Fentanyl’s Little Brother, Even More Dangerous

“They Narcan’ed me four different times but it didn’t work against xylazine.” 

One addict seeking treatment

It’s used as a surgical tranquilizer for larger animals, often livestock or larger zoo animals. It is an opioid that is mostly imported and strictly controlled. And for reasons unknown, it is finding its way in combination with fentanyl to make a vastly more deadly and destructive high… withdrawal… with horrific aftereffects. Most fentanyl users are not even aware that their high is the result of that increasingly used combination. Some demand it. It too is a pharmaceutically manufactured drug; it’s called xylazine hydrochloride… or just xylazine.

“Xylazine was first detected as an adulterant in underground heroin supplies in Puerto Rico over 20 years ago. However, it has spread and become more common stateside in recent years. It emerged in Philadelphia, PA, over three years ago. By 2021, xylazine was detected in 90% of street opioid samples in Philadelphia. It has been increasingly detected in overdose deaths and drug seizures in the northeast, including in New York City, Maryland and Connecticut.” A May 23, 2023 study by drugpolicy.org.

But nowhere has been devastated than one of the poorest states in the land, West Virginia. Laura Strickler, writing for the December 10th NBCNews.com, provides the ugly facts: “Dr. Steven Corder didn’t think his job treating people addicted to fentanyl in Wheeling, West Virginia, could get any harder, but then he began encountering patients who were addicted to both fentanyl and a second drug with its own destructive power — the livestock tranquilizer xylazine… ‘Opioid withdrawal is hard enough,’ Corder said. But his usual tools, he lamented, ‘couldn’t touch the withdrawal from xylazine.’

“Xylazine is now present in one out of every nine overdose deaths nationwide involving illicit fentanyl, according to the Centers for Disease Control and Prevention… West Virginia, which remains ground zero in the American opioid crisis, with nearly twice as many overdose deaths per capita as its nearest competitor, seems to be taking a disproportionate hit from xylazine as well. It now shows up in at least half of the needles in Wheeling, and between 15% and 20% of the needles used statewide, according to 2023 data from West Virginia University.

“The drug is known for leaving deep flesh wounds that can sometimes lead to amputations. The wounds develop from skin ulcers that can appear at the point of injection or elsewhere on the body… Laura Weigel, who runs a treatment center for the local YWCA, said one patient recently had her breast and part of her shoulder amputated because of xylazine. ‘We are not being able to do anything fast enough to get ahead of it,’ she said…

“While the Food and Drug Administration and the Drug Enforcement Administration have taken steps to stop some imports of xylazine, the drug appears to be easily available from overseas pharmacies… Domestic pharmacies ask buyers for a prescription, but within minutes NBC News was able to engage at least five suppliers in India who were willing to ship xylazine immediately without a prescription. One seller wrote that getting through customs could be difficult but another said in a WhatsApp message, ‘It will get through Customs. If not received then we will send again,’ the seller wrote… The Indian supplier who flagged a customs concern also offered an alternative, ‘Dexmedetomidine,’ which law enforcement officials in Philadelphia have already identified as a possible new alternative to xylazine. ‘Their hands are tied’…

“In the past month, local police and public officials in at least 11 states have issued warnings about xylazine. California Gov. Gavin Newsom has pledged a new crackdown… A bipartisan group of lawmakers in Congress say a push to schedule xylazine — meaning to officially designate it as a drug with potential for abuse — is gaining steam, but so far the bill has not passed the House or Senate. Sen. Catherine Cortez Masto, D.-Nev., who introduced the bill in February and has led the effort, said she is optimistic… Thirty senators are on board, said Cortez Masto, and 39 state attorneys general pushed for it in a letter this past spring.

“The attorneys general argued that if the federal government schedules the drug, it would let the DEA track the drug’s manufacturing, work to stop the drug’s diversion and crack down on misuse… U.S. veterinary associations have expressed support for scheduling it as long as veterinarians can still obtain it legally… In West Virginia, however, attitudes about scheduling xylazine are mixed… Corder is skeptical about how much of an impact scheduling would have. ‘Scheduling xylazine would sure be nice,’ he said, ‘[but] I don’t have much faith in methods that prevent access.’

“Meanwhile, Charles Mueller, the public health professional at West Virginia University who oversaw [a] needle-testing study, said it let him give useful, real-time data to local law enforcement and health officials about the state’s illicit drug supply. ‘It’s not often you can create a new dataset that can be used to empower,’ Mueller said… Mueller said local officials were able to pivot quickly to provide users with test strips to check for the presence of xylazine in their drugs. He’s disappointed, however, that funding for the program was recently canceled… Without the rapid-response testing, Mueller said, law enforcement and public health officials have to rely on data from medical examiners that can be delayed by up to 30 days.”

We live in a world where computer simulations, accelerated by artificial intelligence, can easily create entirely new designer drugs to mimic existing narcotics very quickly. It is almost impossible to control or predict, and you can see from the above that there are already proposed substitutes for xylazine that are readily available. Whatever we are doing, we are doing it wrong. We’ve made detection, tracking, prevention and treatment infinitely more difficult by pushing these seriously addicting, and always available, narcotics underground.

“Restricting prescription opioids did not end demand for opioids. Instead, it just sent people to the underground heroin supply. Crackdowns on heroin led suppliers to produce cheaper, potent and easily smuggled fentanyl. Harsh fentanyl penalties incentivized fentanyl analogues to flood our markets. And now, history is once again repeating itself. The classwide scheduling of fentanyl-related substances—which criminalizes all fentanyl-related substances more harshly, regardless of whether they are harmful or not—and the criminalization of fentanyl analogues more generally is leading to new and even more unknown drugs, like xylazine. We are increasingly seeing xylazine, etizolam, benzodiazepines, and nitazenes overtaking some markets as a result of harsh crackdowns on fentanyl analogues.” drugpolicy.org. Addictive and illicit narcotics have always found a ready market amid poverty and hopelessness. As income/wealth inequality continues to soar, enabling selling illegal drugs is good business and terrible policy.

I’m Peter Dekom, and we know that society has to restore hope and stop shoving these problems under the rug… the rug is full!