EMCrit FOAM Feed · Scott D. Weingart, MD FCCM

EMCrit Wee - A Discussion of Opioid Adulterants with a Harm Reduction Specialist

November 21, 2025·43 min·3 clips

Every time there is a major seizure or crackdown on fentanyl, I know the drug supply is about to get more dangerous, because they will find something worse to replace it.

This episode features Scott Weingart interviewing harm reduction specialist and FTIR technician Courtney Doherty about opioid adulterants. Doherty analyzes drug samples at St. Ann's Corner of Harm Reduction in the Bronx to identify contaminants in the street supply. The discussion centers on why adulteration occurs and the specific health impacts of current adulterants like xylazine and metonitazene. Doherty explains that adulterants appear primarily in the opioid supply due to government crackdowns and seizures, which disrupt the availability of fentanyl or heroin. She notes that other drug supplies, like crack or meth, rarely contain these adulterants. The conversation details how xylazine, a veterinary tranquilizer, caused severe soft tissue wounds and necrosis among users in the Bronx. Doherty describes how metonitazene has now surpassed xylazine in prevalence, leading to extreme sedation, delayed overdoses, and hallucinations reported by users. A key insight is that users often become dependent on a specific cocktail of multiple adulterants, making withdrawal exceptionally difficult. Doherty recounts testing one sample containing 13 to 15 different components. She explains that adulterants are added for various reasons: local anesthetics like lidocaine are used to mask the burn of methamphetamine, while quinine replicates the itchy feeling of heroin. The pressed oxycodone (M30) pills generally contain fewer adulterants than powdered "dope," but their potency can vary dangerously between batches. Doherty advocates for a regulated safe supply, similar to cannabis dispensaries, where users know the purity and composition of substances. She also emphasizes the need for more overdose prevention centers and improved, non-profit-driven rehabilitation programs. The episode has an educational and conversational tone, blending technical drug analysis with frontline public health perspectives. Emergency medicine clinicians and public health workers interested in the practical realities of the opioid crisis would find this episode valuable, while listeners strictly seeking traditional critical care topics might prefer to skip it.

As heard by us

A blunt, useful look at why adulterants are now a critical care problem.

Scott Weingart treats opioid adulterants as an immediate critical care concern, and that framing gives the episode real weight. Courtney Doherty, a harm reduction specialist and FTIR technician, brings the discussion down to practical ground, showing how drug samples are…

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Why you'd press play

For when you need the clinical reason newer opioid adulterants belong in your resus thinking.

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