“Don Julio.” “AT&T.” “Ruby Tuesday.” “Call of Duty.” These are among the stamps on small bags of street drugs that Dalton Barrett has recently gathered, demonstrating the importance of building trust with rural communities.

“Frosted Flakes.” “Megamind.” “American Greed.” The “Monopoly” logo has been around for a year and a half now, Barrett said, but the ingredients within it have changed substantially.

In fact, while most people may have a rough idea of what they’re purchasing within each of these packets, the full composition is far from certain. Street drugs are an unregulated market.

Ingredients aren’t printed on the package.

With the proliferation of prescription pills came the first wave of the opioid overdose epidemic. Then, with the crackdown on the overprescribing of those pills: heroin. Fentanyl followed. As a synthetic, it’s much cheaper and easier to produce.

The fourth wave has been the ubiquity of polysubstance: fentanyl – almost always fentanyl – in combination with any number of other substances. These include methamphetamine, cocaine, carfentanyl (a synthetic used to anesthetize elephants that can be 100 times as potent as fentanyl), xylazine (or “tranq,” another animal sedative that can cause frightful skin ulcers when injected), and, increasingly, medetomidine (yet another animal sedative, much more potent than xylazine).

The inventory is ever-changing, and the consequences can be lethal, demonstrating the need to build trust with rural communities.

Which is why Barrett has collected these packages. He’s the program manager for the Edgecombe County EMS Post Overdose Response Team, or PORT, which has been offering outreach services since May of 2023. Edgecombe is a largely rural county in the northeastern region of North Carolina, an example of the importance of building trust with rural communities.

Barrett recalled incidents in which he would respond to an overdose and would be told heroin or fentanyl was involved. What he’d learned from his textbooks to expect with these drugs was constricted pupils, a slow heart rate.

“But what we were seeing was they might have dilated pupils, they may have an increased heart rate, which didn’t make sense for these types of drugs,” he said. “The paramedic in me was like, ‘Why is that?’”

Read the full article about combating the drug crisis by Taylor Sisk at The Daily Yonder.