrives.