Xylazine emerging as new threat

The use of xylazine, a drug that leads to amputations, is increasing in Ohio. 

Xylazine is a veterinary drug that requires a license to use and is a sedative and muscle relaxer for animals, according to the Drug Enforcement Administration [DEA]. Xylazine, also known as tranq on the street, has similar effects as opioids and is being laced with opioids, like fentanyl, to make their effects last longer. 

“Fentanyl is an extremely potent opioid, but its effects are very rapid,” said Emily Einstein, the chief of the science policy branch at the National Institute on Drug Abuse [NIDA]. “Xylazine has been introduced into the drug supply in some places, and people may seek it out in order to prolong the drug effects of fentanyl.”

Aside from fentanyl, xylazine is being laced with alcohol, cocaine, heroin, prescription opioids, benzodiazepines, gabapentin and methadone, according to the NIDA. Users inhale, swallow, snort and inject xylazine. 

From 2020 to 2021, the DEA saw a 7% increase in xylazine use in Ohio, said Brian McNeal, a public information officer for the DEA. The DEA has seen even bigger increases in other areas of the country. 

In Ohio, xylazine could be more prevalent than what is being reported. 

“We don’t necessarily have very good surveillance on emerging substances, such as xylazine,” Einstein said. “Not all jurisdictions are testing for xylazine in overdose fatalities, so we don’t really have a great idea of what the landscape is at the moment.”

Police departments don’t know if xylazine is in their local drug supplies. 

“We send drugs to be tested by the [Ohio] Bureau of Criminal Investigation,” said Michael Lewis, an administrative lieutenant at the Kent Police Department. “I do not know if they regularly test for xylazine.”

Xylazine is not a controlled substance, which is negatively affecting how well it is tracked. 

“Xylazine is not a scheduled drug,” said Steve Irwin, the press secretary for the Ohio Attorney General’s Office who answers questions directed to the Ohio Bureau of Criminal Investigation. “So while it is something that our criminal laboratories see when we’re testing drug samples, we do not track or keep statistics on xylazine.” 

Xylazine would have to become a controlled substance under the Controlled Substances Act [CSA] for statistics to be kept about its use in drug mixtures. The CSA places substances into one of five schedules that take into account the potential for abuse, safety, how dependent people are on substances and medical use. 

Having statistics that show how prevalent xylazine is will further education on xylazine. 

Drug education helps people avoid dangerous substances, according to Covenant Hills Treatment Center.

Repeated xylazine use causes skin lesions and ulcers, which eventually lead to infections and amputations if left untreated. 

“Xylazine is associated with severe skin lesions, and these can appear on parts of the body where the drug isn’t even being injected,” Einstein said. “A cause for that could be that xylazine reduces circulation and reduces oxygenation of the skin. It also has analgesic properties, so people may not realize when they’ve been injured, or they might not perceive pain in a way that could lead to further lesions as well.”

One man who injected himself with fentanyl laced with xylazine had areas of exposed bone, muscle, tendon and fascia on his lower legs, according to the Journal of Hospital Medicine. 

Xylazine users inject at the site of their wounds to reduce the pain of the skin lesions, according to BMJ Journals. This can exacerbate the injuries. 

People need to be met where they are with the services they need, Einstein said. It is a problem that housing and shelters for drug users aren’t permitted to administer wound care. 

In 2021, xylazine was found in over 90% of fentanyl and heroin samples tested in Philadelphia, according to Substance Use Philadelphia, which is part of the Department of Public Health. 

Since xylazine became the number one contaminant in Philadelphia’s opioid supply, bone disease and soft-tissue infections have increased among the general population, according to Philadelphia’s Department of Public Health. Bone disease has increased by 20% and soft-tissue infections have increased by 5%. Xylazine causes wounds to heal slower, endocarditis, a life-threatening inflammation of the inner lining of the heart and sepsis, an extreme response to infection that leads to organ failure, tissue damage and death. 

“Xylazine can cause periods of amnesia or blacking out,” Einstein said. “People have reported engaging in behaviors they don’t remember, [like] driving and not realizing that they’re driving.”

Symptoms of a xylazine overdose include amnesia, drowsiness, slowed breathing and heart rate and dangerously low blood pressure, according to the NIDA. Xylazine is often combined with opioids, so the administration of naloxone, a drug that reverses the effects of opioids, is recommended during an overdose, even though naloxone doesn’t reverse the effects of a xylazine overdose. 

“Naloxone kicks opioids off the [opioid] receptor and blocks them, so that reverses the effects of the opioids,” Einstein said. “Xylazine works by binding to an entirely different receptor.”

First responders treating someone who has overdosed on an opioid drug mixture may not know to apply additional life-saving methods after naloxone only partially reverses overdose symptoms, according to the DEA. 

“It may be important also to provide rescue breathing to someone who has overdosed on a combination of opioids and xylazine,” Einstein said.  

One kilogram of powdered xylazine can be purchased online from Chinese suppliers for prices ranging from $6 to $20, according to the DEA. Buyers don’t have to prove their association with the veterinary profession or show they have the license required for veterinarians to use xylazine. Due to the extreme psychoactive effects of xylazine, drug traffickers can reduce the amount of fentanyl or heroin used in a mixture of drugs. 

Drugs laced with xylazine were first found in Puerto Rico in the early 2000s, according to the DEA. Since then, xylazine has spread throughout the United States. 

“The drug supply is ever-changing,” Einstein said. “Xylazine has emerged as a substance that is really important for us to address because it is associated with some of the more severe negative outcomes than other drugs that we’re seeing.”