image by: Michael Nuccitelli, Psy.D.

HWN Suggests

Gangs mix another potent sedative into U.S. street drugs causing 'mass overdoses'

Experts say the decision to experiment with xylazine, medetomidine or other chemicals in illicit street drug combinations likely reflect which substances are cheap, poorly regulated and readily available. Some critics, including Dr. Jeffrey Singer, a drug policy analyst at the libertarian Cato Institute, believe law enforcement efforts aimed at regulating chemicals used in street drugs are actually encouraging the cartels to experiment with more readily available substances that may be more harmful, including medetomidine.

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Articles of Interest

Beyond Fentanyl: How Drug Adulterants/Cutting Agents are Contributing to Overdose, Chronic Health Problems, and Affecting Naloxone Administration

Drug adulterants/cutting agents are rampant in today’s street drug supply. These are synthetic compounds that may cause a myriad of health problems for people who use substances. These cutting agents have an impact on the administration of naloxone (Narcan) for overdose reversal and treatment for opioid use disorder and other substance use disorders. This information can be useful to professionals in health and criminal justice fields, as the awareness of individual types of adulterants/cutting agents and their health consequences can inform initiatives to prevent these problems from growing.

DEA Reports Widespread Threat of Fentanyl Mixed with Xylazine

Xylazine and fentanyl drug mixtures place users at a higher risk of suffering a fatal drug poisoning. Because xylazine is not an opioid, naloxone (Narcan) does not reverse its effects. Still, experts always recommend administering naloxone if someone might be suffering a drug poisoning. People who inject drug mixtures containing xylazine also can develop severe wounds, including necrosis—the rotting of human tissue—that may lead to amputation.

Perspectives of people in Philadelphia who use fentanyl/heroin adulterated with the animal tranquilizer xylazine; Making a case for xylazine test strips

The interest expressed for xylazine test strips by people who use fentanyl/heroin is an important opportunity to center their voices in the development of innovations designed to mitigate the harms of unwanted adulterant exposure.

The Emerging Role of Toxic Adulterants in Street Drugs in the US Illicit Opioid Crisis

These additional components or ingredients are typically added in illicit noncommercial laboratories and are commonly known as cutting agents or adulterants. These adulterants come from a wide range of pharmacological categories, and many are toxic when ingested alone or in combination with other drugs. The presence of these adulterants in street drugs adds yet another layer of complexity to the US opioid crisis.

What’s Going On With Tranq?

Xylazine is coursing through the illicit drug supply. Here’s what it does—and why it’s not the main concern. Drug dealers have been mixing it with heroin since at least the early 2010s, says Jeanmarie Perrone, the director of the Center for Addiction Medicine and Policy at the University of Pennsylvania, “but it was pretty clinically silent, perhaps because it was in lower concentrations than what we’re seeing now.” Basically: It went under the radar for a while. And now it’s being added to opioids.

Xylazine Adulteration of the Heroin–Fentanyl Drug Supply

Xylazine is an animal sedative, approved by the U.S. Food and Drug Administration, that is commonly used in veterinary medicine and is not approved for human use. Since 2016, xylazine has consistently appeared in the illicitly manufactured fentanyl supply and has significantly increased in prevalence, likely due to its low cost, easy availability, and presumed synergistic psychoactive effect.

Xylazine: A Drug Adulterant of Clinical Concern

Drug adulterants are becoming an increasingly concerning topic regarding public health. The history of drug adulterants illustrates the vast detrimental impact it can have on overdose mortality. Xylazine has been shown to complicate the treatment of opioid overdose. The confounding adverse effects of both illicit opioids and xylazine, in addition to no reversal agent for xylazine, prove to be a challenge when addressing overdose mortalities.

Xylazine: An Increasingly Frequent Adulterant in Fentanyl Street Drugs

Xylazine's effects include sedation, analgesia, and muscle relaxation; it also can cause hypotension and bradycardia. Opioid-induced sedation could have extended duration when xylazine is added to fentanyl. Intoxication or overdose with xylazine is not reversed by naloxone. Because the life-threatening effects of xylazine–fentanyl overdoses likely are attributable to fentanyl, naloxone remains the reversal agent of choice. Xylazine use also has been associated with open skin ulcerations and chronic skin wounds that can occur regardless of route of administration (i.e., oral, inhaled, or injected) and can appear at sites of entry or in locations distant from sites of entry.