Medical researchers have called for greater education about the rise of an animal tranquiliser, xylazine, in the US’s illicit opioid supply that is not only contributing to deaths but causing severe ulcers and open wounds requiring amputation.
The authors of a new study in the Annals of Internal Medicine have warned of insufficient awareness about the drug now widely found mixed in with heroin and the even more deadly opioid fentanyl, which has driven up overdoses to record levels in recent years.
The paper said that “exposure to xylazine mixed into illicitly manufactured fentanyl has been associated with prolonged sedation … and a steep increase in deaths”.
Xylazine can increase the potential for fatal overdoses as the drug further suppresses breathing on top of the effect on respiration caused by opioids.
The combination of xylazine and fentanyl, known as “tranq dope”, has been identified in 48 states. The study estimates that one-quarter of the fentanyl powder supply has the tranquiliser added.
The study, Xylazine Adulteration of the Heroin-Fentanyl Drug Supply, was led by Dr Joseph D’Orazio, an addiction medicine specialist at Cooper university hospital in Philadelphia.
D’Orazio said xylazine is a psychoactive medication that acts like Xanax and other benzodiazepines that reduce anxiety. But he said they also create their own dependency alongside that caused by the opioids and that some of his patients have told him that xylazine made it more difficult to break their addiction to heroin or fentanyl.
“In the Philadelphia area most people who are using opioids are getting exposed to xylazine. They don’t want to be exposed but they really don’t have much choice because more than 90% of the supply in this area is contaminated with it,” he said.
“They’re looking for the opioid experience but they end up getting a good dose of xylazine and are unconscious for hours at a time. Then they wake up and they’re in withdrawal so they’d love to avoid it. But things have evolved, and now people really can’t go without it.”
Fentanyl remains the primary killer but while people who overdose on opioids can be saved with an antidote, naloxone, it has no effect on xylazine which can still result in suffocation and fatal poisonings.
D’Orazio said that xylazine also causes severe open skin ulcerations and chronic wounds.
“We see lots of amputations and infections. People have had dysfunction of a limb or a foot or a hand. We see lots of admissions to clear maggots out of a wound or get antibiotics to clear up a secondary infection,” he said.
The paper said that the ulcers are frequently a significant barrier to obtaining treatment for addiction because rehab centres and homeless shelters turn away people with open infections.
D’Orazio said it is not clear what causes the wounds but they may be associated with needles used for injecting drugs.
A Drug Enforcement Administration report said that xylazine’s low cost makes it an attractive alternative for dealers to more expensive drugs.
“A kilogram of xylazine powder can be purchased online from Chinese suppliers with common prices ranging from $6-$20 per kilogram. At this low price, its use as an adulterant may increase the profit for illicit drug traffickers, as its psychoactive effects allows them to reduce the amount of fentanyl or heroin used in a mixture,” it said.
“It may also attract customers looking for a longer high since xylazine is described as having many of the same effects for users as opioids, but with a longer-lasting effect than fentanyl alone.”
However, the report noted that other users reported that xylazine reduced the effect of heroin and fentanyl and tried to avoid it.
The Office of National Drug Control Policy released a national response plan in July to combat what it described as the “emerging threat” from xylazine.
The arrival of xylazine is just the latest twist in a drug epidemic that began with prescription opioids, shifted to heroin and then caught everyone off guard with the flood of fentanyl.
D’Orazio said he does not know what is coming next but he is not optimistic that the worst drug epidemic in US history will pass any time soon.
“It’s very clear that the epidemic is not nearing an end. I’m concerned that it will just continue to get worse … The monetary forces, the availability, the problems with mental healthcare in the United States have all lead to a worsening problem,” he said.
