A terrifying new synthetic drug mixture is showing up in U.S. emergency rooms—and doctors say it’s hitting faster and harder than anything in recent years.

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The CDC reports that nitazenes, a class of lab-made opioids that can be 20 to 40 times stronger than fentanyl, are now appearing in street samples across multiple states.(CDC)

ER physicians told NPR they’re seeing patients “collapse almost instantly,” often requiring multiple rounds of naloxone just to start breathing again.