Content Warning: This article discusses opioids, overdoses, and substance-related harms. Nitazenes are a highly potent class of synthetic opioids often mixed—unknown to users— into other drugs. They pose extreme overdose risk, can be difficult to detect on standard tests, and may require multiple naloxone doses. With commentary from Subject Matter Expert Arun Gupta, MD

John Makohen—author and counselor with lived experience—details why people who are unhoused face steep barriers to SUD treatment (IDs, phones, insurance, transportation,rigid abstinence-first rules) and calls for Housing First, person-centered MOUD, and compassion over compliance.