Delaware drug addicts and harm reduction officers report that the veterinary tranquilizer Xylazine is increasingly present in the state’s drug supply, particularly in the fentanyl sold in New Castle County.
Xylazine is still not well understood by drug and public health researchers, leaving users and outreach workers to start looking for ways to adapt.
Xylazine appears more frequently in pills and powders tested by the Delaware State Police’s Forensic Chemistry Unit: About 15% of evidence tested between October 2021 and July 2022 found xylazine – also called Tranq. However, since xylazine is not a controlled substance, these tests were done for research purposes only and its presence has not been officially confirmed.
But participants in a New Castle County needle-exchange program say the drug may be more prevalent than state testing suggests. They describe a range of new challenges presented by Xylazine.
Christina, who asked to be identified only by her first name, says the initial high can be extremely intense, sometimes causing crashes during which users can seriously injure themselves.
“It slows you down so much that even when you try to get up slowly, you feel like you’re going to pass out — no matter what,” she said. “Your head looks like a bowling ball and your ears are ringing. You’re going to pass out.
Christina suggests users lie down before the injection to avoid falls. Claire Zagorski, a research assistant at the University of Texas at Austin School of Pharmacology, explains that there’s another reason Xylazine users go to bed.
“Tranq is so sedating that we see people who are pain unresponsive for 18 to 24 hours,” she said. “In a few cases – at least to my knowledge – people have sat bent over the doorstep for so long that they have cut off blood flow to their legs. It should be horribly painful, but with Xylazine people also wake up late with very swollen and discolored limbs, they have to be rushed to the hospital to try to save them, but sometimes there is nothing to do but amputate.
Zagorski adds that Xylazine users try to lie on their side with their knees tucked into their stomachs to maintain circulation.
Christina and other needle exchange program participants also suggested that caffeine pills could help them recover from the most intense phase of the high.
Dr Nabarun Dasgupta, who directs the Street Drug Analysis Laboratory at the University of North Carolina, says the pills could be meaningless in the absence of a clearer medical understanding of the impact of the drug. xylazine.
“The next question I would ask,” he said, “is what it’s like when they wake up.”
Zagorski notes that some Xylazine users may also use stimulants to balance the effect of the tranquilizer.
“It’s becoming more and more common to see people injecting a bit of cocaine or methamphetamine with their Tranq,” she said, noting that accidentally injecting stimulants into muscles can damage tissues and require medical attention.
Caffeine, she said, “may be the safest and most readily available option for people right now.”
Dasgupta added that although the value of caffeine pills as a stimulant has not been medically proven, the sugar content of the pills — or any other high-sugar food — may be helpful on its own.
“Xylazine causes a temporary and quite massive drop in blood sugar,” he said, “and it could be that the sugar helps someone feel better when they come back.”
Most visibly, Christina and others point to ulcers in their skin – some so deep they expose bones – left after the xylazine injection.
C, who asked not to be identified by name, recommends that outreach workers distribute wound care supplies like gauze, saline solution and antibiotics: a lesson she learned after a ulcer had invaded a large part of his forearm.
“Stuff like that, and bandages,” she said. “I also get a cream at the pharmacy. Cleaning wounds is very helpful.
Dasgupta says these wounds look like burns and should be treated the same way.
“It’s going to heal like a burn – from the inside up – not like an abscess that heals from the outside in,” he explained, suggesting outreach teams could consider distributing water-based antibiotics and burn kits.
Although ulcers can appear if a user accidentally injects xylazine into their muscle or fat rather than into a vein, Dasgupta notes that the drug is unusual in that users report ulcers in places they never had before. injected.
Jessica, another participant in the needle exchange program, offered her own experience as an example.
“It’s not like the abscesses we used to get when we were missing a vein,” she said. “It can happen in weird places, and you end up with a hole.” In her case, an ulcer on her wrist prevented her from using one of her hands.
Yonah Hicks, a mobile team member at Brandywine Counseling and Community Service in Dover, pointed out that after scar tissue has formed, users need longer, thicker needles to reach a vein. She says her team has seen an increase in demand for the longest needles in stock.
“There’s been a very serious shift in what people are asking for,” Hicks said, “and that’s part of adapting so we can help people as Tranq pops up everywhere.”
Meanwhile, the growing presence of xylazine could present more fundamental messaging issues for harm reduction programs. Dasgupta pointed out that since xylazine is not an opioid, people who use it regularly in combination with fentanyl might find it difficult to transition to a drug treatment program for opioid use disorder: programs that use weaker opioids like methadone to help people reduce their drug use. use while mitigating the life-threatening effects of withdrawal.
Also, since Xylazine does not respond to naloxone, an opioid overdose reversal drug, some users have expressed concern that they may not know if naloxone will help revive someone who has passed out. Dasgupta says those feelings could become a problem for harm reduction efforts, which often rely heavily on naloxone distribution.
“If the rumor that ‘[naloxone] doesn’t work’ gets the buy, then it will falsely weaken the resolve to have naloxone on hand,” he said. “Even when unconscious from xylazine, he said, a person will probably breathe normally; if they overdose on fentanyl, they won’t.
Dasgupta and Zargoski pointed out that while xylazine has been around as a veterinary drug for decades, substantial research into its impact on humans is just beginning. The suggestions and stories offered by users like those in New Castle County, Zargoski added, are key to helping shape a public health response. “At this point, we have to resort to crowdsourcing,” she said.