Drug overdose deaths remain a significant public health concern in the United States, with fentanyl contributing to many fatalities. While some individuals intentionally use illicit substances, others may unknowingly ingest dangerous drugs found in counterfeit pills marketed as legitimate prescription medications. This issue of Clinical Insight reviews the growing prevalence of counterfeit pills and the risks they pose.

Use of the “gas station drug” tianeptine has been increasing nationwide, despite a public warning from the Food and Drug Administration regarding unproven medical claims on product packaging and adverse effects. This edition of Clinical Insight provides information about what this drug is, its legality, and both its desired and adverse effects.

The Food and Drug Administration (FDA) has warned the public about the next potential phase of the opioid epidemic, which has affected millions of people in the United States. This “fourth wave” is characterized by the emergence of novel synthetic opioids. One substance of growing concern is “7-OH”. This edition of Clinical Insight provides information about what 7-OH is, its desired effects, and associated risks and adverse outcomes.

Prescribed medications, though generally safe when taken as directed, can pose risks if taken in higher than prescribed doses or combined with other substances. This edition of Clinical Insight will highlight a few prescription medications that have been known to be misused.

The opioid epidemic in the United States has evolved over the years, with the substances and adulterants involved changing over time. Fentanyl has increasingly been found in the drug supply, contributing to a dramatic rise in overdose deaths. More recently, the veterinary drug Xylazine has emerged as an additive to not only fentanyl but also other drugs of misuse, resulting in a growing number of overdose deaths nationwide. Given that many people are not aware that the drugs they are using contain Xylazine, these mixtures are particularly concerning. This edition of Clinical Insight explores what Xylazine is, its effects, and the challenges it presents within the illicit drug supply.

Marijuana is the most commonly abused illicit substance in the United States. Because THC can come from a variety of sources and test results may be influenced by multiple factors, this issue of Clinical Insight reviews key concepts to consider.