‘Highly prevalent’: Xylazine, a veterinary tranquilizer, is making the fentanyl epidemic even deadlier

Featured photo: Xylazine is a veterinary tranquilizer primarily used to sedate large animals that is being circulated along with fentanyl.

“Everyone knows someone,” said Michael Thull, program director of Guilford County Solution to the Opioid Problem, when he discussed how xylazine — a tranquilizer that is increasingly found laced in illicit substances —  impacts the community. “That’s someone’s son, daughter, mother, father, friend or anyone else who is loved.”

Many have never heard of xylazine (pronounced zai-luh-zeen). But like its predecessor fentanyl, there is increasing evidence that this lesser-known drug is making its way through the country and may eventually become as widespread as fentanyl is today. 

Xylazine is a veterinary tranquilizer primarily used to sedate large animals. The FDA has not approved it for human use, so little is known about its long-term effects on humans. As a tranquilizer, it falls under the category of a depressant or downer. It is what’s called an “alpha-2 adrenergic agonist,” which distinguishes it from other depressants like opioids, based on how it works in the brain and affects the body.

On its website, the US Drug Enforcement Agency says it “seized xylazine and fentanyl mixtures in 48 of 50 states” and makes the alarming claim that “xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier.”

The overdose epidemic is a public health issue that continues to harm communities. Nationally, 50 percent of Americans have a close friend or family member with a substance use disorder according to the Pew Research Center. Now, it appears that a new drug is complicating matters even more for communities who are already harmed by a constantly changing drug supply.

‘I’ve seen it everywhere’

Often, reporting on drug use focuses on the criminal aspects of the issue, rather than the human cost. This can lead to people who use drugs being stigmatized and dehumanized. However, the first step to understanding the rising cases of xylazine use is to understand its origins, prevalence, and the impact on the community.

“It’s difficult to quantify it, but I suspect we have a lot of xylazine here,” Thull said.

While difficult to understand the whole reality of this situation, the North Carolina Department of Health and Humans Services released a document on May 12 stating that, “xylazine was first introduced into the NC drug supply nearly two years ago and has become highly prevalent in the illicit opioid supply.”

NCDHHS also stated that “in a February 2023 report from UNC’s Street Drug Analysis Lab, their in-depth testing of street-acquired drug samples from 30 NC counties confirmed the presence of xylazine in approximately 27 percent of those samples.”

While some academic reports suggest people are not actively seeking out xylazine, the drug still poses a danger because it is often mixed with other drugs, primarily other depressants like heroin or fentanyl.

BR, an individual who preferred to use just his initials for this story, uses drugs in Greensboro and shared his experience with “tranq dope,” a combination of xylazine and fentanyl. He described it as “a peculiar, lightheaded rush” that differed from the “warm and relaxing sensations associated with opioids.” Shortly after using it, he noticed unusual changes in his vision and an “overwhelming sense of sleepiness.”

According to BR, the high induced by xylazine wasn’t “pleasant or euphoric, unlike fentanyl.” 

Thull, who has seen an increase in xylazine in Greensboro, said the usage of the drug restricts blood vessels and circulation, which causes wounds which can take months to heal.

“The wounds we’re seeing are particularly concerning,” he said. “They’re showing up on different parts of the body, regardless of injection sight.” 

The DEA Laboratory System reported that in 2022, “approximately 23 percent of fentanyl powder and 7 percent of fentanyl pills seized by the DEA contained xylazine.” 

The drug can also be found  in meth, cocaine, and other stimulants, which Thull finds concerning because “people are less likely to expect it to be in a drug like cocaine or meth because they are less likely to expect a depressant mixed with a stimulant.” 

When asked about the first time he noticed xylazine, BR said, “About a year ago, I thought I was purchasing heroin — well, with fentanyl in it — but then I got the worst bag of my life. Since then, I’ve seen it everywhere and in any drug that comes as a powder or pill.”

Now what?

Xylazine is another complication to the overdose epidemic and Greensboro’s already tainted drug supply. However, there are many in the community that are taking to address the growing issue.

GCSTOP started in 2018 as a joint partnership between Guilford County and UNCG to take an approach to address the broader epidemic, harm reduction. A few of the organization’s approaches include increasing community access to naloxone (Narcan) — an overdose-reversing drug, and providing testing strips to detect the presence of unwanted substances and syringe exchange services to prevent the spread of blood-borne diseases like HIV and Hep-C. 

Recently, the organization acquired a van to bring health care directly to affected people. 

“People who use drugs might hesitate to seek medical care or feel the cost is too burdensome,” Thull said. 

“Now, the organization has a nurse practitioner who can provide testing for hepatitis and other blood-borne diseases and suboxone, a medication to treat opioid dependence, Thull said.

“The county provides us with good support [financially],” he added.

 However, he also said, “sustainable funding for Narcan nasal sprays is our biggest challenge because they cost us about $30 to $60,” as opposed to its generic injectable counterpart, which costs about $4 a kit. 

Unfortunately, naloxone only works on opioids and not xylazine. But Thull said that “naloxone continues to be a crucial tool” for addressing overdoses. And that’s because “even if xylazine is present with fentanyl, the naloxone can reverse enough of the opioid to bring someone back,” he said. There is also a medication to reverse xylazine (tolazine), but it is currently only approved for veterinary use.

More than anything, the best thing allies can do to address this is, as BR said, “see me as another human.”

If you or a loved one is suffering from an addiction, contact GCSTOP at gcstop.org.