Xylazine, an animal sedative never approved for human use, has emerged in recent years as a dangerous addition to illicit fentanyl. This combination, sometimes called "tranq," "tranq dope," or the "zombie drug," poses serious health risks and complicates overdose response efforts. This blog post examines the rise of xylazine, its effects when mixed with fentanyl, and why it presents such a threat to public health.
Zombie Drug: A Veterinary Sedative Infiltrating the Illicit Drug Supply
Xylazine is a powerful sedative and muscle relaxant used by veterinarians to sedate large animals like horses and cattle. It has never been approved for use in humans. Recently, however, drug traffickers have been mixing xylazine into illicit fentanyl, heroin, and cocaine.
Reports of xylazine in drug samples tested by forensic labs have soared in recent years. According to the U.S. Drug Enforcement Administration (DEA), the number of drug samples laced with xylazine jumped by over 1,300% from 2019 to 2021. Xylazine was found in over 90% of speedball samples tested in some areas.
The reason traffickers add xylazine is that it intensifies and prolongs the effects of opioids like fentanyl and heroin. This allows them to "cut" the drugs with xylazine to increase profits. Some users even seek out "tranq dope" for its powerful sedative high. But why is this animal sedative so dangerous for humans?
The Dangers of Xylazine (Tranq): A Risky Opioid Potentiator
Xylazine is not an opioid, so it does not respond to opioid overdose reversal drugs like naloxone (Narcan). When xylazine is mixed with fentanyl or heroin, reversing the opioid overdose does not address the sedative effects of xylazine.
This means xylazine-laced opioids can be extremely deadly. Fentanyl overdoses involving xylazine are more difficult to resuscitate with naloxone alone. Drug overdose deaths involving xylazine have become common.
Xylazine also slows heart rate, breathing, and other vital functions. It can cause drowsiness, hypotension, seizures, and coma. These compound the life-threatening effects of fentanyl, making overdoses more likely to be fatal.
In addition, repeated xylazine use leads to painful skin wounds and ulcers, sometimes requiring surgery or amputation. Xylazine causes constriction of blood vessels and decreased blood flow to extremities. This impairs healing of injection sites and skin integrity leading to dead tissue. People routinely injecting drugs laced with xylazine may develop severe wounds in the arms or legs which may lead to amputation.
The Startling Rise of Xylazine in Overdose Deaths
In Philadelphia, xylazine was detected in 31% of fatal opioid overdoses in 2019, up from less than 2% in 2010. Some areas have seen xylazine present in over 25% of overdose deaths involving fentanyl.
According to provisional CDC data, over 68% of the 107,000 U.S. overdose deaths in 2021 involved synthetic opioids like illicit fentanyl. As xylazine increasingly infiltrates the drug supply, it likely to increase the number of deaths further.
However, the true scope is difficult to determine, as many forensic labs and medical examiners do not routinely test for xylazine. Some jurisdictions vary in whether they record deaths linked to xylazine on death certificates. But areas that do test for xylazine are detecting it in a growing proportion of overdose deaths.
Xylazine Poses Challenges for Overdose Response
Because xylazine intensifies the effects of opioids but does not respond to naloxone,
standard opioid overdose reversal protocols are less effective when xylazine is involved.
Naloxone may still help reverse the opioid effects. However, the patient will require additional supportive care and monitoring, as xylazine-induced sedation can persist even if opioids are reversed by naloxone. Currently, there are no FDA-approved antidotes for xylazine overdose. Potential treatment options are limited to medications used off-label, like the α-2 adrenergic blockers yohimbine and atipamezole. More research is urgently needed to find an effective xylazine antidote.
Effects on Special Populations: Pregnancy, Withdrawal, and More
While there are no human studies, animal research indicates xylazine reduces uterine blood flow. This raises serious concerns about fetal oxygen deprivation if used during pregnancy.
Abruptly stopping xylazine after regular use can possibly lead to withdrawal symptoms like muscle twitching, anxiety, and restlessness. However, there is very little clinical evidence regarding xylazine withdrawal in humans.
Chronic xylazine abuse could also potentially contribute to lasting cognitive damage, based on limited case reports. More research is needed to characterize long-term effects of xylazine exposure.
Detecting Xylazine: Drug Checking and Toxicology Testing
Since illicit fentanyl is increasingly laced with the animal tranquilizer xylazine, checking drugs for xylazine can help users avoid adverse effects. Using both fentanyl and xylazine test strips together provides the most complete analysis.
Routine toxicology testing should also check for xylazine in suspected overdoses, especially when opioid overdose is not fully reversed with naloxone. This helps surveillance and reporting on xylazine-involved deaths. Postmortem testing protocols should be updated to reflect xylazine's growing threat.
What's Being Done to Address the Xylazine Threat?
In response to the rising crisis, the White House Office of National Drug Control Policy designated the drug combination xylazine and fentanyl as an emerging drug threat in April 2023. Some states are also pushing to schedule xylazine as a controlled substance.
The Food and Drug Administration (FDA) is taking steps to limit xylazine's diversion into illicit channels while still ensuring veterinary access. Continued regulatory and scheduling actions can help curb the spread of xylazine into the drug supply.
On the clinical side, algorithms have been proposed to help predict likely xylazine exposure in overdose patients who do not respond sufficiently to naloxone. This allows providers to tailor management accordingly.
Harm Reduction Strategies for At-Risk Populations
Because xylazine heightens the dangers of opioid use, effective harm reduction strategies are critical. This includes promoting safer injection practices, providing sterile equipment, supervised injection facilities, and wound care.
Drug checking resources empower users to screen their drugs for xylazine. Alerting users about xylazine-adulterated products enables them to make safer choices. This knowledge could prevent xylazine-related overdoses and skin ulcers.
For opioid users in treatment or recovery, awareness about xylazine can improve vigilance. Information on xylazine's risks needs to be incorporated into treatment programs and community outreach.
Looking Ahead: Needs for Research and Public Health Action
The infiltration of xylazine into illicit opioids creates an extremely hazardous situation, but more research is required to drive informed policy and clinical practice.
Areas for further study include xylazine's pharmacology and toxicology in humans, interactions with other substances, and potential addiction liability. We urgently need data to guide overdose prevention and treatment protocols.
On the public health front, expanding drug checking and toxicology testing for xylazine is vital for surveillance. Harm reduction resources should target xylazine risks. And greater awareness among both users and providers remains crucial for mitigating this emerging threat.
Key Takeaways
Xylazine, also known as "tranq," is an animal sedative being mixed into illicit fentanyl and heroin, posing serious health risks
It intensifies and prolongs opioids' effects but doesn't respond to naloxone, complicating overdose reversal
People using illegal drugs laced with xylazine have a higher risk of suffering a fatal overdose
Xylazine has been detected in a growing number of overdose deaths, but is likely undercounted
Repeated use can cause painful skin ulcers and wounds requiring surgery
More research is urgently needed to guide overdose treatment protocols and antidote development
Drug checking, provider education, and other harm reduction strategies are key to address this threat
The infiltration of the veterinary sedative xylazine into illicit drugs underscores the need for innovative, multipronged public health strategies targeting this new hazard. While many unknowns remain about xylazine's long-term impact, the immediate priority must be equipping users, communities, and providers with awareness and resources to mitigate harm. A coordinated response drawing on evidence-based substance use and harm reduction approaches can help counteract the dangers posed by ever-changing illicit drug markets.
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Frequently Asked Questions
Q: What is fentanyl and why is it dangerous?
A: Fentanyl is a strong opioid that is approved for treating severe pain. However, it is addictive and can be lethal when abused. Even small amounts of fentanyl can cause overdoses and potentially fatal respiratory depression.
Q: How is the animal tranquilizer xylazine exacerbating the fentanyl crisis?
A: Xylazine is being illegally combined with dangerous illicit opioids like fentanyl and heroin on the streets. When mixed together, xylazine enhances the potency and reinforcing properties of opioids while also causing its own toxic effects. This dangerous combination intensifies the harms of the fentanyl epidemic.
Q: What regulations exist around fentanyl and xylazine?
A: Pharmaceutical fentanyl is a controlled substance regulated by the FDA and DEA. However, illicitly manufactured fentanyl and non-medical use are not regulated. Xylazine is only approved for veterinary use, not human consumption. Their presence in counterfeit pills or street drugs is extremely hazardous and illegal.
Q: What is naloxone used for?
A: Naloxone is a medication that reverses opioid overdose. It is a critical lifesaving tool that bystanders or first responders can administer during a fentanyl or heroin overdose emergency.
Q: How prevalent are xylazine-involved overdose deaths?
A: It is difficult to determine the exact number due to limited testing. However, there are troubling indicators that xylazine is contributing to more fatal overdoses, especially when mixed with dangerous opioids like fentanyl.
Q: How does xylazine increase overdose risks?
A: Xylazine makes opioids like fentanyl even more potent and deadly while also causing sedative effects itself. This combination severely impairs vital functions and heightens the likelihood of a fatal overdose.
Q: What actions are being taken to address this public health issue?
A: Health agencies are raising awareness of the dangers of illicit xylazine-laced drugs. There are also efforts to curb the proliferation of xylazine, improve detection, and prevent diversion from veterinary uses into illegal channels. Harm reduction strategies are critical.
Q: When did the White House formally recognize the threat of fentanyl-xylazine combinations?
A: In April 2022, the White House Office of National Drug Control Policy officially designated mixtures of fentanyl and the veterinary tranquilizer xylazine as an emerging threat to public health and safety.
Q: Can chronic xylazine abuse lead to tissue damage or amputation?
A: While not a direct effect, severe complications from intravenous xylazine misuse can potentially result in significant tissue damage, poor wound healing, and limb amputation in severe cases. However, more research is required.
About the author:
Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.
This website is provided for educational and informational purposes only and does not constitute providing medical advice or professional services. The information provided should not be used for diagnosing or treating a health problem or disease, and those seeking personal medical advice should consult with a licensed physician or another qualified medical professional. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
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