Latest reporting
San Francisco's First MGM-15 Death Puts a Gas-Station Opioid on the Record
San Francisco recorded its first fatal overdose tied to MGM-15, a kratom-derived opioid sold in convenience stores. Naloxone is the guidance. The bigger problem is what the label says.
The House Voted to Schedule Xylazine. The Drug That Replaced It Sends People to the ICU.
Nine states scheduled xylazine and saw medetomidine reports climb. As Congress weighs a federal xylazine ban, hospitals report ICU-level withdrawal and people who use say the sedation can't be fought. What helps now.
If Someone Stays Under After Naloxone, the Supply Changed. Medetomidine Is Why.
Medetomidine has replaced xylazine in the fentanyl supply, according to 2026 lab data. Naloxone does not reverse it, and its withdrawal can look like a cardiac emergency.
Through eight lenses
Science
Alpha-2 agonists (xylazine, medetomidine — veterinary sedatives), nitazenes as μ-opioid agonists (synthesized in 1950s, never approved, re-emerging), kratom mitragynine partial μ-agonist + alpha-2, tianeptine atypical antidepressant with opioid activity at high doses.
Biology
Xylazine causes necrotic skin ulcers characteristic + prolonged sedation not reversed by naloxone; nitazenes act like high-potency fentanyl analogs (naloxone-reversible, higher dosing may be needed); kratom has its own withdrawal syndrome; tianeptine "gas station heroin" causing emergency-dept surges.
Psychology
Dependence patterns mirror the parent class but often with gaps in clinical recognition.
Policy
DEA scheduling scramble — xylazine FDA-declared emerging threat, nitazene analogs being scheduled piecemeal, kratom DEA deferred twice, tianeptine state-by-state patchwork.
The House Voted to Schedule Xylazine. The Drug That Replaced It Sends People to the ICU.
Oct 21Massachusetts Banned Kratom Overnight. The People Using It to Stay Off Opioids Got a Withdrawal and No Plan.
Oct 6The DEA Wants 7-OH in Schedule I. Nobody Has Said What Happens to the People Taking It Today.
Oct 4
Trends
Xylazine now in 48 states' supply; medetomidine identified in Chicago-area 2024; kratom retail boom.
Treatment
Xylazine wound care + opioid co-treatment; nitazene overdose reversal with naloxone; kratom dependence — buprenorphine effective; tianeptine dependence — like opioids.
The House Voted to Schedule Xylazine. The Drug That Replaced It Sends People to the ICU.
Oct 21Nobody Had a Name for What Dominic Cipriano's Body Was Doing. Doctors Took Nine Months to Write One Down.
Oct 7Naloxone Won't Touch Medetomidine. The Withdrawal That Follows Can Land Someone in the ICU for Weeks.
Oct 5
Harm Reduction
Test strips for xylazine + nitazenes (where available), stay with person during prolonged sedation, don't use alone, high-dose naloxone availability.