"Demon" street drug from Philadelphia: Implications for North Carolina

Full results and code available in .ipynb attached and the Deepnote website provided below. Objective: Determine if a combination of substances involved in overdose in Philadelphia are of immediate concern in North Carolina. This analysis was initiated on May 8, 2024 based on an alert from the Philadelphia Poison Center (on April 29, 2024). 10 cases of hospitalizations were described, including one death, where a combo of fentanyl, bromazolam, and xylazine were implicated. Quinine and caffeine were also listed, but the alert was ambiguous: it did not specify if all 5 substances were found in the sample sample, or if this was a collection of cases where subset of combos of the substances were identified.
The combination of fentanyl+bromazolam+xylazine is not unexpected. Out of 63 samples form NC since April 1, 2024, none have contained all three substances together. 8 samples from 2023 did contain these three substances. Further monitoring is warranted before assuming this report from Philadelphia is an immediate threat in North Carolina. However, general education about xylazine is recommended, as is the danger of respiratory depression from potent benzodiazepines combined with fentanyl in the unregulated drug supply.