JUNE 23, 2023:
WASHINGTON (AP) — A powerful animal sedative in the illicit drug supply is complicating the U.S. response to the opioid crisis. It’s called xylazine (pronounced ZY’-lah-zeen). It’s not intended for human use and can cause severe skin wounds in people who inject it. But whether it is leading to more deaths — as suggested by officials in Washington — is not yet clear. In fact, some early data suggests the drug may inadvertently be diluting the effects of fentanyl, the synthetic opioid behind most overdose deaths. But there is broad agreement that information is needed to understand xylazine’s impact and craft ways of disrupting illegal supplies.
Extended version:
WASHINGTON (AP) — A powerful animal sedative in the illicit drug supply is complicating the U.S. response to the opioid crisis, scrambling longstanding methods for reversing overdoses and treating addiction.
Xylazine can cause severe skin wounds, but whether it is leading to more deaths — as suggested by officials in Washington — is not yet clear, according to health and law enforcement professionals on the front lines of efforts in New Jersey, New York and Pennsylvania. In fact, early data suggests the drug may inadvertently be diluting the effects of fentanyl, the synthetic opioid behind most overdose deaths.
There is broad agreement, however, that much more information is needed to understand xylazine’s impact, to craft ways of disrupting illegal supplies and to develop medicines to reverse its effects.
“We don’t know whether xylazine is increasing the risk of overdose or reducing the risk of overdose,” said Dr. Lewis Nelson of Rutgers New Jersey Medical School, who advises federal regulators on drug safety. “All we know is that there are a lot of people taking xylazine and a lot of them are dying, but it doesn’t mean that xylazine is doing it.”
In almost all cases, xylazine — a drug for sedating horses and other animals — is added to fentanyl, the potent opioid that can be lethal even in small amounts. Some users say the combination, dubbed “tranq” or “tranq dope,” gives a longer-lasting high, more like heroin, which has largely been replaced by fentanyl in U.S. drug markets.
Like other cutting agents, xylazine benefits dealers: It’s often cheaper and easier to get than fentanyl. Chinese websites sell a kilogram for $6 to $20, no prescription required. Chemicals used to produce fentanyl can cost $75 or more per kilogram.
“Nobody asked for xylazine in the drug supply,” said Sarah Laurel, founder of Savage Sisters, a Philadelphia outreach group. “Before anybody knew it, the community was chemically dependent on it. So now, yes, people do seek it out.”
From a storefront in Philadelphia’s Kensington neighborhood, Laurel’s group provides first aid, showers, clothes and snacks to people using drugs.
Xylazine’s effects are easy to spot: users experience a lethargic, trance-like state and sometimes black out, exposing themselves to robbery or assault.
“It’s a delayed reaction, I could be walking down the street, it’s 45 minutes later,” says Dominic Rodriguez, who is homeless and battling addiction. “Then I wake up, trying to piece together what happened.”
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U.S. regulators approved xylazine in 1971 to sedate animals for surgery, dental procedures and handling purposes.
In humans, the drug can cause breathing and heart rates to drop. It’s also linked to severe skin ulcers and abscesses, which can lead to infections, rotting tissue and amputations. Experts disagree on the exact cause of the wounds, which are much deeper than those seen with other injectable drugs.
In Philadelphia, the drug’s introduction has created a host of new challenges.
Naloxone, a medication used revive people who have stopped breathing, doesn’t reverse the effects of xylazine. Philadelphia officials stress that naloxone should still be administered in all cases of suspected overdose, since xylazine is almost always found in combination with fentanyl.
With no approved reversal drug for xylazine, the Savage Sisters group has taken to carrying oxygen tanks to help revive people.
Meanwhile, a roaming van staffed by local health workers and city staffers aims to treat the skin wounds before they require hospitalization.
The wounds can make it harder to get people into addiction treatment programs, which typically don’t have the expertise to treat deep lesions that can expose tissue and bone.
“If you have someone out there who’s ready to come in for treatment, you really want to act on that quickly,” said Jill Bowen, who runs Philadelphia’s behavioral health department.
The city recently launched a pilot program where hospitals treat patients for wounds and then directly transfer them into addiction treatment.
Xylazine can be addictive and patients who stop taking it report severe withdrawal symptoms, including anxiety and distress. There’s no approved treatment but physicians have been using the blood pressure-lowering drug clonidine, which is sometimes prescribed for anxiety.
In April, federal officials declared xylazine-laced fentanyl an “ emerging threat,” pointing to the problems in Philadelphia and other northeastern cities. Testing is far from uniform, but the drug has been detected in all 50 states and appears to be moving westward, similar to earlier waves of drug use.
Officials describe the drug’s toll in stark terms and statistics: Fatal overdoses involving xylazine increased more than 1,200% percent between 2018 and 2021. But that largely reflects increased testing, since most medical examiners weren’t looking for the drug until recently.
“What it is doing is making the deadliest drug we’ve ever seen, fentanyl, even deadlier,” Anne Milgram, head of the Drug Enforcement Administration, told attendees at a recent conference.
But those who have studied the problem closely aren’t so sure.
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One of the only studies looking at the issue reached a startling conclusion: People who overdosed on a combination of fentanyl and xylazine had “significantly less severe” outcomes than those taking fentanyl alone.
It was the opposite of what Dr. Jennifer Love and her colleagues expected, given xylazine’s dangerous effects on breathing. But their analysis of more than 320 overdose patients who received emergency care found lower rates of cardiac arrest and coma when xylazine was involved.
Love, an emergency medicine physician at New York’s Mount Sinai hospital, suggested xylazine may be reducing the amount of fentanyl in each dose. She stressed that this is only one possible explanation, and more research is needed into xylazine’s long-term effects. She also noted that the study didn’t track downstream effects of xylazine that could be deadly, including skin infections and amputations.
But hints that xylazine could be blunting fatal overdoses are showing up elsewhere.
In New Jersey, about one-third of the opioid supply contains xylazine, based on testing of drug paraphernalia. But less than 8% of fatal overdoses involved xylazine in 2021, the latest year with complete data.
Police Capt. Jason Piotrowski, who oversees the analysis of state drug data, said xylazine’s ability to extend users’ high may be a factor in why it’s showing up less than expected in fatal overdoses.
“If xylazine is lasting longer and that’s why people are using it, then they’re not going to need as many doses,” he said. “So now their exposure to the more deadly fentanyl decreases.”
Like other experts, Piotrowski stressed that this is only one theory and xylazine’s impact is far from clear.
Philadelphia officials see no upside to the drug.
“I don’t frankly see a plus side to xylazine,” said Dr. Cheryl Bettigole, the city’s health commissioner. “It seems to increase the risk of overdose and it causes these severe, debilitating wounds that interfere with peoples’ ability to get into treatment.”
Philadelphia’s annual toll of fatal overdoses has climbed by 14% since xylazine became a significant part of the local drug market around 2018. In 2021, the city reported 1,276 overdose deaths. Bettigole expects final 2022 figures to show another increase.
More than 90% of lab-tested opioids in Philadelphia contain xylazine, according to city figures.
Even as Savage Sisters and other advocates deal with xylazine’s toll, they are seeing newer drugs circulate, including nitazenes, a synthetic opioid that can be even more potent than fentanyl.
A shifting mix of opioids, stimulants and sedatives has come to define the U.S. drug epidemic, making it harder to manage a crisis that now claims more than 100,000 lives a year.
The Biden administration and Congress are considering changes to try to limit xylazine prescribing and distribution.
But past restrictions didn’t solve the problem: When regulators cracked down on painkillers like OxyContin, people largely shifted to heroin and then fentanyl.
“First we had pills, then we had heroin and then we had fentanyl,” Piotrowski said. “Now we have everything. And xylazine is just a part of that.”
MAY 18, 2023:
NEW ORLEANS (AP) — Drug overdose deaths in the U.S. rose slightly in 2022. That makes it the first year without a substantial increase since 2018. Officials with the Centers for Disease Control and Prevention say the numbers plateaued for most of last year. New estimates from the CDC show about nearly 110,000 U.S. overdose deaths last year. That’s nearly 2% more than 2021. Eight states that have had some of the highest overdose death rates saw sizable decreases. But experts caution that overdose deaths could rise again due to things like scaling back telehealth services.
Extended version:
NEW ORLEANS (AP) — Drug overdose deaths in the U.S. went up slightly last year after two big leaps during the pandemic.
Officials with the Centers for Disease Control and Prevention say the numbers plateaued for most of last year. Experts aren’t sure whether that means the deadliest drug overdose epidemic in U.S. history is finally reaching a peak, or whether it’ll look like previous plateaus that were followed by new surges in deaths.
“The fact that it does seem to be flattening out, at least at a national level, is encouraging,” said Katherine Keyes, a Columbia University epidemiology professor whose research focuses on drug use. “But these numbers are still extraordinarily high. We shouldn’t suggest the crisis is in any way over.”
An estimated 109,680 overdose deaths occurred last year, according to numbers posted Wednesday by the CDC. That’s about 2% more than the 107,622 U.S. overdose deaths in 2021, but nothing like the 30% increase seen in 2020, and 15% increase in 2021.
While the overall national number was relatively static between 2021 and 2022, there were dramatic changes in a number of states: 23 reported fewer overdose deaths, one — Iowa — saw no change, and the rest continued to increase.
Eight states — Florida, Indiana, Kentucky, Maryland, Michigan, Ohio, Pennsylvania and West Virginia — reported sizable overdose death decreases of about 100 or more compared with the previous calendar year.
Some of these states had some of the highest overdose death rates during the epidemic, which Keyes said might be a sign that years of concentrated work to address the problem is paying off. State officials cited various factors for the decline, like social media and health education campaigns to warn the public about the dangers of drug use; expanded addiction treatment — including telehealth — and wider distribution of the overdose-reversing medication naloxone.
Plus, the stigma that kept drug users from seeking help — and some doctors and police officers from helping them — is waning, said Dr. Joseph Kanter, the state health officer for Louisiana, where overdose deaths fell 4% last year.
“We’re catching up and the tide’s turning — slowly,” said Kanter, whose state has one of the nation’s highest overdose death rates.
Beginning in the mid-1990s, abuse of prescription opioid painkillers was to blame for deaths before a gradual turn to heroin, which in 2015 caused more deaths than prescription painkillers or other drugs. A year later, the more lethal fentanyl and its close cousins became the biggest drug killer.
Last year, most overdose deaths continued to be linked to fentanyl and other synthetic opioids. About 75,000, up 4% from the year before. There also was a 11% increase in deaths involving cocaine and a 3% increase in deaths involving meth and other stimulants.
Overdose deaths are often attributed to more than one drug; some people take multiple drugs and officials say inexpensive fentanyl is increasingly cut into other drugs, often without the buyers’ knowledge.
Research from Dr. Daniel Ciccarone, a drug policy expert at the University of California, San Francisco, suggests “there appears to be some substitution going on,” with a number of people who use illicit drugs turning to methamphetamines or other options to try to stay away from fentanyl and fentanyl-tainted drugs.
Ciccarone said he believes overdose deaths finally will trend down. He cited improvements in innovations in counseling and addiction treatment, better availability of naloxone and legal actions that led to more than $50 billion in proposed and finalized settlements — money that should be available to bolster overdose prevention.
“We’ve thrown a lot at this 20-year opioid overdose problem,” he said. ”We should be bending the curve downward.”
But he also voiced some caution, saying “we have been here before.”
Consider 2018, when overdose deaths dropped 4% from the previous year, to about 67,000. After those numbers came out, then-President Donald Trump declared “we are curbing the opioid epidemic.”
But overdose deaths then rose to a record 71,000 in 2019, then soared during the COVID-19 pandemic to 92,000 in 2020 and 107,000 in 2021.
Lockdowns and other pandemic-era restrictions isolated people with drug addictions and made treatment harder to get, experts said.
Keyes believes that 2022’s numbers didn’t get any worse partly because isolation eased as the pandemic ebbed. But there may be issues ahead, others say, like increased detection of veterinary tranquilizer xylazine in the illicit drug supply and proposals to scale back things like prescribing addiction medications through telehealth.
“What the past 20 years of this overdose crisis has taught us is that this really is a moving target,” Keyes said. “And when you think you’ve got a handle on it, sometimes the problem can shift in new and different ways.”
APRIL 12, 2023:
UNDATED (AP)- The U.S. Office of National Drug Control Policy is designating the tranquilizer xylazine when mixed with fentanyl as an emerging threat. The drug was approved for veterinary uses more than 50 years ago. But recently, it’s been showing up in the supply of illicit drugs across the U.S., where it’s sometimes known as “tranq.” It’s a depressant that can slow down users’ heart rates and breathing and cause skin ulcers and abscesses. No antidote has been identified. President Joe Biden’s top drug-control official says the designation clears the way to spend taxpayer money to develop strategies to deal with xylazine.
Extended version
UNDATED (AP)- The U.S. has named a veterinary tranquilizer as an “emerging threat” when it’s mixed with the powerful opioid fentanyl, clearing the way for more efforts to stop the spread of xylazine.
The Office of National Drug Control Policy announced the designation Wednesday (April 12, 2023), the first time the office has used it since the category for fast-growing drug dangers was created in 2019.
Dr. Rahul Gupta, director of the drug policy office, said xylazine (pronounced ZAI’-luh-zeen) has become increasingly common in all regions of the country.
It was detected in about 800 drug deaths in the U.S. in 2020 — most of them in the Northeast. By 2021, it was present in more than 3,000 fatalities —with the most in the South — according to a report last year from the Drug Enforcement Administration.
“We cannot ignore what we’re seeing,” Gupta said. “We must act and act now.”
Xylazine was approved for veterinary use in 1971. Sometimes known as “tranq,” it’s been showing up in supplies of illicit drugs used by humans in major quantities in only the last several years.
It’s believed to be added to other drugs to increase profits. Officials are trying to understand how much of it is diverted from veterinary uses and how much is made illicitly.
The drug causes breathing and heart rates to slow down, sometimes to deadly levels, and causes skin abscesses and ulcers that can require amputation. Withdrawal is also painful.
While it’s often used in conjunction with opioids, including fentanyl and related illicit lab-made drugs, it’s not an opioid. And there are no known antidotes.
Gupta said his office is requesting $11 million as part of its budget to develop a strategy to tackle the drug’s spread. Plans include developing an antidote, learning more about how it is introduced into illicit drug supplies so that can be disrupted, and looking into whether Congress should classify it as a controlled substance.
Gupta said it needs to be available for veterinary uses even amid crackdowns on the supply used by people. He also said systems to detect the drug and data about where it’s being used need to be improved.
The drug is part of a deepening overdose crisis in the U.S.
The U.S. Centers for Disease Control and Prevention estimates that more than 107,000 people died from overdoses in the 12 months that ended Oct. 31, 2022. Before 2020, the number of overdose deaths had never topped 100,000.
Most of the deaths were linked to fentanyl and other synthetic opioids. Like xylazine, they’re often added to other drugs — and users don’t always know they’re getting them.
APRIL 5, 2023:
The South Dakota Department of Health (DOH) has issued a warning to the public and medical professionals about the threat of fentanyl mixed with xylazine. The Drug Enforcement Administration (DEA) has reported that this mixture is becoming increasingly widespread and poses a significant risk to public health.
“We want to make sure the public is aware of the dangers of this mixture and that medical professionals are equipped to handle any cases that may arise,” said Dr. Tim Southern, Public Health Laboratory Administrator at the South Dakota Department of Health. “It is essential to note that naloxone is an opioid antagonist medication used to reverse an opioid overdose, which can occur with an overdose of fentanyl. But xylazine is not an opioid, therefore naloxone will not reverse its effects, which makes this combination much more deadly.”
Fentanyl is a potent synthetic opioid that is often mixed with other drugs to increase their effects. Xylazine is a sedative commonly used on large animals such as horses and is not intended for human consumption. The combination of these two substances can lead to respiratory depression, seizures, and even death.
DOH urges medical professionals to be vigilant in their drug testing protocols and to report any cases of fentanyl and xylazine mixtures immediately. Guidelines for the treatment of individuals who may have been exposed to these substances are available here.
“The safety of South Dakotans is our top priority, and we will continue to monitor this situation closely and take appropriate action,” Dr. Southern added.
DOH is working closely with the DEA and other state and federal agencies to address this threat and keep the public informed. Anyone who suspects they may have come into contact with fentanyl mixed with xylazine should seek medical attention immediately.
For more information and resources on this issue, please visit https://doh.sd.gov/.
DECEMBER 23, 2021:
CHESTER, Vt. (AP) — An animal tranquilizer is turning up in drug overdoses across the country. A report from the Centers for Disease Control and Prevention says xylazine was involved in fatal drug overdoses in 23 states in 2019, with a highest rate — 67% — happening in the Northeast. Officials say the the animal sedative used in veterinary medicine to sedate cows, horses, sheep and other animals is being added to other drugs, mostly fentanyl and heroin, as a cutting agent. But unlike opioids there’s no antidote, like Narcan, specific to a xylazine overdose. The tranquilizer is also not a controlled substance and not approved for human use.
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