Fentanyl and xylazine in Indiana now share the same syringe more often than most families realize, and a newer sedative called medetomidine is spreading fast. The headline news is good: Indiana’s overdose deaths are falling. The warning underneath it is that the drug supply is getting more unpredictable, and some of what is now mixed into fentanyl does not respond to naloxone at all. If you love someone who uses drugs, the overdose you plan for today is not the same one you planned for two years ago.
Overdose deaths are falling in Indiana
The progress is real and worth stating plainly. Indiana recorded one of the sharpest turnarounds in the country, with overdose deaths down about 18 percent from 2022 to 2023, the second-largest drop of any state, and the decline has held since. Reporting in early 2026 shows Indiana’s opioid overdose deaths have fallen by roughly half since their 2023 peak. The trend is national too. The most recent federal data put overdose deaths at about 69,000 for the 12 months ending in January 2026, down roughly 13 percent year over year and the third straight year of decline. State leaders credit expanded treatment access and wider naloxone distribution for bending the curve.
That is the part everyone wants to hear. The problem is that a falling death count can hide a rising danger in what people are actually using, and that is exactly what public health officials are now flagging.
A more dangerous supply is testing that progress
In April 2026, the Centers for Disease Control and Prevention issued a national health alert about medetomidine, a veterinary sedative that is turning up in the illegal fentanyl supply. It follows several years of xylazine, another animal tranquilizer, spreading through the same supply. These are not fringe contaminants. They are increasingly part of what is sold as fentanyl or pressed into counterfeit pills, and their presence changes how an overdose looks and how it has to be treated.
The reason this matters is simple. Fentanyl is still the leading substance in Indiana overdose deaths, so naloxone is still essential. But xylazine and medetomidine are not opioids, and naloxone does nothing to reverse them. When they are mixed with fentanyl, a person can get the opioid reversed and still stay dangerously sedated, which is a situation many families and even some responders are not prepared for.
What xylazine and medetomidine actually are
Both are sedatives approved only for animals, not people. Xylazine, known on the street as tranq, is a tranquilizer that slows breathing, heart rate, and blood pressure. Medetomidine, sometimes called rhino tranq or dex, works in a similar way and is powerful in very small amounts. Neither belongs to the opioid family, so the medication that reverses an opioid overdose has no effect on the sedation they cause.
They are added to the supply because they deepen and extend a high, which also makes each dose less predictable. A bag that looks the same as last week’s can contain a different mix, and the person using it has no way to know.
Naloxone still matters, and here is why
This is the part that saves lives, so it is worth being precise. Because fentanyl is present in nearly all of these overdoses, you should still give naloxone every time you suspect one. The CDC guidance is to keep giving naloxone every two to three minutes as needed so the person takes at least one breath every five seconds. Naloxone reverses the fentanyl, and reversing the fentanyl is often what keeps someone breathing.
What has changed is that you cannot count on the person waking up fully the way naloxone alone might once have managed. If they stay sedated after naloxone, that is a sign a sedative like xylazine or medetomidine may be involved, which makes calling 911 and supporting their breathing more important than ever.
What to do if you suspect an overdose now
The steps have not changed so much as gained weight. If someone is unresponsive and you suspect an overdose:
- Call 911 first, and tell them the person is not breathing or is unresponsive.
- Give naloxone, and repeat it every two to three minutes if there is no response.
- Support their breathing with rescue breaths, which matters more when a sedative is in the mix and the person stays down.
- Place them on their side in the recovery position so they do not choke.
- Stay with them until help arrives, because sedation can outlast the naloxone.
Indiana’s overdose Good Samaritan law offers limited legal protection to people who call for help in good faith, so the priority is always the call and the person.
New risks families should watch for
Two specific dangers come with these drugs. Xylazine is linked to serious skin wounds that can appear even away from an injection site, and those wounds can become infected and worsen quickly, sometimes leading to amputation if they are not treated. Any open, non-healing wound in someone who uses drugs deserves medical attention, not shame.
Medetomidine brings a brutal withdrawal. The CDC alert describes a severe syndrome with racing heart, dangerous spikes in blood pressure, tremors, and relentless nausea that can peak within a day or two of the last use and may require emergency care. This is not something to push through alone at home, and it is one more reason medically supervised care matters.
Why this makes treatment more urgent, not less
A more dangerous supply raises the stakes on every use, and it makes stopping use the only reliable protection. It also raises the bar on how withdrawal should be handled, because coming off a fentanyl and sedative mix can be more complicated and more medically risky than opioids alone. That is why professional drug addiction treatment in Indiana matters now more than it did even a couple of years ago.
Naloxone and test strips reduce the chance that a bad moment turns fatal. They do not treat the addiction driving the risk, and they do not make a contaminated supply safe. Treatment is what actually lowers exposure, and the sooner it starts, the better.
How Red Ribbon Recovery Indiana helps
Red Ribbon Recovery Indiana is an outpatient provider based in Greenwood, serving the Indianapolis metro and, through telehealth addiction treatment in Indiana, Hoosiers across the state. Our opioid addiction treatment in Indiana combines medication-assisted treatment, a partial hospitalization program, an intensive outpatient program, standard outpatient care, dual diagnosis treatment for co-occurring mental health conditions, and long-term aftercare.
Because withdrawal from a fentanyl and sedative mix can be severe, medical detox is often the right first step. Red Ribbon Recovery Indiana does not provide detox or inpatient rehab in Indiana at our facility. When a higher level of care is needed first, we coordinate that placement with trusted partners and then bring the person into our outpatient programs to keep recovery going.
Because xylazine and medetomidine complicate withdrawal and wound care, structured treatment matters more, not less. Our partial hospitalization program in Indiana provides full-day clinical support while you live at home.
Cost is usually the first question, and it should not be a barrier. We verify your insurance quickly and explain your options before you commit to anything, so the path forward is clear.
Frequently asked questions
Does naloxone work on xylazine or medetomidine?
No. They are not opioids, so naloxone does not reverse them. You should still give naloxone, because fentanyl is almost always present and reversing it can keep the person breathing.
How do I know if a drug has xylazine or medetomidine in it?
You cannot tell by looking. Test strips for xylazine, and increasingly for medetomidine, are becoming available through harm reduction programs, and any non-prescription drug should be treated as unpredictable.
Why does my loved one have wounds that will not heal?
Xylazine is associated with skin wounds that worsen quickly and can become infected. Those wounds need medical care, and they are often a sign it is time to talk about treatment.
The supply is changing faster than most families realize. If someone you love is using, call Red Ribbon Recovery Indiana at (317) 707-9848 to verify your insurance and start a plan.
Sources
- Centers for Disease Control and Prevention. (April 2, 2026). Medetomidine in the U.S. illegal fentanyl supply increasing risk for overdose and severe withdrawal syndrome. Health Alert Network.
- Centers for Disease Control and Prevention. (May 16, 2024). What you should know about xylazine. Overdose Prevention.
- Indiana Public Media. (March 23, 2026). Drop in opioid overdose deaths nears 50% since 2023. Indiana Public Media.
- Centers for Disease Control and Prevention. (2026). Provisional drug overdose death counts. National Center for Health Statistics.
- WFYI Public Media. (May 16, 2024). New data shows Indiana had second largest decrease in overdose deaths in 2023. WFYI.
- Overdose Lifeline. (n.d.). Naloxone distribution in Indiana.
- Indiana Department of Health. (n.d.). Overdose prevention. IN.gov.
