How animal sedatives add new pain to the opioid drug crisis

WASHINGTON (AP) – Potent animal sedatives in illicit drug supply complicate US response to opioid crisis, disrupting long-standing methods for reversing overdoses and treating addiction there is

Xylazine can cause severe skin wounds, according to frontline health and law enforcement professionals in New Jersey, New York and Pennsylvania, but Washington officials have suggested. As such, it is not yet clear whether xylazine is leading to additional deaths. In fact, early data suggest that the drug may unintentionally attenuate the effects of fentanyl, the synthetic opioid behind most overdose deaths.

However, it is widely agreed that more information is needed to understand xylazine’s effects, devise ways to stop its illicit supply, and develop drugs to reverse its effects.

Dr. Lewis Nelson of the Rutgers New Jersey School of Medicine, who advises federal regulators on drug safety, said, “I wonder if xylazine increases or reduces the risk of overdose. I don’t know,” he said. “All we know is that there are a lot of people taking xylazine and a lot of them are dying, but that doesn’t mean xylazine is causing it.”

Most often, xylazine, a drug used to sedate horses and other animals, is added to fentanyl, a powerful opioid that can be fatal even in small doses. Some users claim the combination, called “tranq” or “tranq dope,” provides a longer-lasting high, similar to heroin, which has largely been replaced by fentanyl in the U.S. drug market.

As with other cutting agents, xylazine has benefits for dealers. It is often cheaper and easier to obtain than fentanyl. A Chinese website sells it without a prescription for between $6 and $20 a kilo. The chemicals used to make fentanyl can cost upwards of $75 per kilogram.

“Nobody asked for xylazine in the drug supply,” says Sarah Laurel, founder of the Philadelphia advocacy group Savage Sisters. “Unbeknownst to anyone, communities have become addicted to chemicals. So now, yes, people want it.”

Laurel’s group provides first aid, showers, clothing and snacks to drug users at stores in Philadelphia’s Kensington area.

The effect of xylazine is easy to see. The user is lethargic and trance-like, sometimes unconscious, and is at risk of robbery or assault.

“I’m slow to react, maybe 45 minutes after walking down the street,” said homeless addict Dominic Rodriguez. “Then I woke up and tried to sort out what had happened.”

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US regulatory agencies approved xylazine in 1971 for the purpose of sedating animals for surgery, dental procedures, and handling.

In humans, this drug may slow breathing and heart rate. It has also been associated with severe skin ulcers and abscesses, which can lead to infection, tissue decay, and amputation. Experts disagree about the exact cause of the scars, which are much deeper than those seen with other injection drugs.

In Philadelphia, the introduction of the drug created many new challenges.

The drug naloxone, which is used to resuscitate people who have stopped breathing, does not reverse the effects of xylazine. Philadelphia officials stress that because xylazine is most often used in combination with fentanyl, naloxone should continue to be administered in all cases of suspected overdose.

With no approved cure for xylazine, the Savage Sisters Group set out to carry oxygen tanks to help resuscitate people.

Meanwhile, mobile vans with local health workers and city officials aim to treat skin wounds before hospitalization is required.

Scars can make it difficult to get people into addiction treatment programs, but the programs typically lack the expertise to treat deep lesions that can expose tissue and bone. .

“If someone is ready to come in for treatment, they want to act now,” said Jill Bowen, director of behavioral health in Philadelphia.

The city recently launched a pilot program in which hospitals treat patients’ wounds and then move directly to addiction treatment.

Because xylazine is addictive, patients who stop taking it report severe withdrawal symptoms such as anxiety and distress. There is no approved treatment, but doctors have used the blood pressure-lowering drug clonidine, which is sometimes prescribed for anxiety.

In April, federal officials declared fentanyl, including xylazine, a “new threat,” pointing to 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 the early waves of drug use.

Officials describe the drug’s harm in harsh terms and statistics. Fatal overdoses with xylazine increased by more than 1,200% between 2018 and 2021. But most coroners weren’t looking for the drug until recently, so this largely reflects an increase in testing.

“We’re making fentanyl, the deadliest drug we’ve ever seen, even deadlier,” Drug Enforcement Administration Director Ann Milgram told attendees at a recent conference.

But those who have studied the matter in depth are less convinced.

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One of the only studies investigating this issue came to a surprising conclusion. People who overdosed on a combination of fentanyl and xylazine had “significantly less severe” outcomes than those who took fentanyl alone.

It was the opposite of what Dr. Jennifer Love and colleagues expected, given the dangerous effects of xylazine on breathing. However, an analysis of more than 320 overdose patients undergoing emergency care found a lower incidence of cardiac arrest and coma when xylazine was involved.

Love, an emergency physician at New York’s Mount Sinai Hospital, suggested that xylazine may be reducing the amount of fentanyl in each dose. She stressed that this was just one of her possible explanations and that the long-term effects of xylazine require further research. He also noted that the study did not track potentially fatal downstream effects of xylazine, such as skin infections and amputations.

But hints that xylazine might blunt a fatal overdose are emerging elsewhere.

About one-third of the opioid supply in New Jersey contains xylazine, according to drug paraphernalia tests. However, in 2021, the most recent year with complete data, less than 8% of fatal overdoses involved xylazine.

Police Capt. Jason Piotrovsky, who oversees the analysis of state drug data, said xylazine’s ability to prolong a user’s high may explain why fatal overdoses are less frequent than expected. said to be sexual.

“If the effects of xylazine were long-lasting and people were using it, they wouldn’t need so many doses,” he says. “So now we have less exposure to the more lethal fentanyl.”

Piotrovsky, like other experts, stressed that this is just one theory and that xylazine’s effects are not clear.

Philadelphia officials don’t think there’s much room for improvement in the drug.

“Frankly, I don’t think there’s a positive side to xylazine,” said city health commissioner Dr. Cheryl Bettigor. “It appears to increase the risk of overdose, causing severe and debilitating scarring and preventing people from getting medical attention.”

Annual overdose deaths in Philadelphia have increased 14% since xylazine became a significant part of the local drug market around 2018. In 2021, the city reported 1,276 overdose deaths. Bettygall expects final figures for 2022 to show further increases.

According to City of Philadelphia statistics, more than 90% of the opioids tested in Philadelphia contain xylazine.

As the Savage Sisters and other advocates address the damage of xylazine, we see new drugs on the market, including Nitazen, a synthetic opioid that may be even more potent than fentanyl. ing.

A changing mix of opioids, stimulants, and sedatives has come to define the drug epidemic in the United States, making it difficult to cope with a crisis that now claims more than 100,000 lives annually.

The Biden administration and Congress are considering changes to limit the prescription and distribution of xylazine.

But past regulations didn’t solve the problem. As regulators cracked down on pain relievers like OxyContin, people moved primarily to heroin and then fentanyl.

“First I took pills, then heroin, then fentanyl,” Piotrovsky said. “Now we have it all, and xylazine is just part of it.”