Skin-Rotting “Zombie Drug” is Compounding the Opioid Crisis

<p>From the headline alone, you already know this drug shouldn’t be touched with a 10ft pole.</p> <p>Xylazine is the latest gruesome turn in the opioid crisis; a new player in a pharmacological scene marked by killers like fentanyl and oxycodone. A sedative and not an opioid, this formidable animal tranquilizer (also known as "Tranq") has become infamous across the United States for causing long, deep blackouts (up to 12 hours) that leave users exposed to assault, robbery, or worse.</p> <p>Xylazine causes wounds to degenerate into scaly, rotting flesh that sometimes necessitates an amputation — hence, the moniker of "zombie drug". This is attributed to xylazine’s vasoconstricting properties, meaning it narrows blood vessels which can then cause terrible skin abscesses.</p> <p>It’s meant for big animals like horses and is not approved for people. In a recent Health Canada report, xylazine was discovered in 1,350 samples of drug seizures, while in Philadelphia, health authorities report that over 90% of dope samples contained the drug in 2021. Some 3,000 Americans died of xylazine-related overdoses that same year, triple the number from 2020. </p> <h2>Combo with fentanyl: a catalyst for destruction</h2> <p>The rise of xylazine reflects the ever-evolving nature of the U.S. illegal drug market, as dealers use synthetic substances to fill out their stock and earn a greater bottom line. Xylazine is often cut with fentanyl, with the former enhancing the latter’s effect by prolonging the euphoric sedation through a slowed heart rate, breathing, and blood pressure. Many users are unaware xylazine is present in the fentanyl they obtained.</p> <p>Xylazine’s inclusion in fentanyl mixes undermines attempts to reverse overdoses while bringing its own dangers to the table. We have naloxone for fentanyl, but we don’t have an antidote for xylazine itself. Experts still recommend administering naloxone if you encounter someone overdosing (even if the combo is present, which won’t be readily obvious) and to call for backup if they don’t respond.</p> <p>Fentanyl has been a component of drug mixes for years now, finding its way into heroin, cocaine, and methamphetamines as a cheaper way to get high. Some 107,000 Americans died between August 2021 and August 2022 from drug poisonings, and 66% of these deaths involved synthetic opioids including fentanyl.</p> <p>The devastation of fentanyl became increasingly prominent through the 2010s, and now xylazine is bolstering its effect. To what degree xylazine alone will play out compared to its predecessor remains to be seen, although the DEA does not expect it to replace fentanyl or other opioids among users.</p> <p>Little research has been done on xylazine and its effects on humans, so the primary sources of information on its adverse effects are the experiences of users. Several side effects from dry mouth and drowsiness right through to respiratory depression have been reported.</p> <p>For users, even if they manage to curb opioid withdrawals, the separate and harsh xylazine withdrawal continues, leading people back into a cycle of using tranq dope to avoid getting sick with migraines, nausea, sweats, extreme anxiety, numbness, and more. Anecdotal reports suggest that withdrawal from xylazine may be as severe or even worse than that of heroin.</p> <p>One user interviewed by the New York Times described her experience with the necrotic effects of xylazine, saying that, after accidentally injecting tranq into an artery, it felt like dipping her hands into acid. The intense wounds that users suffer are so extreme that doctors are often “perplexed” at how they resemble chemical burns, according to the same report.</p> <figure><img alt="" height="480" src="https://cdn.storymd.com/optimized/LA1RlgIQo5/thumbnail.jpg" width="640" /> <figcaption>Fentanyl. 2 mg. A lethal dose in most people. <em>Source: United States Drug Enforcement Administration</em></figcaption> </figure> <h2>Circulation and legality</h2> <p>The FDA issued a countrywide xylazine alert for clinicians in November, and although it’s been reported in dozens of states, the saturation of the deadly drug is likely much higher than what we know. According to the DEA, numerous jurisdictions across the U.S. may not include xylazine in forensic laboratory or toxicology testing.</p> <p>“Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” said DEA Administrator Anne Milgram. “DEA has seized xylazine and fentanyl mixtures in 48 of 50 States. The DEA Laboratory System is reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.”</p> <p>In a fall report from 2022, the DEA noted that a kilogram of xylazine can be bought from online Chinese suppliers for $6–$20, providing dealers with room to pad out their fentanyl or heroin mixtures more cheaply.</p> <p>Tranq exists in a legal limbo at the federal level as it is not a controlled substance, but moves are underway to crack down on it. The FDA wants to cut importation, and lawmakers across the aisle are working on proposals to constrict legislation.</p> <p>“We need to make sure that we make it illegal for human use because of the devastating impact we see, but I also know, working with cattlemen and the ranchers in my state, that they need to be able to treat their horses and large animals with this drug,” said Senator Catherine Cortez Masto, a Nevada Democrat, to the New York Times.</p> <h2>More on Substance Abuse and Addiction</h2><ul><li><a href="https://soulivity.storymd.com/journal/jkal3k3ibm-opioid-overdose" target="_blank">Opioid Overdose: Prevention, Signs, Treatment</a></li><li><a href="https://soulivity.storymd.com/journal/mr7bnbptzj-fentanyl" target="_blank">Fentanyl</a></li><li><a href="https://soulivity.storymd.com/journal/6j498d4cnm-drug-use-and-addiction" target="_blank">Drug Use and Addiction</a></li></ul>