A new and growing drug threat is quietly reaching communities across the country, including rural areas like ours. It’s being called “fentanyl-plus,” and it’s different from what many people think of when they hear the word fentanyl.

This danger is not limited to people seeking opioids. In many cases, individuals never intend to use fentanyl at all.

What is “Fentanyl-Plus”?

“Fentanyl-plus” refers to fentanyl mixed with other substances, such as:

  • Methamphetamine
  • Cocaine
  • Xanax or other anti-anxiety pills
  • Unknown chemicals like xylazine or powerful sedatives

Sometimes the mixing is intentional. Other times, it happens without the user knowing, especially when pills or powders are bought on the street or shared by friends.

National drug surveillance systems report that this type of drug mixing has become more common in the later stages of the opioid crisis, increasing the risk of overdose and death.

Why this matters in rural communities

Rural areas face unique risks when it comes to fentanyl-plus:

  • Slower emergency response times
  • Limited access to treatment and detox services
  • Greater reliance on shared or non-prescribed medications
  • Higher exposure to methamphetamine and counterfeit pills

In Arkansas, youth prevention data already shows early experimentation with alcohol, vaping, marijuana, and prescription drugs. These substances can unintentionally expose young people and adults to fentanyl through contaminated or counterfeit products.

The hidden pill problem

One of the most alarming trends involves counterfeit pills. Fake Xanax and pain pills are being manufactured to look nearly identical to real prescriptions but often contain fentanyl or other dangerous drugs.

Someone may believe they are taking a pill to relax, sleep, or ease anxiety — but instead are exposed to a substance that can slow or stop breathing within minutes.

Parents, grandparents, and caregivers should know:

Not all pills are what they appear to be.

Naloxone helps — but it’s not enough

Naloxone (Narcan) saves lives and should always be used in an overdose emergency. However, some substances now found mixed with fentanyl do not fully respond to naloxone, especially when sedatives like benzodiazepines or xylazine are involved.

This makes prevention, awareness, and early education more important than ever.

What families and communities can do

Prevention begins with awareness and conversation. Health experts recommend:

  • Talking openly with youth about mixed drugs and fake pills
  • Never sharing prescription medications
  • Locking up medications at home
  • Learning the signs of overdose
  • Calling 911 immediately in any overdose situation
  • Keeping naloxone available, even if opioids are not used in the home

A community responsibility

Churches, schools, civic groups, and families all play a vital role by creating safe spaces for education without stigma or shame.

This issue is not about blame. It is about protecting lives.

Fentanyl-plus is appearing in places many never expected — including small towns, farming communities, and close-knit neighborhoods. Awareness today can prevent tragedy tomorrow.

For more information about local prevention programs, parent education, or community trainings, contact Bridging The Gaps of Arkansas at 1.888.978.8441 or www.BTGArkansas.org

Sources & Data

This article is based on national and state public health data, including:

  • National Drug Early Warning System (NDEWS)
  • U.S. Special Report on EMS encounters for nonfatal fentanyl-plus overdoses (2024–2025) — Reports over 31,000 nonfatal overdoses involving fentanyl mixed with stimulants or other substances, with 29% occurring in Southern states.
  • Ciccarone, D. (2025). “Fentanyl-Plus”
  • Donovan Memorial Fund Lecture; NDEWS Scientific Advisory Group — Documents the rise of intentional and unintentional drug mixing involving fentanyl, stimulants, benzodiazepines, and adulterants.
  • Peer-Reviewed Research
  • Nature Neuropsychopharmacology (2025): Research on fentanyl mixed with other psychoactive substances and increased overdose risk.
  • Journal of Prevention Science / Springer (2025): Studies highlighting polysubstance use and fatal overdose patterns.
  • Arkansas Prevention Needs Assessment (APNA), 2024
  • Arkansas Department of Human Services / UA Little Rock MidSOUTH Center — Regional data showing early substance initiation and prescription drug misuse among youth in Southwest Arkansas.

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About Bridging The Gaps of Arkansas

Bridging The Gaps of Arkansas provides community-based substance misuse prevention, youth leadership development, and family education services across Southwest Arkansas, working with schools, churches, and local partners to build healthier, safer communities.

Source: https://www.eldoradonews.com/news/2025/dec/15/a-new-drug-danger-is-emerging-and-its-not-what/