The veterinary drug xylazine, used primarily as a tranquilizer for horses and other large animals, is being found in doses of fentanyl and other illicit drugs coming into the area, adding a new layer of problems for those trying to combat the opioid crisis.
Known on the street-level as “tranq” or “tranq dope,” short for tranquilizer, xylazine has never been approved for use in humans by the Federal Drug Administration, only animals.
Xylazine is now present in one out of every nine overdose deaths nationwide involving illicit fentanyl, according to the Centers for Disease Control and Prevention.
“We’ve been aware that xylazine has been mixed with fentanyl both in the powder and in the pill form in narcotics that are coming to West Virginia,” said Dr. Lee Smith with Monongalia County Health Department. “Unfortunately, people thought it would be a fun thing to inject,”
For humans, Smith said, the drug will cause suppression of the central nervous system.
It will also cause some pain relief, sedation and muscle relaxation, he said, but when you start to depress the central nervous system, it slows down breathing, causing the respiratory rate to get dangerously low. It will also slow down the heart and lower the blood pressure.
“If you don’t have a way to stabilize the patient,” he said. “They could die.”
Smith said while there is an antidote for large animals, there is no antidote approved for use in humans.
The common counter for a fentanyl overdose, Narcan, does not work with xylazine, because it is not an opioid, although the symptoms from it may look very similar to someone who is overdosing on opioids.
The drug also frequently causes another scary side effect for drug users – skin ulcers.
“It doesn’t have to occur at the site of injection, and they can be diffused all over the body,” Smith said. “So, if you are injecting your left arm, you could get one on your foot or on the back of your neck. These are pretty horrific.”
Smith said once an ulcer forms, they have a pretty predictable trajectory, growing from an ulcer to becoming enlarged. The area will then ulcerate and turn black and necrotic, at which point it needs to be removed. The ulcers are difficult to treat, and it is a long process to clear the wounds.
The ulcers have led to xylazine being coined “the zombie drug.”
Smith said local emergency rooms have seen patients for the wounds, but sometimes there is a reluctance to get them treated because it may mean hospitalization and that may mean withdrawal.
“It’s an added layer of complication I wish we didn’t have,” he said.
The research
An exploratory study done earlier this year through West Virginia University looked at alternative ways to determine when new drugs, like xylazine, are being introduced in an area.
Currently, “if something is coming into a community, we have to either catch the dealer and figure out what that substance was and that takes time, or we are looking at a body because someone has died, and that toxicology report on the autopsy can take months if not longer at times. Before you even know something like carfentanil (an extremely potent fentanyl) has made it into your community, multiple people have died,” said Dr. Charles Mueller, who oversaw the WVU study.
The researchers provided sharps boxes to six harm reduction centers and needle exchanges in the region and sent the syringes to a lab that could analyze the contents. In turn, they would provide the centers with the data they gathered as to what drugs were present so they could be better prepared.
Mueller said they wanted to set up a kind of surveillance system that can get ahead of the curve, because health professionals and law enforcement were constantly trying to figure out what was coming next.
From the region, 6,718 syringes were tested between January and August — approximately 350-400 tested syringes each week.
Mueller said it was difficult to find a lab with the capability to test what they wanted, but once they got going, they could provide data weekly.
“So something that was coming in on Monday we could tell you probably on Friday, if we were running at full strength, what’s in your community right now,” he said.
Over the course of the study, Mueller and team found 51 different substances – at least 13 that emerged after the first batch of 1,000 syringes were tested. They found 20 substances that appeared more frequently than others.
Xylazine was the first new substance they found and then they started seeing it everywhere, he said. The drug was found in 15% to 20% of the syringes tested.
Mueller said while this study was more qualitative than quantitative – meaning they were just looking for the presence of drugs, not the amount that was present – he believed it demonstrated the capabilities of what could be done by studying syringes from exchanges and they were able to reveal some clarity and trends.
“This data doesn’t exist anywhere,” he said. “I think in the states maybe New York is doing it, maybe D.C., but there’s no other states that have this data, that know what’s in these syringes – it just doesn’t exist.”
This type of research could expand into detecting amounts of different drugs present and can even help with areas like the spread of diseases like HIV and Hepatitis C.
“I can sit there and look for different combinations of substances within each syringe,” he said, “because sometimes there’s one substance and sometimes there’s 15. Knowing those patterns, we can see that now xylazine is showing up – what is it showing up with?”
Mueller said the short study also saw some other odd drugs, like a benzodiazepine that had been developed by a company in the 1970s but had never been brought to market. But, in 2016, someone in Sweden figured out the recipe for it and started making it as a party drug.
Now in 2023, they are detecting Sweden’s party drug – one that was never officially prescribed or brought to market – in syringes in West Virginia.
“That’s what’s nice about this study,” he said, “people don’t have to die for us to get that information.”
Using the research
Locally, the Monongalia County Quick Response Team (QRT) does a weekly analysis of how people are looking for treatment or other assistance. Part of that is to follow the number of reported overdoses, Dr. Smith said. Although, not all overdoses are reported.
“We’ve been aggressive in getting Narcan out to the community so that people with substance use have access to that because the idea is to keep them alive until they can make a decision that they don’t have to live their life this way,” Smith said.
“Over the last 18 months, we’ve had at least 32 deaths that we’re aware of,” he said.
Smith said that high numbers of deaths in the community, particularly in the younger population where overdose deaths typically occur, could have repercussions downstream. These things affect numbers like the annual community health rankings in which one of the data points is looking at lost lives – this could play a factor in new businesses moving into the area.
Mueller said that if more studies like his are funded, groups like the QRT will be able to pivot from what they normally do when drugs, like xylazine, that are resistant to current methods are found in the community and will help law enforcement determine the sources.
“We’re all just out here trying to figure out how to solve a problem that’s changing all the time,” Mueller said. “You think you have fentanyl figured out and the next thing you know xylazine is your new thing.”
Affects on vets
As far as xylazine goes, lawmakers are currently working to schedule the drug, but how will that affect veterinary medicine?
Local veterinarian Dr. Rush Holt, who has worked in large animal medicine, said he has commonly used xylazine when doing dental work on horses or repairing lacerations.
“It does a really nice job,” he said. “It’s short-acting. It’s safe.”
However, he said even large animals like bulls, only need a small dose of the drug, adding that an angry bull will “just melt” with the tiniest dose.
“Now hearing what it’s being used for now, it’s pretty terrifying,” Holt said. “I feel awful for the people that are using it. I mean, sure, it’s an inconvenience for me to have it made a Schedule II, but at the same time, I think keeping people safe is very important, too.
“It’s just another hoop that we will have to jump through and I feel like veterinary medicine is all hoops and there’s always a new hoop that you need to jump through. If it means keeping the public safe, then that’s what we’re gonna do,” he said. “We’re gonna adapt. The number one priority is health and keeping the animals and people safe. But it’s scary. Yeah, it is scary.”
