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For Overdose prevention and response email alert subscribers, this page includes the full text of recent email alerts sent to subscribers.

There is new evidence of fentanyl being sold in rock form in King County. If you or someone you know is using rock or powdered drugs (especially those who believe you are using crack or powder cocaine), be aware it could be fentanyl or contain fentanyl.

Regardless of what substances are used, reduce overdose risk by doing the following:

  • Test drugs for fentanyl. Order Fentanyl Test Strips here:

  • Always have naloxone. Get naloxone at most pharmacies or order it anonymously here:

  • Do not use alone. If you must,
    • Use a service like that will alert paramedics if you stop responding to a live chat.
    • Have someone check on you often, or
    • Use in a place you are more likely to be found by others

  • Go slow. Start with a small amount to see how it affects you before you take more. Increase slowly.

  • Watch and wait. If using with others, don't use at the same time.

  • Avoid mixing drugs.
    • If you do, use less & use one at a time.

  • Know the signs of overdose and how to respond.
    • Not responding, abnormal breath sounds (snoring, gurgling) or not breathing.
    • Call 911, administer naloxone, and give rescue breaths.

  • Have naloxone. Tell your friends you have it, where it is, and how to use it.

To learn more and access treatment resources, visit:
To learn more about responding to an overdose, visit:

There was an overdose cluster in the South Seattle area on 3/27 and 3/28. Several people reported using crack cocaine that may have been laced with fentanyl.  Reduce your overdose risk by testing drugs, always having Naloxone, not using alone. 

Given the high risk of overdose from pills and powder containing fentanyl, we are urging people not to use alone. We are seeing more and more people in or community die of drug overdose when using alone. Some of the recent deaths were among people who had naloxone with them, but no one was present to administer naloxone to reverse the overdose.

We are also concerned by recent situations in which two people have died at the same time after using fentanyl together. When using with others, reduce risk by taking turns: watch and wait before the next person uses. Visit for more info on fentanyl and overdose prevention.

Ways to reduce risk of overdose:

  • Avoid using alone: if you overdose, there is no one there to help.
  • If you must use alone:
    • Use a service like that will call 911 if you stop responding to a live chat or phone call,
    • Have someone check on you often, or
    • Use in a place you are more likely to be found by others
  • Watch and wait before next person uses.
  • Go slow and start with a small amount. Increase slowly.
  • Avoid mixing drugs. If you do, use less of each and use one type of drug at a time.
  • Know the signs of overdose and how to respond:
  • Have naloxone accessible. Tell others you have it, where it's located, and how and when to use it.
  • Medications to treat opioid addiction, methadone and buprenorphine, significantly reduce risk.
  • These medications are available across King County, see to find an option close by.

How you can help prevent an overdose death: Tips for Overdose Awareness Day

On this final day of August, we are remembering and mourning those who have lost their lives to fatal drug overdose. And as part of International Overdose Awareness Day, it's a good time learn about the risk of overdose and evidence-based practices and resources that mitigate harm and help to reduce stigma associated with overdose and substance use.

Continue reading from our Public Health Insider blog:

Public Health — Seattle & King County has been alerted to an increasing trend in fentanyl-involved overdoses in the unstably housed population.

In both May and July 2021, the King County Medical Examiner's Office identified 10 fatal overdoses involving fentanyl in unstably housed individuals, which is 5 times the amount of fatal fentanyl overdoses seen in the preceding months.

Locally, fentanyl is most commonly found in counterfeit pills. These pills are often blue and marked with "M30" and referred to as "oxys" or "percs." Fentanyl has also been found in white powder drugs and, more rarely, in black tar heroin.

Please share this information widely with colleagues, clients and patients.

Reduce risk of opioid overdose

Access to treatment

Medications such as methadone and buprenorphine are effective treatments for opioid use disorder. Starting medication for opioid use disorder is now more accessible than ever. People can connect with a provider via phone or online from their own home to get started on buprenorphine. Call the Washington Recovery Helpline for resources at 1-866-789-1511 or

King County has seen an increase of fentanyl-related overdose deaths in recent months amongst individuals living unsheltered or unstably housed. Fentanyl continues to be primarily found in the form of counterfeit blue M-30 pills. Visit to learn more about how to prevent overdose and treatment options.

Methamphetamine deaths have increased 600% in the last decade in Washington state, with about half of these deaths attributed to meth alone and the other half attributed to meth with an opioid. The biggest risks of methamphetamine overdose (aka overamping) include overheating, heart attacks, strokes, and not breathing.

Be on alert for these danger signs:

  • Super fast heart rate
  • High body temperature (sweating or hot, dry skin)
  • Really painful headache
  • Chest pain or tightness
  • Can't walk or move
  • Won't wake up
  • Can't feel arms or legs
  • Seizure or shaking you can't control

If you see signs of overdose, call 911 right away. The Good Samaritan Law protects you and the victim from prosecution.

Learn more at Printable materials with this information are available:

Want to cut down on your meth use or need other help? Contact the Washington Recovery Help Line at 1-866-789-1511.

Public Health – Seattle & King County is alerting our community about a sharp rise in fatal overdoses over the past two weeks. In the period from Dec. 27, 2020 to Jan. 9, 2021, the King County Medical Examiner’s Office identified 42 suspected or confirmed overdose deaths. Sadly, this two-week period is the highest number of overdoses in a two-week period ever documented in King County. Preliminary testing has found that the majority of the recent overdoses involved multiple types of drugs including 17 fatal overdoses that likely involved methamphetamine and 7 that likely involved fentanyl.

Public Health encourages everyone to be aware of the risks and to share this information throughout our community:

For more information visit: Alert: Spike in fatal overdoses in our community

King County is seeing a rise in counterfeit pills of all kinds

Recently there's been an increase of counterfeit pills sold and marketed as Adderall that test positive for methamphetamine (see photos). We also continue to see fake oxycodone as M-30 pills that contain illicit fentanyl. We encourage anyone purchasing pills from anyone other than a pharmacy to exercise extreme caution. Safer use strategies include taking a small sample as a tester, avoid using alone, and have naloxone on hand.

For more safer drug use strategies:

Three incidents of overdose death due to fentanyl in King County

Since March, we have seen at least three incidents of overdose death due to fentanyl in white powder in King County. You cannot see nor taste fentanyl. Please make sure to not use alone, go slow and have naloxone on hand if you are using drugs. Treatment is available at

See updates to the following:

How to access free naloxone (Narcan) in King County

King County offers two options for community organizations to order free naloxone (Narcan) kits.

  1. For kits intended to be kept on-site to respond to an overdose, nasal Narcan is available. Order online at
  2. For kits intended to be re-distributed to people at risk of experiencing or witnessing an overdose, injectable naloxone is available. Order at

For areas with more limited access to harm reduction services, People’s Harm Reduction Alliance offers mail delivery of Narcan anywhere within WA state, as well as harm reduction supplies, such as syringes and pipes, to anywhere within King County. Order online at

New blog post with details on the 3 recent cases of fentanyl in black tar heroin

Fentanyl in black tar heroin in King County

Fentanyl is newly being seen in black tar heroin in King County. There have been 3 incidents since March, including two fatal overdoses. Previously in the county, fentanyl was typically only found in counterfeit pills and white powders.

Buprenorphine (Suboxone) prescribers initiating patients by phone

Many buprenorphine (Suboxone) prescribers in King County are now available to initiate new patients by phone. This is possible due to a relaxing of federal rules during COVID-19. To find a participating provider, call the WA Recovery Helpline at 1-866-789-1511.

First fatal overdose connected to fentanyl in black tar heroin in King County

The first fatal overdose connected to fentanyl in black tar heroin occurred in King County in March. Test results were confirmed 4/23. We have not identified additional fatal overdoses involving fentanyl in black tar heroin.

With continued fatal overdoses from opiates including fentanyl, we want to remind our community that it is now easier to access medications to treat opioid use disorder. Several prescribers in King County are now available to start people on bupe/suboxone by phone. Learn more by calling the Washington Recovery Helpline at 1-866-789-1511.

Public Health calls for community safety as fentanyl-involved deaths rise

Public Health – Seattle & King County reminds our community that pills purchased off the street or online without a prescription likely contains illicit fentanyl—the drug that can lead to overdose and death. In just the past two weeks, the King County Medical Examiner's Office identified 14 people whose lives were lost to drug overdose involving fentanyl.

Elevated fentanyl-involved deaths in past week are due to blue M30 pills that are counterfeit

Thank you for registering to receive drug alerts from Public Health – Seattle and King County.

This past week, we have seen an elevated number of overdose deaths involving fentanyl in King County. Many of the fentanyl-involved deaths continue to be related to blue "M30" pills, often referred to as "oxys" or "percs." Warning: these pills are counterfeit and contain fentanyl! Remember: If you can, don't use alone; if you do, have someone check on you.

To order free materials, direct others where to sign up for alerts, and access the latest data dashboards go to: