Over the past few years, the overdose crisis has accelerated rapidly with the introduction of adulterant chemicals. These are what people are referring to when they say a drug has been cut or laced with another substance. These substances may be used to enhance drug effects, to add bulk (for higher profits), or to counterfeit a different drug. Currently, the most well-known of these adulterants is fentanyl, a powerful synthetic opioid routinely found mixed in with heroin and other drugs. Now xylazine, a veterinary anesthetic sometimes referred to as “tranq,” is being increasingly found in the illicit opioid supply. Its most notable presence has been in Philadelphia, however, it is infiltrating drug supplies across the country.
What is xylazine?
Xylazine is an animal tranquilizer not approved for human consumption, but it is increasingly being added to heroin, fentanyl, and other drugs due to its sedating and euphoric properties. Since it is a tranquilizer, it sedates people and can exacerbate overdose symptoms like unconsciousness, slowed heartbeat, and respiratory depression. Unfortunately, since xylazine is not an opioid, the opioid reversal medication naloxone (Narcan) is not effective in reversing the symptoms. Other harm reduction strategies that are geared towards fentanyl and opioid response are also less helpful in dealing with xylazine—there are no testing strips or other simple and portable ways for someone to test their drug supply for xylazine. Currently, only a lab can test for the presence of xylazine.
Why is it dangerous?
Beyond the dangers of sedation, xylazine has a number of negative side effects. The most worrisome of these is the development of skin abscesses that can progress to necrotizing tissue—the death of the tissue. In some cases, this can require amputation. And this isn’t an incredibly rare side effect. This study of people who use xylazine reported that 35% of participants experienced skin lesions. This side effect is likely due to the effect the drug has on skin oxygenation. Some believe that intravenous use may accelerate the appearance of lesions, but lesions can crop up away from the injection site and also occur with other forms of non-intravenous use, like smoking. Xylazine can also cause significant withdrawal symptoms, which can make it harder to quit, especially when used in concert with opioids like fentanyl or heroin.
Are there harm reduction strategies for xylazine?
Thus far, xylazine has mostly been reported in Philadelphia and other counties in Massachusetts, Maryland, Connecticut, and Illinois. However, it is likely that this isn’t because there’s more use of it in these areas, but because these places have robust harm reduction policies that allow for better monitoring of the drug supply and deeper community engagement around drug use. As xylazine lengthens the euphoric feelings of opioids, it is likely we will see more community-spread across the country. As such, here are some quick harm reduction strategies around xylazine use:
- Don’t use alone.
- Try to use in as safe a place as possible, in case you lose consciousness.
- Start low, go slow
- Carry naloxone (Narcan). If after administering it, the person begins to breathe regularly but is still sedated, put them into rescue position, call 911, and keep an eye on them.
- If you develop skin lesions, keep them clean and dry, and seek medical care as they can progress rapidly with ongoing use.
What can we do about xylazine?
The alarming increase of dangerous adulterants being used to alter drug supply as a result of pandemic supply chain issues is likely to continue and become more complex. The best way to address the dangers of xylazine and other potential contaminants is with significant drug policy changes to allow for more agile community care of people who use drugs. The current stratospheric overdose rates in the country make common sense measures—like drug checking facilities that allow for people to submit small amounts of substances for testing without fear of criminal prosecution—a long overdue first step in the right direction.
A summary of quick facts about xylazine:
- It’s a veterinary anesthetic, not approved for human use.
- Sometimes known as “sleep cut” or “Tranq”, it is used to cut primarily fentanyl and heroin, but has been found in other drugs.
- It’s a powerful sedative that can exacerbate or cause overdose.
- Since it’s not an opioid, naloxone is not an effective reversal.
- It has substantial negative side effects, including skin abscesses and necrotizing flesh.