According to the US Centers for Disease Control and Prevention, 107,735 Americans died from drug poisonings between August 2021 and August 2022, with 66% of the deaths involving synthetic opioids like fentanyl. The Sinaloa Cartel and Jalisco Cartel in Mexico, using chemicals largely sourced from China, are primarily responsible for the vast majority of the fentanyl that is being trafficked in communities across the United States.
On March 20, the US Drug Enforcement Administration issued an alert about the widespread threat of fentanyl mixed with xylazine, which is an animal tranquilizer known as tranq on the streets. It's not approved for humans but has been found in fentanyl and cocaine supplies. Xylazine surged first in some areas of Puerto Rico and then in Philadelphia. The Drug Enforcement Agency (DEA) has seized xylazine and fentanyl mixtures in 48 of 50 states. In 2022, the DEA Laboratory System detected xylazine in 23% of the fentanyl powder and 7% of the fentanyl pills that had been seized.
Xylazine is manufactured as a liquid for veterinary use, but can be converted into a salt or dried into a powder, which can be mixed into other powders or pressed into pills for illicit use.
On April 12, 2023, the Biden administration labeled fentanyl mixed with a powerful animal sedative called xylazine an “emerging threat to the United States”. The purpose of this designation was to prioritize federal resources to boost testing and treatment and stanch the illegal supply of the tranquilizer.
There's a lot of speculation about how and why the use of xylazine is on the rise. Xylazine is cheap and fairly unregulated. Dealers might have begun adding it as a bulking agent and then continued to do so because xylazine extended the effects of a fentanyl high. It has also been combined with stimulants such as methamphetamine and cocaine.
Xylazine is a central alpha-2 adrenergic receptor agonist that causes a rapid decrease in the release of norepinephrine and dopamine in the central nervous system. The combination of fentanyl and xylazine make drug overdoses more deadly. Xylazine may contribute to death by slowing breathing and heart rate, as well as decreasing blood pressure. Related injection of xylazine adulterated drugs can also cause severe, necrotic skin ulcerations due to vasoconstriction and decreased tissue perfusion.
Patients taking xylazine do not respond to naloxone, but experts recommend giving naloxone to people who may be overdosing on a drug and consider xylazine exposure if the person doesn’t respond to naloxone. When xylazine is involved in an overdose, additional support, such as supplemental oxygen, fluid resuscitation to raise blood pressure, and airway management to improve breathing. A victim’s entire body should be examined for ulcers and necrotic tissue.
Routine toxicology screens do not detect xylazine, and additional analytical techniques are required to detect xylazine when it might be involved in illicit drug overdoses. BTNX, a biotechnology company, has developed rapid test strips to detect xylazine in liquid or powder.
Reference
DEA Reports Widespread Threat of Fentanyl Mixed with Xylazine, March 20, 2023, https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine
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