In advance of the following update about overdose impacts in our community, we want to remind folks that they can reach out to the Washington Drug and Alcohol Commission to access narcan/naloxone and to learn about treatment options at 724- 223-1181. You can request a free Narcan Kit here. CCJ is also a community distributor of Narcan and can help folks obtain it by contacting our Field Program Coordinator, Paul, at 724-229-7333 or email@example.com.
There is currently a less-commonly-known drug contributing to the increase in overdoses and overdose deaths across the nation. The drug is marketed under several brand names including Rompun, Anased, Sedazine, and Chanazine, and goes by the street name of tranq or tranq-dope, but is otherwise known as xylazine. Xylazine, a nonopioid veterinary tranquilizer most commonly used on large animals such as horses, is not approved for human consumption but is becoming more prominent in Pennsylvania communities. From 2015 to 2020, the percentage of drug overdose deaths involving xylazine increased from 2% to 26% in Pennsylvania.
In the mid- to late-2010s, xylazine emerged in the U.S. drug market, with Philadelphia as its primary marketplace, and public health and harm reduction practitioners began to see it as a common additive to the street opioid supply. By the late 2010s, it appeared in tandem with fentanyl, and people who use drugs reported finding it difficult to obtain heroin. Xylazine almost never appears alone. According to a 2022 health alert from the Philadelphia Department of Public Health, 91% of samples of purported heroin or fentanyl from Philadelphia also contained xylazine, making it the most common adulterant in the local drug supply.
Xylazine is a nonnarcotic and nonopioid sedative and muscle relaxer. It is frequently mixed with fentanyl to “give it its legs” (to extend and enhance the effects of it). It is a central nervous system depressant that can cause drowsiness, amnesia, slowed breathing and heart rate, and dangerously low blood pressure levels. At very high doses, or with other central nervous system depressants, xylazine can cause loss of physical sensation, loss of consciousness, and an intensification of the effects of other drugs, which can complicate overdose presentation and treatment.
In the event of a suspected xylazine overdose, experts recommend giving the opioid overdose reversal medication naloxone because xylazine is frequently combined with opioids. Be aware that the person may breathe normally after receiving naloxone, but still be sedated from the substance. More naloxone would not be needed in this case. While there is no reversal agent for xylazine itself that is safe for use in humans, supportive care is recommended, including rescue breathing. The person’s blood pressure may also be unstable and in need of monitoring or intervention.
Those who use xylazine may experience skin and soft tissue wounds, including ulcerations. These wounds present themselves atypically, usually being found on the legs and arms (sometimes away from the site of injection), and appear to worsen more quickly than other skin wounds. There have been reports that note necrotic tissue damage and severe abscesses after injecting and/or snorting xylazine that appear to be independent of injection sites.
In March of this year the Drug Enforcement Association released a Public Safety Alert stating that they have seized xylazine and fentanyl mixtures in 48 of 50 states, and that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.
A 2022 study found that overdose data from 10 jurisdictions, representing all four major US census regions, demonstrated an increasing presence of xylazine. These numbers may be even higher due to xylazine not being included in routine immunoassay toxicology screens. Even with appropriate testing, xylazine may not be detected due to its rapid elimination from the body, with a half-life of 23-50 minutes.
Xylazine testing is becoming more common in certain areas. BTNX, a Canadian biotechnology company, is manufacturing xylazine testing strips, which research from Philadelphia’s health department and a local lab has found to be effective in detecting the tranquilizer on the street. The test strips will soon be available to public health workers, health departments, and grassroots harm-reduction groups as well as individual drug takers to test substances for traces of xylazine.
Due to the passing of H.B. 1393, which amended the Controlled Substances Act and changed the definition of drug paraphernalia, the testing strips could soon become legal to obtain and use in Pennsylvania. This amendment allows for the legal use of testing products not limited to fentanyl testing strips. Essentially, any newly developed product that can be utilized to determine whether a controlled substance contains chemicals, toxic substances, or hazardous compounds in quantities which can cause physical harm or death has the potential to become legal immediately after it passes through the development process and becomes available for use by the public.
On Tuesday April 18th, Governor Josh Shapiro announced that he is upgrading the powerful animal sedative to a level three schedule on the state’s list of controlled substances. This will allow the state to put tighter controls, security, and record-keeping requirements in place to keep these substances out of our communities. However, many harm reduction workers and activists are concerned that this will do more harm than good, because a person can be prosecuted for having fentanyl, and the fact that the two substances are typically mixed ensures that the individual being charged will likely face harsher penalties that will more than likely lead to a more prolonged recovery.
In conclusion, the use of xylazine in illicit drugs is a dangerous trend that is associated with a range of adverse effects. As drug use continues to be a widespread problem, it is important for individuals, organizations, coalitions, healthcare professionals, and policy makers to work together to address this issue and to promote education, prevention, and harm reduction initiatives that can help to minimize overdoses and overdose deaths within our communities.
CCJ is working with the Washington County Opioid Overdose Coalition to provide educational information and resources to the community around the harms of this and other substances. We are strong advocates for harm reduction strategies and resources that can help to meet people where they are and decrease the amount of overdoses and overdose deaths within our communities. We will provide updates on this information when we receive new details.
Keep an eye on CCJ’s Facebook page and website for upcoming events in the community, narcan distributions, and harm reduction support.