Xylazine, also known as “Tranq,” is a horse tranquilizer that has found its way into the hands of drug dealers who are mixing it with illicit drugs – primarily fentanyl and other opioids, as well as meth and cocaine.
Also known as the “zombie drug,” Xylazine is not a controlled substance in the United States. The drug is sold legitimately through pharmaceutical distributors in liquid form and sold in vials or preloaded syringes for veterinary use, but it is also sold on other internet sites in liquid and powder form where it can be readily purchased, often with no requirements to prove legitimate needs and is inexpensive, according to the DEA.
Tranq prolongs the high of fentanyl but at a terrible cost. Major risks when using Xylazine include reduced heart rate and hypothermia, and those who continually use the drug can develop open wounds, which, if left untreated, may lead to amputation.
A user, Maggie, told CNN, “You shoot up and you miss, you get sore. You don’t take care of your sore; you’ll wind up in a hospital with a hole.” Maggie ended up at the hospital with a half-dollar-sized wound. “I could have lost my hand.”
Emergency physician and addiction medicine specialist at Temple University Hospital, Dr. Joseph D’Orazio, says that the wound can get down to the tendons or even the bones.
The drug is affecting both the east and west coasts of the United States. In the Bay Area, it has led to at least four deaths. Over the last three years, Xylazine has become prevalent in Philadelphia‘s street fentanyl supply, where the smell of rotting flesh lingers in the city. Law enforcement has said they’re “astonished” with how quickly it has spread in New York City.
The numbers in the northeast and across the U.S. are likely underestimated. UCLA epidemiologist Chelsea Shover told Fortune that xylazine overdoses aren’t part of any national data set.
“Our understanding of its scope is limited to what is being reported directly from medical examiners or through toxicological testing,” she says.
Shover added that it’s expensive to test for a non-standard drug, so many jurisdictions don’t test for xylazine or only do so when no other drug has been implicated in the death.
According to a publication from the American Public Health Association, It’s hard to know what drugs have xylazine in them because there is a little testing capability that limits public health intervention, implementation of harm reduction strategies, or development of novel treatment strategies.
“It’s like playing Russian roulette. So really, if you choose to use any illicit substance out there on the street today, it could be your last breath,” says Donna Branch, Director of California Outpatient at Hazelden Betty Ford Foundation.
Public health agencies won’t be able to make progress in the fight against xylazine until they know more about what it does to users, either on its own or combined with fentanyl or other opioids.