Drug Checking Findings: July - September 2026

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The Philadelphia Department of Public Health (PDPH), Division of Substance Use Prevention & Harm Reduction (SUPHR), analyzed 372 drug samples collected between July and September 2026. Most samples consisted of drug litter recovered by SUPHR staff from public spaces.  

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 drug-related paraphernalia, found in public spaces between July and September 2026 (Table 1). Samples were also submitted by two collaborating community-based organizations, collected via 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. Still, they can be used for harm reduction education, updating response to overdose, adapting clinical management, and informing early warning about the adverse effects of the illicit drug supply.

Most samples were collected in the Kensington area (Table 2). Center City accounted for 15 percent of the samples, while smaller numbers came from North/Northeast (9 percent), South/Southwest (6 percent), and West (4 percent).  Three percent of samples (n=13) were from an unknown section of the city. Seven samples were excluded from analysis because no substances were detected (n=3) or they were pending analysis at the time of this report (n=4).

Sample Collection

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Table 1. Drug Sample Collection Volume, July - September 2026

Month n (%)
July 120 (32)
August 128 (35)
September 124 (33)
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Table 2. Drug Sample Collection Volume by City Section, July - September 2026

Section n (%)
Kensington 229 (62)
Northeast/North 34 (9)
Center City 54 (14)
South/Southwest 23 (6)
West 14 (4)
Unknown 18 (5)

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 determined by the staff submitting the sample, based on the visual characteristics of the drug product, the packaging type, and/or the drug associated with the 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 or Fentanyl (n=227) 

Fentanyl remained the most frequently detected substance in suspected dope samples, detected in 94 percent of samples, a 5 percent decrease since 2026 Q1 (Table 3).1 Carfentanil continues to decline and was present in 7 percent of samples, a 36 percent decrease from the previous quarter. Acetylfentanyl, a fentanyl analog approximately 15–30 percent as potent as fentanyl, was detected in 36 percent of samples.2 Heroin was detected in 28 percent of samples, an 87 percent increase from 2026 Q1. Of the samples that tested positive for heroin, 22 percent (n=14) did not have fentanyl present, an increase from last quarter, where only 1 percent (n=4) of samples with a primary substance of heroin did not have codetection of fentanyl. Biologically inactive fentanyl precursors, including 4-ANPP (88%), phenethyl-4-ANPP (82%), and ethyl-4-ANPP (51%), remained highly prevalent, consistent with continued illicit fentanyl synthesis. There is a wide range in the quantity of fentanyl in the dope supply, with the current average being around 6 percent, consistent with the potency reported in the last quarter.3
Suspected dope samples, or samples in which fentanyl (n=182) or heroin (n=45) were identified as the primary substance, contained an average of 10.5 detected compounds (range: 3-21). Two suspected dope samples were excluded because no active substances were identified.
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Table 3. Most Frequent Co-Occurring Substances in Samples with Fentanyl or Heroin as the Primary Drug and Percentage Change Since 2026 Q1

Substance n (%) Percent Change
Fentanyl 213 (94) - 5%
4-ANPP 209 (92) - 5%
Phenethyl-4-ANPP 187 (82) - 3%
Lidocaine 185 (81) - 9%
Medetomidine 183 (81) - 10%
Procaine 149 (66) - 5%
Cocaine 131 (58) - 2%
Ethyl-4-ANPP 115 (51) - 15%
Caffeine 81 (36) - 38%
Acetylfentanyl 81 (36) - 8%
Tetracaine 69 (30) - 19%
Methamphetamine 65 (29) + 3%
Heroin 63 (28) + 87%
Quinine 51 (22) + 47%
Xylazine 46 (20) - 28%
Acetaminophen 23 (10) - 67%
BTMPS 22 (10) + 42%
Carfentanil 17 (7) - 36%
Veterinary sedatives continue to be widespread in the dope supply, with 82 percent of all dope samples containing xylazine and/or medetomidine. Nevertheless, dope samples without medetomidine or xylazine increased from 7 percent in the previous quarter to 17 percent, a 142 percent increase. Medetomidine continues to be detected in most suspected dope samples (81 percent) but decreased by 10 percent from last quarter. There is a wide range in the quantity of medetomidine in the dope supply, the current average being around 13 percent.4
Xylazine detection continues to decline and was detected in 20 percent of samples, a 28 percent decrease from last quarter. Codetection of xylazine and medetomidine also continues to decline from 26 percent during Q1 2026 to 18 percent, representing a 31 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. Veterinary Sedatives in Samples with Fentanyl or Heroin as the Primary Substance in 2026 Q3

Tianeptine, an atypical antidepressant that is not FDA-approved for medical use in the U.S., was detected in trace amounts in 9 samples collected during 2026 Q2. Tianeptine is commonly sold at gas stations, smoke shops, and online, and is also known by the product names Tianaa, Zaza, and Neptune’s Fix.8 Although these compounds were detected in only a small number of samples at low concentrations, which are not expected to produce clinically significant effects, tianeptine can produce opioid-like effects, and frequent exposure can lead to adverse events, including respiratory depression, sedation, withdrawal symptoms similar to opioid withdrawal, and death.9
Phenothiazines, a class of first-generation antipsychotics, were detected in six samples this quarter.10 Chlorpromazine, an antipsychotic, and promazine, a metabolite of chlorpromazine and often used as a tranquilizer in veterinary medicine, were identified in four samples. Acepromazine, a veterinary sedative and antiemetic, was detected in two samples.11 Although these compounds were detected in only a small number of samples at low concentrations, which are not expected to produce clinically significant effects, higher concentrations could result in prolonged sedation and signs of toxicity associated with phenothiazine-derived antipsychotics, including sedation, tachycardia, hypotension, QT prolongation, anticholinergic effects, and hyperthermia.12–14
Quinine detection has increased from 15 percent in the last quarter to 22 percent, a 47 percent increase. 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.15,16
Though detections of local anesthetics declined, they remained widely present, including lidocaine (81 percent), procaine (66 percent), and tetracaine (30 percent). At least one local anesthetic was present in 92 percent of dope samples (n=209). There is a wide range in the quantity of local anesthetics in the dope supply, with the current average being around 17 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.17,18
Cocaine was detected in 58 percent of suspected dope samples. Notably, 55 percent of dope samples (n = 125) contained fentanyl, cocaine, and at least one sedative. Methamphetamine was detected in 29 percent of samples with fentanyl as the primary substance, a slight increase from the previous quarter. The frequent detection of stimulants highlights continued polysubstance use, which may reflect attempts to counteract the sedative effects of the current dope supply.19 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.20 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.21 Elevated seizure risk has been associated with cocaine, methamphetamine, and local anesthetics.17

Samples with Primary Substance Cocaine (n=181) 

An average of 3.7 substances were identified in samples with cocaine as a primary substance (range: 1 to 15). One suspected cocaine sample was excluded because no active substances were detected.  

Relative to dope samples, cocaine samples contained fewer adulterants, although several substances increased in frequency compared to the previous reporting period (Table 4). The most common co-occurring substances were lidocaine (28 percent) and phenacetin (17 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.22
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Table 4. Most Frequent Co-Occurring Substances in Samples with Cocaine as the Primary Drug and Percentage Change Since 2026 Q1

Substance n (%) Percent Change
Lidocaine 50 (28) + 22%
Phenacetin 31 (17) + 13%
Caffeine 18 (10) + 233%
Medetomidine 17 (9) + 50%
Fentanyl 14 (8) + 14%
Levamisole 11 (6) + 20%
Methamphetamine 8 (4) + 300%
Levamisole detection increased to 6 percent in Q2 2026, a 20 percent increase 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 a painful, purple rash that forms a "retiform" (branching) pattern commonly found on the ears, nose, face, or extremities and can become necrotic.23–27
Medetomidine (9 percent) and Fentanyl (8 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 before use. Nonetheless, these findings highlight continuing patterns of polysubstance exposure, whether intentional or unintentional.

Samples with Primary Substance Methamphetamine (n=36) 

Similar to cocaine, an average of 3.2 substances were detected in samples with methamphetamine as a primary substance (range: 1 to 15). One suspected methamphetamine sample was excluded because no active substances were detected. A larger number of methamphetamine samples is needed to strengthen future analysis.  

The most frequently co-occurring substances detected in methamphetamine samples were cocaine, lidocaine, fentanyl, and medetomidine. Compared with 2026 Q1, the prevalence of fentanyl and medetomidine increased to 19 percent. Local anesthetics tetracaine (14 percent), lidocaine (22 percent), and procaine (14 percent) also increased in prevalence since the previous quarter. Precursors dimethylamphetamine (active precursor to methamphetamine) and 4-ANPP (inactive precursor to fentanyl) were both present in 19 percent of samples. Cocaine (28 percent) was the only one of the most detected co-occurring substances to decrease. 

These findings should be interpreted with caution, as some samples consisted of drug litter, including smoking paraphernalia. These results should not be taken to imply that medetomidine or fentanyl are present in the broader methamphetamine supply, as the end user may have mixed other drugs in the sample before use. Nonetheless, these findings highlight continuing patterns of polysubstance exposure, whether intentional or unintentional. 

Three samples with methamphetamine as the primary substance were orange pills with markings resembling Adderall 30 mg (see Pills Tested between June 2025 and June 2026 for more information)

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Table 5. Most Frequent Co-Occurring Substances in Samples with Methamphetamine as the Primary Drug and Percentage Change Since 2026 Q1

Substance n (%) Percent Change
Cocaine 10 (28) - 10%
Lidocaine 8 (22) +16%
Dimethylamphetamine 7 (19) + 217%
Fentanyl 7 (19) + 217%
Medetomidine 7 (19) + 26%
4-ANPP 7 (19) + 217%
Tetracaine 5 (14) + 133%
Procaine 5 (14) + 8%

Samples with Primary Substance Cannabis or Synthetic Cannabinoids (n=36)

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Table 6. Most Frequently Found Substances in Samples with Semi- and Synthetic Cannabinoids as the Primary Drug and Percentage Change Compared to 2026 Q2*

Substance n (%) Percent Change
5F-ADB (S) 10 (83%) +55%
MDMB-INACA (S) 4 (33%) -13%
Cocaine 3 (25%) +225%
Lidocaine 3 (25%) +8%
Diphenhydramine 2 (17%) NA
Cannabidiol (CBD) (N) 1 (8%) +8%
Cannabigerol (CBG)(N) 1 (8%) NA
Cannabinol (CBN) (N) 1 (8%) +8%
Delta-8 THC (SS) 1 (8%) +8%
Delta-9 THC (N) 1 (8%) +8%
Hexahydrocannabinol (HHC) (SS) 1 (8%) NA
Hydroxy-Hexahydrocannabinol (SS) 1 (8%) +8%
Delta-9 THC-O (SS) 1 (8%) NA
MDMB-4en-PINACA (S) 1 (8%) -78%
MDMB-5me-INACA (S) 1 (8%) -46%
Medetomidine 1 (8%) -73%

An average of 3.3 substances was detected in samples with a primary substance of cannabis (n=23) or a synthetic cannabinoid (n=13), with a range of 1 to 14. Delta-9 THC refers to naturally occurring THC from cannabis. 5F-ADB, AB-MDMSBA, MDMB-INACA, MDMB-5me-INACA, and MDMB-4en-PINACA are synthetic cannabinoids.  

Co-detection of delta-9 THC and synthetic cannabinoids was identified in one sample, a counterfeit cannabis vape. Three synthetic cannabinoid samples tested positive for fentanyl and dope-associated substances (medetomidine, local anesthetics). This included a rolled cigarette and two samples of plant residue in mylar bags. Given the increase in prevalence of smoking fentanyl in the community, these codetections likely reflect polysubstance use or shared smoking equipment rather than adulteration of synthetic cannabinoids. 

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Table 6. Most Frequent Co-Occurring Substances in Samples with Cannabis as the Primary Drug and Percentage Change Compared to 2026 Q2*

Substance n (%) Percent Change
Delta-9 THC (N) 12 (100%) 0%
Cannabinol (CBN) (N) 9 (75%) +44%
Tetrahydrocannabinolic Acid (THCA) (N) 6 (50%) -36%
Cannabigerol (CBG)(N) 6 (50%) +130%
THC-O Acetate (SS) 4 (33%) +156%
Cannabidiol (CBD) (N) 4 (33%) +527%
Delta-9 THC-O (SS) 3 (27%) +527%
Methamphetamine 2 (17%) +283%
Cocaine 1 (8%) -4%
Lidocaine 1 (8%) NA
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.28

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

  • Seven samples with a primary substance of PCP (n=5) and ketamine (n=2) 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. 

Two synthetic cannabinoid samples were white rectangular pills with markings resembling alprazolam (see Pills Tested between June 2025 and June 2026 for more information).

Additional Notes

This report was prepared by Tracy Esteves Camacho, MPH; Rose Laurano, MPH; Allyson Bisgay, MPH(c); 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.  

Corresponding author: Tracy Esteves Camacho, MPH: tracy.camacho@phila.gov 

Acknowledgements

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