Sarah Laurel spends her days in Philadelphia’s Kensington neighborhood, home to some of the most concentrated drug use found anywhere in the United States.
More and more, she encounters a new horror: gruesome infections, sores and wounds among people who use illegal opioids.
“They’re down to the bone. Muscle tissue is exposed,” says Laurel, who runs an organization that helps people who are addicted. “It’s necrotic. It smells like rotting flesh in the street and people are dying because they are rotting to death.”
The cause of those wounds, the veterinary tranquilizer known as xylazine, has made its way to central Pennsylvania. Xylazine, a powerful central nervous system depressant, also increases the risk of fatal overdose.
Dauphin County Coroner Graham Hetrick describes the prevalence as “like candy.” For the past 6-8 months, he says, it has regularly been present in bodies of people who have fatally overdosed.
In York County, it caused at least seven overdose deaths since last August, according to Pam Gay, the coroner. Perry County Coroner Robert Ressler says it has contributed to two deaths.
Xylazine, also referred to as “tranq,” “tranq dope” and “zombie drug,” is approved for use on animals, but not humans.
It’s increasingly being added to the supply of what used to be mostly heroin, and which now consists largely of fentanyl, a man-made opioid.
Here’s the most urgent threat from xylazine: it’s not an opioid and therefore doesn’t respond to naloxone, which is often used to revive people who have overdosed on opioids.
Mark Pynes | pennlive.com
“I’m positive we have lost individuals experiencing an overdose where xylazine is involved, due to individuals not knowing what is actually in the drug supply and individuals not knowing how to respond accordingly,” says Melinda Zipp, director of outreach for the Lancaster Harm Reduction Project.
Still, Zipp and others stress that xylazine is typically mixed with fentanyl, which will respond to naloxone. Therefore, naloxone must still be given to overdose victims.
If the person doesn’t quickly wake up, it means xylazine may be involved, and the person will need rescue breathing and additional aid.
“The key is to make sure the individual is breathing. If not, rescue breathing must be performed and 911 called,” Zipp says.
Suppressed breathing is a major consequence of xylazine. Laurel, who responds to overdoses in Kensington daily, says she and her colleagues now bring oxygen and commonly use rescue breathing.
The lesions, sores and wounds that can result from xylazine have also reached central Pennsylvania.
“I can say definitively that we see this,” says Dr. Mitch Crawford, the director of addiction services for York-based WellSpan Health. Jack Carroll, the head of drug treatment programs for Cumberland and Perry counties, says treatment providers have told him “we’re starting to see significant numbers” of xylazine-related wounds.
Health experts note the wounds are often associated with injection sites, but can arise on other parts of the body. They also can affect people who snort or smoke drugs containing xylazine.
“The xylazine actually creates an environment where there’s not enough oxygen for those tissues to continue living and they start dying,” Crawford says.
In some cases, amputation is the end result.
Crawford tells of someone in central Pennsylvania who lost two fingers. Laurel and others tell of people who have lost limbs.
“The seriousness of these wounds is often under-estimated in the early stages by clients until they become horrendous, leading to possible amputations by the time they seek medical care,” says Zipp, whose organization works to keep opioid users alive and as healthy as possible.
Here’s yet another added danger from xylazine: it puts people into a deeper sleep, and for a longer duration, than fentanyl and heroin. So users are at greater risk of being sexually assaulted or robbed or harmed by outdoor exposure.
Xylazine is highly addictive in its own right, producing intense, painful withdrawal that causes users to soon crave more. Much remains unknown about the full impact of xylazine on humans.
However, the U.S. Food and Drug Administration says it’s complicating treatment of people trying to recover from opioid addiction, since withdrawal symptoms can’t be managed with recovery medications such as methadone, buprenorphine or naltrexone.
Xylazine began turning up in Philadelphia as long ago as 2006, with the prevalence steadily growing, especially during the past few years.
Philadelphia health officials say 90% of street opioid samples contained xylazine in 2021, with xylazine involved in 434 fatal overdoses, up from 15 in 2015.
November 12, 2019.
Dan Gleiter | [email protected]
According to the National Institute on Drug Abuse, xylazine was involved in 26% of Pennsylvania overdoses in 2020, up from 2% in 2015.
In general, xylazine first showed up in major eastern cities and has spread westward, becoming ever more common in rural areas. Philadelphia is considered the first national hotbed of xylazine use. In western Pennsylvania, Westmoreland County officials say it was involved in 31 of 168 fatal overdoses in 2022.
“Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” according to a recent alert from the U.S. Drug Enforcement Administration. The DEA noted that 107,735 Americans died of overdoses in the 12 months leading up to August, with 66% involving opioids and possibly xylazine. The DEA says xylazine and fentanyl mixtures have been seized in 48 states, with 23% of fentanyl powder and 7% of fentanyl pills containing xylazine in 2022.
Authorities remain uncertain about the source of the xylazine, although some experts believe it’s being added by local dealers as a cheap way to “give legs” to the intensity of the high. Federal officials say it’s unclear whether xylazine is being produced in illegal labs or being diverted from the veterinary supply.
The New York Times recently reported that “some epidemiologists theorize that during the pandemic, bottles of domestic xylazine, purchased online with a veterinary prescription or diverted from veterinary supply chains, became popular as a cheap, easy opioid filler.”
Hetrick, the Dauphin County coroner, says xylazine also is being added to drugs including cocaine.
Xylazine isn’t a controlled substance, although there’s an effort within Congress and federal agencies to change that. Its present status benefits dealers, because it means the penalties for possession aren’t as harsh as those for drugs such as fentanyl, says Laurel, the Kensington-based advocate.
“It’s throughout Pennsylvania,” says Carla Sofronski, the executive director of the Pennsylvania Harm Reduction Network. “Now we have a poisoned drug supply that is literally eating people from the inside out.”
Pennsylvania officials say drug treatment is available to anyone who needs it, regardless of their financial status. People who want more information can begin by calling the Pennsylvania Department of Drug and Alcohol Programs at 1-800-662-4357 or going to its website.
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