Non-opioid tranquilizer for animals, for which there is there is no antidote mixes in michigan street drugs, which it already does lethal delivery is more dangerousaccording to toxicologists and researchers.
Xylazine, a fast-acting central nervous system depressant that is not approved for human use, is primarily found in fentanyl, a highly potent synthetic opioid that is mixed with heroin and pressed into counterfeit pills and is responsible for more overdose deaths than any other drug. Adding xylazine to fentanyl, which is also a depressant, increases the already high chance of overdose. This is a double whammy on the central nervous system. It “must be avoided at all costs,” said UCLA researcher Joseph Friedman, who has studied the drug extensively.
In Michigan, xylazine has been found in toxicology tests on nearly 200 people who have died of drug overdoses since 2019, said Varun Vohra, director of the Michigan Poison and Drug Information Center at Wayne State University in Detroit.
This figure is definitely an underestimate. Most drug tests in hospital emergency rooms are not calibrated to detect xylazine, and because xylazine overdoses are similar to opioid overdoses — dilated pupils, loss of consciousness, slow or no breathing — they are often mistaken for heroin or fentanyl overdoses. Also, medical examiners don’t always look for xylazine postmortem.
Researchers say that xylazine, which has completely infiltrated the supply of illicit drugs in Philadelphia – 91% from illegal the fentanyl tested there tested positive for an animal tranquilizer — making its way west, as does fentanyl. “We’re starting to see it more … more clearly in Michigan and all over the place,” said Vohra, who is involved in the xylazine study.
“It’s definitely coming up now,” said Shannon Phillips, an epidemiologist for the Washtenaw County Health Department.
There is concern that xylazine will push the already record number of overdoses in Michigan and across the country further into the stratosphere. Narcan (generic name: naloxone) can reverse an opioid overdose if given in time. But it only works on opioids. And xylazine is not an opioid.
What do you need to know about this latest threat?
Here are the details:
Why should I care?
If you or someone you love uses street drugs, there is an increased chance that those drugs – especially fentanyl – can be laced with xylazine. With more than 107,000 people in the United States dying of drug overdoses last year ― including 3,040 in Michigan ― the presence of xylazine could cause even more people to overdose and/or die.
If the loss of life doesn’t bother you, here’s the thing: drug overdoses cost a lot of money. According to the two-part report US Commission on Illicit Trafficking in Synthetic Opioidsoverdose deaths cost the country an estimated $1 trillion a year, including medical costs, police response and lost productivity.
So what is xylazine?
Also called a “tranquilizer,” xylazine is a non-opioid animal tranquilizer often used in horses. It is not approved by the US Food and Drug Administration for human use. The use of the drug is allowed only by licensed veterinarians, who use it as a sedative, muscle relaxant and anesthetic in animal surgeries, according to the US Drug Enforcement Administration. “Xylazine is scary,” said Friedman, the UCLA researcher who is the lead author of the groundbreaking paper on xylazine. “Xylazine is something that, unfortunately, I think is becoming more and more common that has really serious side effects in humans.”
What are the side effects?
If an overdose doesn’t kill you or stop you breathing long enough to cause brain damage or other permanent damage, there are other complications. The use of xylazine is associated with horrendous skin ulcers that turn into craters of rot. It’s “not even a normal abscess,” Friedman said, referring to the ulcers that often accompany intravenous drug use. “It’s more like tissue dying. it’s black necrotic tissues destruction.” And necrotic tissue doesn’t necessarily develop at the site of the drug’s injection. There’s evidence that it can appear anywhere on the body. Because xylazine can knock a person out for hours, it puts users at risk for sexual assault and robbery and other crimes.
David Clayton, who runs HARM:LESS, Families Against Drugs’ street medicine and harm reduction program, said his team has seen an increase in tissue damage in metro Detroit. He thinks the damage is related to xylazine, which dissolves in the medicine, but the only way to know for sure is to test the medicine in a lab. “Whatever it’s cut with, it’s causing serious soft tissue wounds,” he said.
How is xylazine added to street drugs?
Vets usually use xylazine in liquid form. But a can of xylazine can be dried or boiled down into a white, crystalline powder that dissolves in water, meaning xylazine can be snorted, smoked, injected, or swallowed. Because it is most often mixed with fentanyl, which is then mixed with a variety of street drugs, including heroin and counterfeit pills, users use it in the same way as illegal fentanyl. When they take off the fentanyl, they take off the xylazine. When they sniff fentanyl, they sniff xylazine. If they smoke… you get the idea.
Do drug users know they are taking xylazine?
“It’s anyone’s guess whether most users know what’s in (the drug) now,” Vohra said. Some probably consume it unwittingly, just as heroin users unwittingly consumed fentanyl when dealers first started mixing it into heroin; these days, most drug users know that the chances of finding pure heroin are very slim. Some drug users may want to use xylazine, just as some heroin users now want fentanyl in their high.
Why would anyone need xylazine in their medicine?
Fentanyl’s high is more intense than heroin’s, but it’s also relatively short-lived. Drug users, including those interviewed in the long-term study by Friedman and colleagues, told researchers that xylazine increased the euphoric feeling they got from taking fentanyl.
So is it all about chasing the best high?
Yes, they chase it and sell it too. Drugs are a business. Dealers want to have the most desirable product on the market. If they believe that adding xylazine will do it, they will add it. For them, it’s about money.
How long has xylazine been a street drug in the US?
In 2006, xylazine was discovered in an autopsy of the seven people who died in Philadelphia. It only became more common from there. Between 2015 and 2020, the percentage of xylazine overdose deaths in Pennsylvania jumped from 2% to 26%. Friedman’s research. In 2020, xylazine was implicated in 10% of overdoses in Connecticut. In 2021, it accounted for 19% of overdose deaths in Maryland.
Xylazine appeared in 91% of illicit fentanyl samples tested in Philadelphia. And hospital toxicology tests showed it was present in 78% of people who also tested positive for fentanyl.
And now it is moving west.
How common is xylazine in Michigan?
It’s here. It is found in drugs, most commonly in fentanyl, although it has been found in combination with other drugs.
Michigan began tracking deaths from xylazine in 2019, according to the Michigan Department of Health and Human Services. Between 2019 and 2021, xylazine was linked to 171 deaths, according to the MDHHS. Almost all of these deaths were also opioid-related. Some involved opioids and cocaine. And some involved opioids as well as methamphetamine. It breaks down as follows: Between 2019 and 2020, xylazine deaths among Michigan residents increased by 86.8%. However, from 2020 to 2021, they appear to have decreased by 12.7%, although the 2021 data is preliminary and testing of the drug in the state is inconsistent.
Regionally, xylazine deaths decreased 24.6% in southeast Michigan between 2020 and 2021 and increased 44.4% in southwest Michigan, MDHHS data show.
But in Washtenaw County, xylazine appeared in toxicology reports for eight — or 8 percent — of opioid overdose deaths that occurred between Jan. 1, 2021, and May 2022, Phillips said. “We were particularly struck by the fact that 50% of them are a relatively small set of cases given our numbers – 50% of them have occurred since the beginning of 2022,” she said. Overdoses involving opioids cut with xylazine “have already surpassed xylazine-related opioid overdose deaths in 2021.”
Eight percent of opioid deaths linked to xylazine seems like a small number, but it is higher than those analyzed in Friedman’s study of drug overdose deaths linked to xylazine. Researchers in this study looked at overdose deaths in 10 jurisdictions — none in Michigan — and found that xylazine was present in 6.76 percent of those overdose deaths.
But how many people did xylazine really kill?
It is difficult to define. Remember: death from xylazine does not count. Vohra knows that xylazine was present in nearly 200 deaths, but whether it was the cause of those deaths is unclear.
However, researchers continue to study its effects. One study of people who died in 2019 with xylazine in their bodies found that xylazine was the cause of death in 64% of those cases.
Is it possible to overdose on fentanyl and revive, but die from an overdose of xylazine?
yes. Fentanyl, a synthetic opioid that is 50 times stronger than heroin and 100 times stronger than morphine, is responsible for more overdose deaths than any other drug. These days, it takes more Narcan (generic name: naloxone) than ever — often multiple doses — to reverse an opioid overdose because fentanyl has infiltrated the street drug market so thoroughly. Xylazine is not an opioid. So if someone uses fentanyl mixed with xylazine, it’s really possible that their fentanyl overdose might be reversed, but they’ll die from the xylazine. There is no antidote for it.
What do you do if someone has overdosed on xylazine?
You give them Narcan because a xylazine overdose looks like a heroin/fentanyl overdose and without toxicology you can’t be sure what kind of overdose it is. Also, xylazine is almost always mixed with fentanyl, and as Gina Dahlem, a professor of nursing at the University of Michigan, said, “at least naloxone will be effective with the opioid.” If naloxone does not seem to be working, the person who has overdosed should go to the hospital. “Treatment for a xylazine overdose is to secure the airway, rescue breathing, and if you’re in the emergency room, they’ll give you fluids or other medications to raise your blood pressure,” Dahlem said.
Is there a way to tell if the drugs contain xylazine?
Fentanyl test strips that can tell if drugs contain fentanyl in minutes. Knowing that drugs contain fentanyl can help users take precautions, such as not injecting themselves, having Narcan available, and using more slowly. But there are no xylazine test strips. Without extensive laboratory testing, there is no easy way to determine if it is present in the drugs a person is about to use.
Additional sources: National Institute on Drug Abuse; US Drug Enforcement Administration; Michigan Department of Health and Human Services; US Centers for Disease Control and Prevention