November 21, 2019

The Iowa Department of Public Health, Department of Public Safety, Poison Control Center and Office of Drug Control Policy are issuing an advisory to health care providers regarding the mixtures of illicit drugs that are being sold on the street as heroin.

Illicit drugs seized by law enforcement and analyzed by the Iowa Division of Criminal Investigation’s (DCI) laboratory have been found to contain a variety of opiates and stimulants. It should be noted that while many of the samples analyzed have been found to contain either heroin or fentanyl alone, approximately half of the samples were found to have heroin or fentanyl mixed with one or more other potent opioids. The opioids detected by the DCI laboratory include: heroin, fentanyl, several fentanyl derivatives (e.g. acetyl fentanyl, carfentanil), U-47700, tramadol, hydrocodone, oxycodone, and morphine.

Some drug samples have been found to have both an opioid / opioid mixture and a stimulant. The two stimulants detected are methamphetamine and cocaine. Combining an opioid and a stimulant is done in an attempt to maximize some of the illicit drugs’ effects (e.g. euphoria) while minimizing other effects (e.g. somnolence, agitation). The combination of heroin and cocaine is the classic “speedball.” Depending upon the amounts of each drug, symptoms of either the opioid or the stimulant may predominate.

Counterfeit Opioid Tablets Still Being Found in Iowa

In July, 2017, this group issued an alert regarding counterfeit opioid tablets that actually contained the opioids fentanyl and U-47700. The pills had been made to resemble the prescription pain reliever oxycodone. Counterfeit opioid tablets are still being found in Iowa. Earlier this year, tablets made to resemble prescription oxycodone were found to contain fentanyl. Tablets acquired from a source other than an authorized health care provider can be deadly counterfeits.

Health care providers need to remain vigilant when dealing with patients reporting use or abuse of heroin or prescription opioids since drugs being illicitly obtained may contain deadly amounts of a fentanyl or other potent synthetic opioids. Importantly, there is no need to be concerned that prescription medicine obtained from licensed prescribers and pharmacies could contain fentanyl or other illicit opioids.

The Iowa Poison Control Center advises hospital and emergency medical service personnel to treat a patient who has overdose on these potent opioids the same as that of any other opioid overdose: maintain airway and ventilation; and know that larger than normal doses of naloxone (4 mg or more) may be needed to reverse the respiratory depressant effects of fentanyl, fentanyl derivatives and U-47700. Providers with questions can contact the Iowa Poison Control Center at 800-222-1222 or

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