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Extracted from a. recently publsihed artcile by one of Torralva Medical Therapeutics principals: Deaths from fentanyl and fentanyl analogues (F/FA) are dramatically increasing in spite of the availability and awareness of naloxone as an opioid overdose reversal drug. Literature reviews demonstrate that naloxone and other mu opioid receptor antagonists are ineffective against the underlying central noradrenergic effects of F/FA, which clinically manifest as the rapid onset of severe muscle rigidity and airway compromise (e.g. wooden chest syndrome) and are distinct from the respiratory depression seen with F/FA and morphine derived alkaloids. A physiologic model is proposed and implications for new drug development and treatment are discussed.