Fentanyl Substitutes: What ASCs Need to Know
A New Chapter in the Opioid Crisis
While fentanyl overdose deaths are finally declining, new fentanyl substitutes are emerging that pose equally dangerous — and less understood — risks. For Ambulatory Surgery Centers (ASCs) and healthcare professionals, this changing landscape demands updated awareness, stronger detection methods, and enhanced staff protection protocols.
Encouraging Data with Hidden Dangers
Recent reports show a sharp drop in fentanyl-related deaths — roughly 30,000 fewer fatalities annually in the U.S. according to addiction researchers. However, this progress is offset by the rise of new synthetic opioids designed to mimic or replace fentanyl.
Two Major Fentanyl Substitutes on the Rise
1. Xylazine ("Tranq")
Originally a veterinary tranquilizer, xylazine has infiltrated the illicit drug market, often mixed with fentanyl. According to DEA data, 23% of fentanyl powder and 7% of fentanyl pills seized in 2022 contained xylazine.
Key clinical aspects:
Not detected in standard toxicology screens
Unresponsive to naloxone (Narcan)
Causes severe tissue necrosis and “zombie-like” wounds
Slows breathing and heart rate to dangerous levels
2. Nitazenes
Nitazenes are synthetic opioids more potent than fentanyl, found increasingly in counterfeit pills and illicit blends. They were never approved for medical use but are now contributing to hundreds of overdose deaths globally.
Key clinical aspects:
Potency can exceed fentanyl by several times
Often disguised as prescription pills
May require multiple doses of naloxone for partial reversal
Escalating prevalence in toxicology reports
Clinical Implications for ASCs and Healthcare Facilities
Detection Challenges
Standard testing methods often fail to detect fentanyl substitutes like xylazine or nitazenes. Specialized toxicology panels are needed when overdose symptoms are present but test results are negative.
Treatment Complications
Naloxone may only work partially — or not at all — for mixed-substance overdoses
Supportive care and respiratory management become crucial
Wound care innovation is required for xylazine-related tissue injuries
How Healthcare Facilities Can Strengthen Safety Protocols
1. Enhanced Detection and Monitoring
Implement advanced toxicology screening
Train staff on identifying symptoms linked to emerging drugs
Stay informed on regional drug trends through DEA or CDC bulletins
2. Updated Treatment Protocols
Revise overdose response procedures to account for synthetic blends
Keep multiple doses of naloxone accessible
Introduce specialized wound treatment for xylazine exposure
3. Staff and Facility Protection
Strengthen PPE guidelines for staff handling exposed patients
Enhance decontamination processes
Conduct routine training on overdose recognition and response
Hyperlink idea: Link “staff training” to your ASC article on ongoing ASC staff development.
Global Outlook: A Moving Target
The synthetic opioid crisis is no longer limited to North America. According to The Lancet (January 2025), nitazene-contaminated pills have been detected in Europe, Australia, and Latin America.
As fentanyl precursor supplies tighten, cartels are experimenting with unpredictable substitutes — making clinical preparedness essential worldwide.
Key Takeaway: Fentanyl Declines, But New Risks Emerge
For ASC and healthcare professionals, the decline in fentanyl deaths is encouraging — but it’s not the end of the crisis. The rise of fentanyl substitutes such as xylazine and nitazenes underscores the need for continuous vigilance, education, and system upgrades.
MedServe remains dedicated to supporting ASCs and healthcare teams with tools and insights that enhance medication safety and compliance.
👉 Learn how MedServe can help your facility stay protected →
