Local and federal officials are issuing a warning for Western New York.
"This may be the deadliest synthetic mix that we've ever seen," Erie County Executive Mark Poloncarz said.
Poloncarz was joined by United States Attorney William Hochul, Erie County Public Health Commissioner Gale Burnstein and Drug Enforcement Administration Resident Agent in charge John Flickinger to address the emergence of dangerous drugs like heroin laced with fentanyl.
"This is very scary," Poloncarz said. "What's on the street right now is the equivalent of a death sentence for anyone who takes it ."
"You know this is very, very toxic brown powder that's out there," Burnstein said. "People need to be careful."
Officials believe the opioid comes from China. In Erie County alone 23 people have died since January 29th.
"Twelve of the 23 individuals live in towns, they do not live within the city of Buffalo," Poloncarz said. "The deaths may have occurred in the city of Buffalo as they purchase the drugs in the city and immediately took the hit and unfortunately died."
Hochul says his office will do everything they can to get drug traffickers off the street but it all starts with a decision.
"The public needs to realize it begins with a choice. Whether to put the pill in your mouth or the needle in your arm. (That) will inevitably lead to a suicide pact, and it's one you cannot win."