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Drug alerts

We regularly send text or email alerts about new overdose risks, changes in the drug supply, and new programs and services available for people who use drugs. Subscribe to receive alerts. This page includes the full text of messages sent to subscribers.

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Analysis shows fentanyl concentrations in rocks and powders vary from 43‑89%

New analysis from powder and rock substances found at overdose death scenes shows fentanyl concentrations varying from 43‑89%. This highlights how difficult it is to tell the potency of the substance being used. Small amounts can be deadly. Start slow, don’t use alone, and have naloxone.

Test your drugs to confirm the presence of fentanyl. Rocks and powders containing fentanyl are visually identical to other drugs, especially cocaine, creating the opportunity for confusion during distribution and use.

For up to date information on the local drug supply please visit your local needle exchange:

Ways to reduce risk of overdose: 

  • Test drugs for fentanyl. Order fentanyl test strips and educational materials at
  • Have naloxone ready.  You can get naloxone without a prescription at pharmacies, needle exchange programs, by mail and other locations listed at
  • Learn the signs of opioid overdose.
  • Avoid using drugs alone.  If this is not an option, use a service like or have someone check on you regularly.
  • If you suspect an overdose, call 911 right away. The Good Samaritan Law protects you and the overdose victim from drug possession charges.
  • Call the WA Recovery Helpline at 1-866-789-1511 to get connected to treatment.

2023 email and text alerts

Correction: Xylazine remains rare in King County drug supply

Xylazine remains rare in King County drug supply. Public Health is monitoring closely and will alert if changes occur.

Xylazine (aka Tranq) found in street drug supplies in King County

Xylazine (aka Tranq) has been seen (a handful of times) in King County and the State of Washington, exclusively in other drugs.

If you have concerns what is in your drugs, contact your local harm reduction agency and see info sheet. The Xylazine fact sheet is also available to order in hard copy format.

While fentanyl pills remain common, carry naloxone and avoid using alone.

While fentanyl pills remain common, we're seeing more fentanyl overdoses from powder and in some cases, people may believe they are using white powder cocaine. The concentration of fentanyl in powder varies – even a small amount can be deadly. Make sure to carry naloxone and avoid using alone. Information from a recent review of drug samples at

Substance use disorder is a treatable health condition. If you have substance use disorder or are looking for support for someone you know, you can learn about treatment options and choose the option that feels best. Find a treatment provider at the Washington Recovery Helpline.

Vending machines dispense critical tools for preventing overdose

With the risk of fatal overdose from fentanyl, we want to ensure everyone in King County has access to tools to help reduce the risk of overdose deaths in our community. Naloxone, the medication to reverse an overdose, and fentanyl test strips are two of the critical tools to help prevent fatal overdoses.

Over the past year, King County has been working with community organizations to expand access to both tools—leading to the distribution of over 100,000 fentanyl test strips and over 13,000 naloxone kits. As part of this outreach effort, Public Health has been working to lower barriers to overdose prevention supplies, not only through online ordering but also through placing supplies in vending machines where they can be easily accessible.

Continue reading from the Public Health Insider blog (posted April 13, 2023).

2022 email and text alerts

Recent overdose deaths associated with powder and pills in different colors

This week in King County, we have seen multiple overdose deaths associated with powder and pills in different colors that contain fentanyl. Please be aware that if you are using powders and pills, including those in various colors, they may contain fentanyl.

Ways to reduce risk of overdose:

Recent spike in overdoses in Shoreline

Emergency Medical Services treated an abnormally high number of overdoses in Shoreline between Dec 5-11, 2022, contributing to the unprecedented high numbers of overdoses occurring across King County in 2022.

There are increasing reports across King County of people experiencing fentanyl overdoses after using what was thought to be white powder cocaine. If you or someone you know is using powder cocaine, be aware it could be fentanyl or contain fentanyl.

Take these steps to prevent overdose:

Heat can be deadly when using drugs

Heat can be deadly, especially when combined with drug use. Stimulants like meth, cocaine, and ecstasy increase body temperature and the risk of dangerous overheating and dehydration. Overamping on meth is especially dangerous. Depressants or "downers" like fentanyl, heroin, benzos, and alcohol can mask heat stroke symptoms and reduce your awareness, so you may not realize you're overheating.

New evidence of fentanyl in rock form in King County

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:

An overdose cluster in the South Seattle area on 3/27 and 3/28

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. 

2021 email and text alerts

Why it’s more important than ever not to use fentanyl 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:

Increasing trend in fentanyl-involved overdoses in the unstably housed population in King County

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

Increased fentanyl-related overdose deaths in King County among those living unsheltered

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 on the rise in Washington state

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.

Sharp rise in fatal overdoses over the past two weeks in King County

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:

  • It is important to have naloxone available to reverse an overdose. Visit
  • Do not use alone.
  • Avoid pills from the street or online
  • If you suspect an overdose, call 911 right away. The Good Samaritan Law protects you and the person overdosing from drug possession charges. More information on the Good Samaritan Law is available.
  • Seek treatment for drug use disorder to help stop using drugs – call the Washington Recovery Hotline for treatment resources. 1-866-789-1511.

For more information visit: Alert: Spike in fatal overdoses in our community, Public Health Insider blog, Jan. 14, 2021

2020 email and text alerts

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:

Counterfeit pills sold and marketed as Adderall

Sample of counterfeit pills sold and marketed as Adderall

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 updated Fatal and Non-Fatal Overdose data dashboards.

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 Washington 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 found in black tar substances could lead to increases in fatal overdosePublic Health Insider blog, June 11, 2020
Fentanyl in black tar has not previously been seen in the county. Fentanyl is commonly found in counterfeit pills and can also be found in white powders.

See updated Fatal and Non-Fatal Overdose data dashboards.

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: