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The US Drug Enforcement Administration says that less fentanyl is present in the nation’s illicit pill supply and that is helping drive down overdose deaths in the United States. But experts say that there are limitations to this claim and that many other factors are probably playing a role. (McPhillips, 11/21)

Some epidemiologists theorize that the growing prevalence of other drugs, sold on their own and also mixed in with fentanyl, is having an impact on how people use fentanyl itself. Fentanyl is now often diluted with xylazine, an animal tranquilizer that can cause horrific skin ulcers, which have even led to limb amputations. But drug policy experts said that xylazine, in some cases, might also be having a lifesaving effect. People addicted to fentanyl often need the drug numerous times a day. But xylazine can sedate users for hours. (Hoffman and Weiland, 11/21)

The U.S. Department of Justice's Los Angeles office filed charges in what could be the nation's first death-resulting criminal case involving a synthetic opioid that is possibly more dangerous than fentanyl. On Thursday, federal prosecutors announced the sole count of distribution of protonitazene resulting in death against 21-year-old Benjamin Anthony Collins, a resident of LA County. He faces a mandatory minimum sentence of 20 years in prison if convicted. The harshest possible punishment for this charge is life in prison. (Rodriguez, 11/21)  

McKinsey is in the final stages of negotiating a deferred prosecution agreement to resolve a US criminal investigation into the consulting firm’s work helping opioid manufacturers boost sales that allegedly contributed to a deadly addiction epidemic, people familiar with the matter said. McKinsey is in talks to pay more than $600m to resolve the longstanding US Department of Justice investigation, which also encompasses findings of civil violations, the people said. (11/21)

After a certain threshold, cumulative opioid use was associated with higher dementia risk, a study of adults over age 60 in Denmark showed. (George, 11/19)

AstraZeneca has ended work on an opioid use disorder (OUD) drug after the orexin 1 receptor antagonist demonstrated a drug-drug interaction with an antifungal during a phase 2 trial. The Big Pharma kicked off the trial in May, according to the company’s website. The study had been assessing how the small molecule, dubbed AZD4041, interacts with the widely used antifungal itraconazole as well as its potential as an adjunctive treatment to the approved OUD drug buprenorphine. (Waldron, 11/22)

There might be a way to relieve pain without money and medication, and it might just blow your mind. A new study suggests mindfulness meditation is more effective at relieving pain than placebo treatments. (McClung, 11/21)