Xylazine – Making the Opioid Epidemic Even More Deadly

 

There’s a new drug on the scene, one that continues to crop up in opioid overdose toxicology reports despite efforts by the DEA and other law enforcement branches to prevent people from using it. Xylazine overdose deaths are being reported all across the U.S., particularly in Michigan, Ohio, Connecticut, Massachusetts, and Maryland.

Xylazine is not currently a household name. It is best defined simply as a highly potent animal tranquilizer, usually used to sedate horses and other large mammals. What’s particularly concerning about Xylazine is that when it’s mixed into opioid drugs, users often overdose and do not respond to naloxone revival efforts. In certain urban centers like Philadelphia, Xylazine has been involved in as many as 25% to 35% of overdoses.

If families don’t take rapid action to prevent their loved ones from using opioids mixed with Xylazine, more people will overdose on this potent drug, and more people will die from it.

What is Xylazine?

Not a controlled substance, Xylazine is relatively easy to find and get hold of. It is a veterinary drug used as a sedative, analgesic, and muscle relaxant. The drug acts as a tranquilizer in large animals like horses and cows, but it has different, highly dangerous effects on humans.

Long before Xylazine became a widespread threat, a group of researchers wrote a paper about the drug for the Forensic Science International. Their 2014 paper suggested that Xylazine could become a danger among drug users in America. Quoting their material, “In humans, it [Xylazine] could cause central nervous system depression, respiratory depression, bradycardia, hypotension, and even death.” Xylazine was never intended for human consumption. It is far too potent.

In 2014, deaths related to Xylazine were not many in number, though they were well documented and categorized. Again according to the researchers, “There have been publications of 43 cases of Xylazine intoxication in humans, in which 21 (49%) were non-fatal scenarios and 22 (51%) resulted in fatalities. Most of the non-fatal cases required medical intervention. Over recent years Xylazine has emerged as an adulterant in recreational drugs, such as heroin or speedball (a cocaine and heroin mixture). From the 43 reported cases, 17 (40%) were associated with the use of Xylazine as an adulterant of drugs of abuse.” Xylazine makes potent drugs like opioids more dangerous, increasing the chances of an addict suffering an overdose.

Not only does Xylazine pose the threat of overdose and death when it is used on its own (and when it is mixed with opioids), but the drug has other harmful effects. Xylazine use has been associated with physical deterioration, skin ulceration, and other toxic side effects.

DEA Reports Paint a Concerning Picture

Xylazine misuse has surged in the United States in recent years. The drug has become so common in parts of the U.S. that the Drug Enforcement Administration released an official warning regarding the substance. They said, “Xylazine is not approved for human use. Xylazine was identified in over 3,800 NFLIS-DRUG reports from 2015 through December 2020, with each progressing year increasing compared to the previous year with the largest recording in 2020 of 1,492 reports. Many public health departments and poison control centers issued advisories and alerts while seizure activity have also been reported nationwide with large quantities found in PA, CT, and CA.”

While the DEA report does not list the death toll of Xylazine misuse, it does paint a concerning picture as to growing incidences of Xylazine misuse across the United States.

A Surge of Overdoses in Maryland

For information on how many people are dying from the animal tranquilizer, individual states and counties have published warnings and cautionary reports for their residents on the dangerous effects of Xylazine misuse.

Maryland public health officials reported an alarming surge in Xylazine-related overdose deaths. Quoting the state’s toxicology report, “From 2006 through 2018, there were 83 cases that were positive for Xylazine. In 2018 alone, there were 56 cases, a 331% increase from the year before. Fentanyl was also detected in 80 of the Xylazine positive cases, while heroin and/or morphine were positive in 52 cases and cocaine in 28 cases.” The sudden spike in usage suggests opioid drug dealers in Maryland realized mixing Xylazine into their opioid supply would make their drugs more potent and addictive. The problem is, Xylazine also makes opioid drugs more lethal.

Xylazine Overdoses in Connecticut

Connecticut recently experienced a surge in Xylazine-related overdose deaths. Quoting a CT Department of Public Health report: “To enhance drug effects, recreational drugs are often adulterated with other pharmacological agents such as Xylazine, a veterinary sedative not intended for human use. In Connecticut, in March 2019, Xylazine was identified as a novel and emerging adulterant in fatal drug intoxications when combined with fentanyl; it continues to be a problem in 2021. There were 71 Xylazine-involved deaths in 2019 and 141 in 2020.” The report indicates that just in the first two months of 2021, there were 35 Xylazine-related deaths.

Ohio and Xylazine

Just one county in Ohio reported a 45% increase in overdose deaths from 2019 to 2020. In 2019 there were 423 overdose deaths in Franklin County, while 2020 saw 614 such deaths. In 2019, Xylazine was identified in just 9 of those deaths, whereas 2020 saw 21 Xylazine deaths.

Twenty-one might not seem like a large number. But that’s not the factor public health analysts are concerned about. Analysts are concerned about the doubling of Xylazine-related deaths in just one year. If Xylazine deaths doubled in Franklin County every year going forward, it would not take long before hundreds of residents were dying from the animal tranquilizer.

Michigan Overdoses Surge, Partially Because of Xylazine

There have thus far only been a few deaths connected to Xylazine in Michigan, and all of them have involved Xylazine mixed with fentanyl. However, the uptick in deaths was enough for the Michigan Poison Center to warn residents about the veterinary sedative. Quoting the warning: “In humans, Xylazine causes significant slowing of heart rate and blood pressure. Xylazine shares many of the same effects as opioids. However, the effects set in quickly and last longer. Xylazine may be substituted for an opioid such as heroin, or used together with an opioid for additive effects. However, Xylazine does not respond to naloxone to reverse its effects because it is not an opioid.” In many ways, Xylazine is even more dangerous than opioids, hence the serious concern among public health officials all across the country.

Help for Family Members and Loved Ones

The fact that Xylazine is now being added to opioid drugs is yet another issue that makes the opioid epidemic more lethal. If you or someone you care about uses opioids mixed with Xylazine, make sure to contact a drug and alcohol rehab center as soon as possible. Opioids can be fatal. Xylazine makes them even more likely to be fatal.

Sources:

• https://doi.org/10.1016/j.forsciint.2014.03.015
• https://www.deadiversion.usdoj.gov/drug_chem_info/Xylazine.pdf
• https://www.mdpoison.com/media/SOP/mdpoisoncom/ToxTidbits/2019/Jan%202019%20ToxTidbits.pdf
• https://portal.ct.gov/-/media/DPH/Injury-Prevention/Opioid-Overdose-Data/Monthly-Death-Reports/March-2021_2020-and-2019-Drug-Overdose-Deaths-Monthly-Report_CT_Updated-4_12_2021.pdf
• https://coroner.franklincountyohio.gov/getattachment/829bd172-00de-4c4a-b38a-208a5b4997e4/3Q-2020-OD-Report.pdf.aspx?lang=en-US%20:
• https://today.wayne.edu/medicine/news/2020/11/02/michigan-poison-center-issues-warning-related-to-xylazine-abuse-40885

Reviewed by Claire Pinelli, ICAADC, CCS, LADC, RAS, MCAP, LCDC