Breaking the Stigma: Why Provider Attitudes Matter in Opioid Use Disorder Treatment

Community Service Board of Middle Georgia

Over the past several years, fentanyl has become one of the leading drivers of overdose deaths across the United States. While fentanyl remains a significant public health concern, today’s illicit drug supply has become increasingly unpredictable. Many substances sold on the street now contain multiple synthetic drugs mixed together—often without the knowledge of the person using them. This changing landscape presents new challenges for first responders, healthcare providers, harm reduction organizations, and communities alike.

As illustrated in the accompanying graphic, what appears to be fentanyl may actually contain a dangerous combination of substances, including medetomidine, xylazine, nitazenes, and other emerging synthetic drugs. Understanding these changes can help save lives through education, prevention, and harm reduction.

The Illicit Drug Supply Is More Complex Than Ever

Illicit drugs are increasingly being mixed with multiple synthetic compounds to enhance potency, extend effects, or reduce manufacturing costs. Unfortunately, these combinations significantly increase the risk of overdose and complicate emergency medical response.

In addition to fentanyl, healthcare professionals are increasingly encountering:

• Xylazine, a veterinary sedative that is not an opioid and can cause prolonged sedation, dangerously low blood pressure, and severe skin wounds
• Medetomidine, another veterinary sedative that has recently begun appearing in illicit drug supplies across several states
• Nitazenes, an emerging class of synthetic opioids that can be significantly more potent than fentanyl and have been associated with fatal overdoses

Many individuals have no way of knowing these substances are present because they are often mixed into counterfeit pills, heroin, methamphetamine, cocaine, or other illicit drugs (Centers for Disease Control and Prevention [CDC], 2025).

Naloxone Still Saves Lives—But It Isn’t the Entire Solution

Naloxone (Narcan®) remains one of the most effective tools for reversing opioid overdoses. It works by rapidly blocking opioid receptors, allowing normal breathing to return during an opioid overdose.

However, naloxone only reverses the opioid portion of an overdose.

If someone has also been exposed to sedatives such as xylazine or medetomidine, naloxone will not reverse those substances. Even after naloxone is administered, the individual may remain unconscious or continue experiencing dangerous respiratory depression because of the non-opioid sedatives present (CDC, 2025).

This is why it is critical to:

• Always administer naloxone when an opioid overdose is suspected
• Immediately call 911
• Continue monitoring breathing
• Provide rescue breathing if trained
• Stay with the individual until emergency responders arrive

Naloxone may still save the person’s life by reversing the opioid component, even when additional substances remain active.

Why Harm Reduction Matters More Than Ever

As the drug supply evolves, harm reduction strategies become increasingly important.

Evidence-based harm reduction does not encourage substance use. Instead, it recognizes that keeping people alive creates opportunities for treatment, recovery, and healing.

Important harm reduction practices include:

• Carrying naloxone
• Using fentanyl test strips when available
• Staying informed about emerging substances
• Avoiding using alone
• Seeking medical care immediately during suspected overdoses
• Connecting individuals with treatment and recovery services

Research consistently demonstrates that harm reduction strategies reduce overdose deaths while increasing engagement with treatment services (Substance Abuse and Mental Health Services Administration [SAMHSA], 2024).

Knowledge Saves Lives

One of the greatest dangers in today’s overdose crisis is assuming we know what substance someone has taken.

As highlighted in the Two Perspectives Tuesday graphic, what we believe is “just fentanyl” may actually be a mixture of multiple highly potent synthetic substances.

This evolving drug supply requires communities to adapt through ongoing education, surveillance, prevention efforts, and expanded access to lifesaving resources.

Healthcare providers, law enforcement, public health agencies, and community organizations all play vital roles in sharing accurate information and helping individuals understand the risks associated with today’s illicit drug market.

How CSBMG Is Responding

At Community Service Board of Middle Georgia (CSBMG), protecting lives means staying informed as the overdose crisis continues to evolve. Through prevention education, overdose awareness initiatives, recovery support services, treatment programs, and community partnerships, CSBMG works to equip individuals and families with the knowledge and resources needed to respond effectively.

Recovery begins with compassion, education, and access to care. Every conversation about overdose prevention has the potential to save a life.

As the science changes, so must our response.

References

Centers for Disease Control and Prevention. (2025). Understanding the evolving drug overdose epidemic. U.S. Department of Health and Human Services. https://www.cdc.gov/overdose-prevention/

Substance Abuse and Mental Health Services Administration. (2024). Overdose prevention and response toolkit. U.S. Department of Health and Human Services. https://www.samhsa.gov

U.S. Drug Enforcement Administration. (2024). National drug threat assessment. U.S. Department of Justice. https://www.dea.gov/resources/drug-threat-assessment