The opioid epidemic continues to evolve, presenting new challenges for health care providers and communities across the country. To stay informed on emerging trends and evidence-based approaches to treatment, Loretta Bryan, BSN, RN, CPHQ, Clinical Improvement Consultant with the South Dakota Association of Healthcare Organizations (SDAHO), attended the 2026 Opioid & Fentanyl Abuse Management Congress. The conference brought together national experts to discuss emerging drug threats, opioid-related mortality, polysubstance use, medications for opioid use disorder (MOUD), and evidence-based strategies for treating opioid use disorder (OUD). Bryan shared, “The conference provided valuable insight into the ongoing impact and prevalence of opioid use disorder across the United States.”
One key focus of the conference was the illicit opioid supply chain and the ongoing efforts of the Drug Enforcement Administration (DEA) to disrupt it. Presenters highlighted how fentanyl enters the United States through complex trafficking networks involving international chemical supply chains, counterfeit pill production, and smuggling operations. The DEA’s Fentanyl Supply Chain resources emphasize that fentanyl remains a leading driver of overdose deaths, particularly among Americans aged 18 to 45.
Bryan reflected on the importance of understanding these systems, stating, “It was very interesting to learn about the work the DEA is doing to try to stop the amount of fentanyl coming into our country. The people selling the drugs are getting smarter about how they hide counterfeit pills and smuggle substances into the country.”
Beyond fentanyl trafficking concerns, presenters also discussed emerging substances being detected in the illicit drug supply. The conference also highlighted the emergence of a new veterinary sedative entering the illicit drug supply: medetomidine. This substance has increasingly been detected in combination with fentanyl. According to the CDC Health Alert Network communications issued in 2026, medetomidine is an alpha-2 adrenergic agonist that is more potent and longer-acting than xylazine. Its presence in the illicit opioid supply has raised growing concern among clinicians due to its severe physiologic effects.
Bryan noted discussions with emergency department nurses from Delaware who reported treating patients with suspected medetomidine exposure on a regular basis. These patients often presented with profound bradycardia, hypotension, and prolonged sedation. Because medetomidine is frequently found in combination with opioids, naloxone may still be administered; however, it does not reverse the sedative’s effects. Treatment instead focuses on supportive care and symptom management.
At the time of publication, medetomidine had not been identified in South Dakota’s illicit drug supply. However, public health officials are monitoring its increasing presence in other parts of the United States, particularly where it has been found in combination with fentanyl. However, xylazine has been identified in South Dakota’s illicit drug supply, prompting warnings from the South Dakota Department of Health and legislative action to classify it as a controlled substance.
According to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, more than 54,000 Americans continue to die each year from opioid-involved overdoses. Rural communities, including those in South Dakota, continue to experience significant barriers to timely treatment access, including workforce shortages, transportation challenges, and limited behavioral health resources. Data from the Let’s Be Clear website indicates there were 357 overdose deaths in South Dakota between 2020 and 2024, with methamphetamine and fentanyl identified as the most frequently involved substances.
Despite these challenges, there are continued efforts to expand access to treatment and recovery supports. South Dakota is actively increasing available resources, including telehealth services designed to improve access for individuals in rural and underserved communities.
Healthcare organizations interested in learning more about substance use disorder resources, evidence-based treatment strategies, or implementation support are encouraged to contact Loretta Bryan.
Through the South Dakota Overdose Data to Action grant funding, SDAHO offers education, consultation, and technical assistance to hospitals and clinics across South Dakota at no cost.
