In April 2023, the Biden administration declared xylazine-laced fentanyl as an emerging threat to the nation. It was the first time a declaration like this had been made. Rahul Gupta, M.D., director of the Office of National Drug Control Policy (ONDCP) stated that xylazine is “the deadliest drug threat the United States has ever faced.”
Now, more than a year later, recent analysis of urine collection analyzed at the lab of Marshall Toxicology shows that xylazine is clearly present in our local drug supply. Since testing began in June 2023, there have been close to 600 unique patients test positive for xylazine. Every specimen that tested positive for xylazine was also positive for fentanyl or its metabolite (norfentanyl). Upon further analysis, it was discovered that around 75% of those specimens also tested positive for methamphetamine. This creates a dangerous mix of sedatives and stimulant, with methamphetamine possibly being co-consumed in the user’s attempt to balance out the depressant effects of xylazine and fentanyl.
Xylazine was first discovered in Germany in 1962 and was initially studied as a blood pressure medicine. Human trials showed significant central nervous system depression and unsafe drops in heart rate and blood pressure; therefore, it was not approved for use. It was, however, approved by the U.S. Food and Drug Administration (FDA) for use in veterinary medicine as a sedative, analgesic and muscle relaxant routinely used in conjunction with ketamine for animal sedation. It has been proposed that diversion from the veterinary market is responsible for xylazine’s presence in the illicit drug supply.
Since the early 2000s, xylazine has become a popular drug in Puerto Rico, where it was associated with an increasing number of overdose deaths. By 2010, reports out of Philadelphia showed a slow growth of xylazine in the city’s illicit heroin and fentanyl supply. By 2019, it was found in 29% of Philadelphia’s overdose deaths attributed to opioids. Due to its powerful sedation effects, xylazine gained notoriety as “tranq dope” and “zombie drug.” By 2022, a needle exchange program in Maryland reported 80% of the drug paraphernalia that tested positive for fentanyl also tested positive for xylazine.
The most common side effects from human consumption of xylazine include slow heart rate, decreased respiration, low blood pressure and sedation. Long-term use can lead to physical deterioration, dependence and skin ulcerations or abscesses that can cause necrosis, but the side effects are only part of what makes xylazine so dangerous.
Because xylazine is not an opioid, it does not respond to, nor is it able to be reversed by naloxone, or Narcan. If an overdose is suspected, naloxone is still recommended since opioids like fentanyl are almost always involved. While it may not fully wake the individual, it can still save their life by counteracting the effects of the opioids. Emergency services should also be contacted as quickly as possible to ensure proper care is received.
As a new and emerging drug of concern, xylazine has infiltrated our drug supply locally, and we in Huntington, as a recovery community, must now work as diligently as ever to address the needs of our neighbors, friends and families. Although there is no clear treatment pathway to address xylazine abuse and dependence, our continuum of recovery resources allows us to identify those ready to take the first step and partner with them as they work toward sobriety.
For addiction help and treatment, call PROACT (Provider Response Organization for Addiction Care & Treatment) at 304.696.8700 or visit www.proactwv.org for additional information.
Zachary Hansen, M.D., is a Marshall Health primary care physician, medical director of the division of addiction sciences and assistant professor at the Marshall University Joan C. Edwards School of Medicine.
This article was initially published in The Herald-Dispatch.