Officials rush to fight harmful street drugs
As a dangerous new additive found in fentanyl and other street drugs surges from coast to coast, health officials in nearly every state are scrambling to track it.
Xylazine, a large-animal tranquilizer not approved for human use, started showing up routinely in the drug supply in 2019, but didn’t take off until the coronavirus pandemic began in 2020. Also known as tranq, xylazine can give users horrific skin lesions that can result in amputations. It also can cause hours-long blackouts, putting users at risk of theft, rape and exposure to extreme weather.
Now, local health officials in nearly every state are rushing to keep tabs on where xylazine is showing up and in what quantities.
They are trying to alert drug users to steer clear of the toxic additive and educate health professionals and first responders about its devastating effects.
“They’re using any data they can get their hands on to track xylazine and its complicated set of symptoms and effects on users,” said Richa Ranade, senior director of overdose prevention at the Association of State and Territorial Health Officials.
In the past two years, the federal Centers for Disease Control and Prevention has published three field reports tracking the spread of xylazine. But so far, there’s no national plan for how to test for the drug and protect drug users. And because the tranquilizer has only been approved for cows, horses and other large animals, medical researchers know very little about its effects on humans and have not identified antidotes.
Lacking federal guidance, Boston, New York City, North Carolina and Rhode Island have developed innovative methods for rapidly testing illicit drug samples, followed by localized messaging to drug users and medical providers about the dangers of xylazine.
Philadelphia’s health department has published a medical advisory outlining a protocol for xylazine withdrawal management. And Maryland has a pilot project for staffing local harm reduction centers with medical professionals who can treat the horrific wounds the drug is causing.
Epidemiologists at Brandeis University near Boston are working with state and local health officials and law enforcement to collect samples of the drug supply, test them as quickly as possible and immediately report back to the drugusing community on the prevalence of xylazine.
When temperatures dipped below zero in Boston recently, Traci Green, director of the drug testing project at Brandeis, said she worried that drug users in the city could die from exposure if they inadvertently used fentanyl mixed with xylazine.
“That’s something we haven’t had to think about before,” she said. “We’ve had a singular focus on fentanyl for a long time and we’ve made a lot of progress preventing overdose deaths. But many of the tools we have aren’t addressing this particular drug.”
People who overdose after ingesting opioids combined with xylazine should be given naloxone to block the effects of the opioids. But their depressed breathing and heart function may continue because naloxone doesn’t block xylazine, and there’s no known medication that does.
Similarly, withdrawal from opioids can be managed with buprenorphine and methadone, medications approved by the U.S. Food and Drug Administration. But the agency hasn’t approved any drug for xylazine withdrawal since it is not intended for human consumption.