How is it that more and more powerful opioids are appearing among street drugs? Elizabeth Tracey reports.

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Just keeping up with the names is difficult: fentanyl, carfentanyl, xylazine, now nitazines…and each has a host of harms and is more potent than its predecessor. Substance use disorder expert Eric Strain at Johns Hopkins says keeping up is a challenge.

Strain: It's like whack a mole. You say OK we're going to take care of prescription opioids, which we did pretty well with prescription drug monitoring programs and education of physicians. And prescription opioid abuse decreased and then heroin came along. Now expand buprenorphine treatment for heroin use, then fentanyl comes along. Fentanyl's some people would argue is harder to treat with buprenorphine but now we're seeing nitazines and xylazine and these new drugs create new challenges and treatment.  :33

Strain says it’s not clear to him why new synthetics keep being developed but he’d welcome a slowdown. At Johns Hopkins, I’m Elizabeth Tracey.