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The mix of stimulants such as cocaine and methamphetamines with fentanyl a synthetic opioid 50 times as powerful as heroin is driving what experts call the opioid epidemics fourth wave. The mixture of stimulants and fentanyl presents powerful challenges to efforts to reduce overdoses because many users of stimulants dont know they are at risk of ingesting opioids, so they dont take overdose precautions