Seattle, WA: Caleb Banta-Green, PhD, MPH, MSW & Jason Williams, PhD

Drug poisoning deaths appeared to again decline in 2025, down more than 30% from the 2023 peak in King County.

San Francisco, CA: Phillip Coffin, MD, MIA

Drug-related deaths were stable in 2025 after a reduction in 2024. Fentanyl continues to drive mortality. Emerging data suggest a significant proportion of fentanyl overdose deaths involve intermittent, first-time, or unintentional use of fentanyl.

San Diego, CA: Annick Bórquez, PhD

Harm Reduction Coalition of San Diego County shared that some participants have mentioned "pigeon's blood", a red heroin that costs more and is stronger. According to participants, this type of heroin has not been available for 10 years, but has now returned. No evidence available from drug checking at this time.

Nebraska: Patrick Habecker, PhD

As of this year, more interviews with our cohort members have revealed a much higher concern about fentanyl in the their supply. There has also been an increase in reports from cohort members in both knowing people who have recently experienced an overdose and knowing those who have died from an overdose. Paired with wastewater surveillance data this suggests that there is minimally more fentanyl present in the region and that our cohort members are aware and concerned by this.

St. Louis, MO: Heidi Israel, PhD, FNP, LCSW, CCRG

In St. Louis County, drug deaths have continued to decline from a high of 397 in 2021 to 217 in 2024 and then 260 in                                2025. A review of results from the 267 drug samples submitted to St. Louis County's drug checking lab (Project EAGLE FANG) in 2025 show that the submitted combinations have started to change dramatically. A “typical” sample in December 2024 would contain cocaine, Benadryl, fentanyl, lidocaine, methamphetamine, xylazine in white powder (submitted as crack) and a submitted sample of fentanyl (gel cap) contained 6-monoacetylmorphine cyclobenzaprine, DMT ,MDMA, methamphetamine, and olanzapine. In January 2025, BTMPS and heroin were identified in drug mixtures. In July, a higher percentage of fentanyl reported, still in a mixture of drugs, ranging from 22-44%. In September 2025, the the percentage of fentanyl dropped, to low levels, with occasional xylazine, BTMPS, medetomidine, and carfentanil identified. All samples contained fentanyl or heroin, methamphetamine, cocaine, ketamine, or MDMA, and occasional trace amounts of xylazine along with psychoactive and inert substances such as Tylenol. The samples were submitted as bags, gel caps, pills, powder, pipes. Fentanyl continues to be the primary drug used for treatment admission followed by cocaine, methamphetamine, and then heroin.

Texas: Dayong Lee, PhD

Based on the preliminary 2025 toxicology data from Houston Forensic Science Center, as fentanyl cases decrease, hydrocodone shows signs of increasing.

Florida, Bruce Goldberger, PhD

Toxicology laboratory directors continue to report significant decreases in the prevalence of new psychoactive substances (NPS) in decedents including novel benzodiazepines, cathinones, fentanyl analogs, and nitazenes in decedents. Cocaine, fentanyl, and methamphetamine continue to be the predominate substances identified. Laboratories are closely monitoring the shift of nitazenes to -orphine derivatives. Another substance of concern is 7-hydroxymitragynine (7-OH), a pharmacologically-active metabolite of mitragynine (Kratom), with mu-opioid receptor affinity significantly greater than morphine. 7-OH is a Schedule I controlled substance in the state of Florida. NPS and other substances identified in toxicology casework includes alpha-PiHPP (isoPV8), bromazolam, carfentanil, desalkylgidazepam, etizolam, ketamine, methylenedioxymethamphetamine, MDMB-4en-PINACA, ortho-methyl fentanyl, and pyrazolam. Adulterants identified in the quarterly crime laboratory drug report include BTMPS, medetomidine, and xylazine.

Philadelphia, PA: Jeanmarie Perrone, MD

Recently, a patient came to the ED seeking treatment for opioid use disorder withdrawal symptoms reported to be from 7-OH. Withdrawal symptoms improved after 2 mg of buprenorphine was administered based on Clinical Opiate Withdrawal Scale (COWS) score.

New York City, NY: Ellenie Tuazon, MPH

NYC Drug Checking Report for Q4 of 2025 is now available. Provisional drug checking dashboard can be
                                 viewed here.