Drug Checking Findings: January-March 2026

download the report
download the report

The Philadelphia Department of Public Health (PDPH), Division of Substance Use Prevention & Harm Reduction (SUPHR), analyzed 500 drug samples collected between January and March 2026. Most samples consisted of drug litter recovered from public spaces by SUPHR staff.

Testing was conducted by the Center for Forensic Science Research and Education (CFSRE) using advanced toxicological methods. The results reveal a rapidly evolving drug supply, with increasing variability that may increase the risk of overdose, complicate overdose recognition, response, and withdrawal management.

Overview

PDPH SUPHR staff collected primarily drug litter samples, including glassine bags, centrifuge tubes, and other paraphernalia, found in public spaces between January and March 2025 (Table 1). Samples were also submitted by two collaborating community-based organizations, collected through an amnesty box in Kensington and syringe disposal boxes throughout the city. While these samples provide valuable insight into drug use patterns, their origin and handling introduce uncertainty. It is often unclear whether the detected substances were sold together, mixed by the person who consumed the drug, or contaminated after disposal.

These results are based on a limited sample. They should not be considered representative of the broader Philadelphia drug supply, but can be used for harm reduction education, updating response to overdose, adapting clinical management, and informing early warning about adverse effects of the illicit drug supply.

Most samples were collected in the Kensington area (Table 2). Center City accounted for 12 percent of samples, while smaller numbers came from South/Southwest (11 percent), North/Northeast (8 percent), and West (6 percent). Two sample locations were unknown.

Sample Collection

HTML Table Example

Table 1. Drug Sample Collection Volume, January - March 2026

Month n (%)
January 156 (31)
February 105 (21)
March 239 (48)
HTML Table Example

Table 2. Drug Sample Collection Volume by City Section, January - March 2026

Section n (%)
Kensington 315 (63)
Center City 59 (12)
Northeast/North 37 (7)
South/Southwest 55 (11)
Northeast/North 41 (8)
West 28 (6)
Unknown 2 (>1)

The CFSRE laboratory utilizes innovative analytical techniques for drug testing, employing comprehensive non-targeted data acquisition through gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-QTOF). The testing panel includes more than 1,100 substances, including a wide range of novel psychoactive substances (NPS) and other relevant compounds. This report includes results from both GC-MS and LC-QTOF analysis.

The quarterly analysis period is defined by the date on which SUPHR staff collected the samples. Initial classification of drug litter samples is decided by the staff submitting the sample based on visual characteristics of the drug product, packaging type, and/or associated paraphernalia at the time of collection. Following laboratory analysis, samples are reclassified according to the primary substance identified.

Laboratory Analysis

Samples with Primary Substance Heroin, Fentanyl, or Tramadol (n=313)

HTML Table Example

Table 3.Most Frequent Co-Occurring Substances in Samples with Fentanyl or Heroin as the Primary Drug and Percentage Change Since 2025 Q4

Substance n(%) Percent Change
Fentanyl 309 (99) + 2%
4-ANPP 304 (97) + 1%
Medetomidine 283 (90) - 1%
Lidocaine 279 (89) + 8%
Phenethyl-4-ANPP 267 (85) - 2%
Procaine 198 (63) - 22%
Cocaine 184 (59) - 3%
Caffeine 183 (58) + 34%
Acetylfentanyl 121 (39) - 5%
Tetracaine 117 (37) - 42%
Acetaminophen 97 (31) -11%
Xylazine 179 (51) + 35%
Methamphetamine 87 (28) + 40%
Heroin 48 (15) + 15%
Quinine 47 (15) +650%
Carfentanil 34 (11) - 54%
Suspected dope samples, or samples in which fentanyl (n=283), heroin (n=29), or tramadol (n=1) were identified as the primary substance, contained an average of 10.7 detected compounds (range:3-26). The sample containing tramadol as the primary substance was included in this category due to its packaging (a stamped glassine bag). Three suspected dope samples were excluded because no active substances were identified.
Fentanyl remained the most frequently detected substance in suspected dope samples, present in 99 percent of samples, a 2 percent increase since 2025 Q4 (Table 3)1. Carfentanil was detected in 11 percent of samples that had fentanyl (n=29) or heroin (n=5) as a primary substance, a 54 percent decrease from the previous quarter. Despite this decline, the presence of carfentanil in the drug supply remains a significant concern due to its extreme potency, where even small variations in concentration can substantially increase overdose risk.2 Acetylfentanyl, a fentanyl analog approximately 30 percent less potent than fentanyl3, was detected in 39 percent of samples, reflecting a 5 percent decrease from the prior quarter. Heroin was detected in 15 percent of samples, a 15 percent increase from Q4 2025. Fentanyl precursors 4-ANPP (97 percent) and phenethyl-4-ANPP (85 percent) remained highly prevalent. Four samples with a primary substance of heroin did not have fentanyl present, a 52 percent decrease since last quarter. There is a wide range in the amount of fentanyl in the dope supply, with the current average being around 6 percent.4
Veterinary sedatives continue to be widespread in the dope supply, with 92 percent of all dope samples containing xylazine and/or medetomidine. The proportion of dope samples without sedatives present increased slightly from 5 percent during 2025 Q4 to 7 percent in 2026 Q1. Medetomidine continues to be detected in most suspected dope samples (90 percent). There is a wide range in the amount of medetomidine in the dope supply, with the current average being around 15 percent.4 Xylazine was detected in 28 percent of samples, a 45 percent decrease from last quarter. Co-detection of xylazine and medetomidine decreased from 48 percent during Q4 2025 to 26 percent during Q1 2026, representing an 86 percent decrease (Figure 1). The presence of these sedatives complicates overdose response, as naloxone does not reverse their effects. Reported symptoms of medetomidine withdrawal include severe vomiting, diaphoresis, hypertensive crisis, fluctuating hypoactive encephalopathy, tremors, and tachycardia.5,6 Clinical observations in Philadelphia have also indicated high acuity among patients with suspected medetomidine-associated withdrawal, including frequent intensive care admission and need for intubation.7

Figure 1. Sedatives in Samples with Fentanyl or Heroin as the Primary Substance in 2026 Q1

Four samples collected during this quarter contained trace amounts of azaperone, a butyrophenone antipsychotic used primarily in veterinary medicine as a sedative and antiemetic.8 Although current detections are at low levels and not expected to produce significant clinical effects, increased concentrations could result in prolonged sedation and features consistent with antipsychotic toxicity following naloxone administration.9, 10
Quinine detection increased to 15 percent in Q1 2026, a substantial increase from the previous quarter. Quinine, an antimalarial medication, is commonly used as an adulterant in illicit opioids due to its bitter taste, which can mimic heroin. Quinine is pharmacologically active and has been associated with adverse effects, including cinchonism (flushing, tinnitus, sweating), hypoglycemia, and cardiotoxicity. Severe quinine toxicity may result in arrhythmia and hypotension.11, 12
Cocaine was detected in 59 percent of suspected dope samples. Notably, 55 percent of dope samples (n = 173) contained fentanyl, cocaine, and at least one sedative. Methamphetamine detection in samples with fentanyl as the primary substance also increased by 40 percent. The frequent detection of stimulants highlights continued polysubstance use, which may reflect attempts to counteract the sedative effects of the current dope supply.15 This combination, often referred to as “speedballs” (cocaine and fentanyl) or “goofballs” (methamphetamine and fentanyl), is associated with heightened risk of severe outcomes, including coma, stroke, respiratory failure, myocardial infarction, aneurysm, and death.16 The Philadelphia Department of Public Health issued a health advisory in October 2025, noting a 110 percent increase in drug–use–related emergency department visits where seizures were the chief or primary complaint.17 Elevated seizure risk has been associated with cocaine, methamphetamine, and local anesthetics.13
Local anesthetics, including lidocaine (89 percent), procaine (63 percent), and tetracaine (37 percent), remained widely present. At least one local anesthetic was present in 96 percent of dope samples (n=301). There is a wide range in the amount of local anesthetics in the dope supply, with the current average being around 25 percent.4 The presence of these agents may contribute to atypical overdose presentations, including numbness, bradycardia, hypotension, confusion, anxiety, methemoglobinemia, respiratory depression, and seizures. In some cases, this reflects Local Anesthetic Systemic Toxicity (LAST), a rare but life-threatening condition affecting the central nervous and cardiovascular systems.13, 14
Levamisole detection increased to 5 percent in Q1 2026, up from the previous quarter. Levamisole, an anthelminthic agent primarily used in veterinary medicine, is historically a common cocaine adulterant that has been linked to serious adverse effects, including neutropenia, agranulocytosis, and vasculitis, which is associated with painful, purple rash that forms a "retiform" (branching) pattern commonly found on the ears, nose, face, or extremities.19,20 Fentanyl (7 percent) and medetomidine (6 percent) were present in a small number of samples with a primary substance of cocaine. Given that these samples were drug litter, these results should not be taken to imply that medetomidine or fentanyl are present in the broader cocaine supply as the end user may have mixed other drugs in the sample prior to use. Nonetheless, these findings highlight continuing patterns of polysubstance exposure, whether intentional or unintentional.

Samples with Primary Substance Cocaine (n=139) 

HTML Table Example

Table 4.Most Frequent Co-Occurring Substances in Samples with Cocaine as the Primary Drug and Percentage Change Since 2025 Q41

Substance n (%) Percent Change
Lidocaine 32 (23) + 77%
Phenacetin 21 (15) + 50%
Fentanyl 10 (7) +75%
Medetomidine 8 (6) -14%
Levamisole 7 (5) +400%
An average of 3.4 substances were identified in samples with cocaine as a primary substance (range: 1 to 15). Two suspected cocaine samples were excluded because no active substances were detected.
Most cocaine samples contained relatively few adulterants, although several substances increased in frequency compared to the previous reporting period (Table 4). The most common co-occurring substances were lidocaine (23 percent) and phenacetin (15 percent), both typical adulterants associated with cocaine. Phenacetin is a recognized carcinogen, and exposure has been linked to nephrotoxicity, nephropathy, hemolytic anemia, methemoglobinemia, as well as increased risks of kidney and bladder cancer.18 There was an increase in levamisole detection from Q4 2025 onward (5 percent).

Samples with Primary Substance Methamphetamine (n=16) 

An average of 2.5 substances were detected in samples with methamphetamine as a primary substance (range: 1 to 11). One suspected methamphetamine sample was excluded because no active substances were detected. Five samples originally suspected by SUPHR staff to be amphetamine (n=1), cocaine (n=2), and dope (n=2) were reclassified as methamphetamine following laboratory analysis, since it was the primary substance. A larger number of methamphetamine samples is needed to strengthen future analysis.

Increases in cocaine (31 percent), dimethyl sulfone (31 percent), lidocaine (19 percent), and medetomidine (13 percent) were observed in methamphetamine samples (Table 5). One sample with a primary substance of methamphetamine was an orange pill pressed to resemble an Adderall 30 mg. Additional samples are needed to support a more detailed analysis. As with cocaine, these findings should not be taken to indicate that medetomidine is routinely found in methamphetamine. They do, however, underscore ongoing patterns of polysubstance exposure.

HTML Table Example

Table 5. Most Frequent Co-Occurring Substances in Samples with Methamphetamine as the Primary Drug and Percentage Change Since 2025 Q41

Substance n (%) Percent Change
Cocaine 5 (31) + 55%
Dimethyl sulfone 5 (31) + 55%
Lidocaine 3 (19) + 46%
Medetomidine 2 (13) no change
1Percent change should be interpreted with caution due to the small sample size.

Samples with Primary Substance Cannabis or Synthetic Cannabinoids (n=20)

An average of 2.9 substances were detected in samples with delta-9 THC (n=14) or a synthetic cannabinoid (n=6), with a range of 1 to 5. Delta-9 THC is referring to naturally occurring THC from cannabis while 5F-ADB and MDMB-4en-PINACA is a synthetic cannabinoid (similar to opiates (heroin) and opioids (synthetics like fentanyl). A larger number of cannabinoid samples is needed to strengthen future analysis.

There was no co-detection of delta-9 THC and synthetic cannabinoids. One delta-9 THC sample was positive for cocaine, and another was positive for tetracaine. Three synthetic cannabinoid samples had codetection of multiple strains of synthetic cannabinoids. 5F-ADB and MDMB-4en-PINACA were the more prevalent strains of synthetic cannabinoids, both structurally related and potent indazole-based synthetic cannabinoids, linked to adverse side effects that include sedation and coma.21  Given that these samples were drug litter, these results should not be taken to imply that synthetic cannabinoids or cocaine are present in the delta-9 THC supply.

HTML Table Example

Table 6.. Most Frequently Found Substances in Samples with Cannabinoids as the Primary Drug1

Substance n (%)
Delta-9 THC 14 (70)
Cannabigerol 6 (30)
5F-ADB 5 (25)
MDMB-4en-PINACA 3 (15)
Cocaine 2 (10)
1Percent change should be interpreted with caution due to the small sample size.

  • Nine samples with no active substances were excluded from all analyses.

  • Ten samples containing cannabis (n=6), ketamine (n=1), LSD (n=1), MDMA (n=1), and testosterone deanoate (n=1) were excluded from this report due to the limited sample size, which was insufficient for meaningful analysis.

  • Drug litter samples, while non-invasive and informative, limit conclusions about the illicit drug supply.

Additional Notes

Acknowledgements

This report was prepared by Tracy Esteves Camacho, MPH; Rose Laurano, MPH; Aoife Frankel, MPH; Joseph D’Orazio, MD; Daniel Teixeira da Silva, MD, MSHP.  This work is funded by the Centers for Disease Control and Prevention (CDC) through the Overdose Data to Action (OD2A) grant. This report was prepared by Tracy Esteves Camacho, MPH; Rose Laurano, MPH; Aoife Frankel, MPH; Joseph D’Orazio, MD; and Daniel Teixeira da Silva, MD, MSHP. This work is funded by the Centers for Disease Control and Prevention (CDC) through the Overdose Data to Action (OD2A) grant.

  1. January 15, 2026. https://www.substanceusephilly.com/q322025

  2. Philadelphia Department of Public Health. Health Update: Carfentanil Is Increasingly Detected in Drug Supply and Overdose Deaths. 2025. https://hip.phila.gov/document/5891/PDPH-HAN-Carfentanil-11.13.2025.pdf/

  3. Higashikawa Y, Suzuki S. Studies on 1-(2-phenethyl)-4-(N-propionylanilino)piperidine (fentanyl) and its related compounds. VI. Structure-analgesic activity relationship for fentanyl, methyl-substituted fentanyls and other analogues. Forensic Toxicol. 2008;26:1-5. doi:10.1007/s11419-007-0039-1

  4. Center for Forensic Science Research and Education. Drug Checking Quarterly Report (Q4 2025): Mid-Atlantic, USA. April 9, 2026. Accessed April 30, 2026. https://www.cfsre.org/images/content/reports/drug_checking/2025_Q4_Drug_Checking_Quarterly_Report_CFSRE_NPS_Discovery.pdf

  5. Philadelphia Department of Public Health. Health Alert: Hospitals and Behavioral Health Providers Are Reporting Severe and Worsening Presentations of Withdrawal among People Who Use Drugs (PWUD) in Philadelphia. 2024.

  6. Philadelphia Department of Public Health. Health Update: Responding to Overdose and Withdrawal Involving Medetomidine. 2025. https://hip.phila.gov/document/5444/PDPH-HAN-SUPHR-Medetomidine-06.10.2025_1Zu1OZ4.pdf/

  7. London KS, Huo S, Murphy L, et al. Severe Fentanyl Withdrawal Associated With Medetomidine Adulteration: A Multicenter Study from Philadelphia, PA. J Addict Med. Published online August 1, 2025. doi:10.1097/ADM.0000000000001560

  8. National Center for Biotechnology Information. PubChem Compound Summary for CID 15443, Azaperone. Accessed January 28, 2026. https://pubchem.ncbi.nlm.nih.gov/compound/Azaperone

  9. James LP, James L, Abel K, Wilkinson J, Simpson PM, Nichols M. Phenothiazine, Butyrophenone, and Other Psychotropic Medication Poisonings in Children and Adolescents. J Toxicol Clin Toxicol. 2000;38(6). doi:10.1081/CLT-100102010

  10. Long N. Phenothiazines and butyrophenones. November 3, 2020. Accessed January 28, 2026. https://litfl.com/phenothiazines-and-butyrophenones/

  11. Liles NW, Page EE, Liles AL, Vesely SK, Raskob GE, George JN. Diversity and severity of adverse reactions to quinine: A systematic review. Am J Hematol. 2016;91(5):461-466. doi:10.1002/ajh.24314

  12. Bykowski A, Logan TD. Cinchonism. In: StatPearls [Internet]. StatPearls Publishing; 2023. Accessed April 30, 2026. https://www.ncbi.nlm.nih.gov/sites/books/NBK559319/

  13. Palamar JJ, DeBord JS, Krotulski AJ, Goldberger BA. Local Anesthetics Adulterating the Illicit Fentanyl Supply. JAMA Psychiatry. Published online May 21, 2025. doi:10.1001/jamapsychiatry.2025.0952

  14. Song K, Blankenship RB, Derian A. Local Anesthetic Toxicity. In: StatPearls. StatPearls Publishing; 2025. Accessed January 28, 2026. http://www.ncbi.nlm.nih.gov/books/NBK499964/

  15. Ivsins A, Fleming T, Barker A, et al. The practice and embodiment of “goofballs”: A qualitative study exploring the co-injection of methamphetamines and opioids. Int J Drug Policy. 2022;107:103791. doi:10.1016/j.drugpo.2022.103791

  16. Lee-Easton M, Magura S, Abu-Obaid R, et al. Polysubstance use patterns among individuals applying for opioid-use disorder treatment in the U.S. J Subst Use. 2024;0(0):1-8. doi:10.1080/14659891.2024.2372093

  17. Philadelphia Department of Public Health. Health Advisory: Increasing Incidence of Seizures among People Who Use Drugs (PWUD) in Philadelphia. 2025. https://hip.phila.gov/document/5756/PDPH-HAN_SUPHR_Seizures-10.7.2025.pdf

  18. Mohr A, Brown T, Nelson L, Logan B. Phenacetin: A Toxic Adulterant Found in Illicit Street Drugs. Fredric Rieders Family Foundation; 2021. https://www.cfsre.org/images/content/reports/public_alerts/2021.04.20.Public-Alert_Phenacetin_Final.pdf

  19. Solomon N, Hayes J. Levamisole: A High Performance Cutting Agent. Acad Forensic Pathol. 2017;7(3):469-476. doi:10.23907/2017.039

  20. Olash B. Levamisole-Adulterated Cocaine: A Case of Vasculitis and Severe Neutropenia. Cureus. 2025;17(12):e100358. doi:10.7759/cureus.100358

  21. Philadelphia Department of Public Health. Synthetic cannabinoids (K2). Substance Use Philly. Accessed April 30, 2026. https://www.substanceusephilly.com/synthetic

References