The opioid epidemic has become supercharged in the past 10-15 years, first with the widespread replacement of heroin by the more potent fentanyl and more recently with the introduction of alpha agonists such as xylazine and medetomidine into the drug supply. Peter Lorenz, MD, sits down with EM/tox/addiction medicine-trained Rachel Haroz, MD, to discuss this ever-changing landscape and how to best provide lifesaving care to some of our most vulnerable patients in the emergency department.