The rise of Fentanyl mixed with Xylazine
Both the Centers for Disease Control and Prevention and the US Drug Enforcement Administration have issued warnings identifying that fentanyl and xylazine drug combinations have become a significant public health threat. The combination of fentanyl and xylazine is also known as “tranq dope.” It has been the cause of a number of reported drug overdose deaths. Fentanyl is a powerful central nervous system depressant opioid. Xylazine is also a powerful sedative substance approved for veterinary use only. The combination of the two substances can create a highly addictive and toxic outcome for the user.
According to the DEA Laboratory System, in 2022, about 23% of fentanyl powder and 7% of fentanyl pills that were seized contained traces of xylazine. In total, the DEA has seized tranq dope drug mixtures in 48 out of 50 states. According to the US CDC State Unintentional Drug Overdose Reporting System, in 20 states including Washington DC, the average percentage of fentanyl-related overdose deaths with xylazine increased by an estimated 276% from January 2019 to June 2022.
This new drug combination has begun to appear more recently throughout the overdose crisis, so exact numbers are not yet known for its impact on overdose deaths. However, the rapid increase in the lethal drug combination has promoted the White House Office of National Drug Control Policy to declare fentanyl combined with xylazine an emerging threat to the nation. It has become so common that about 80% of opioid overdoses in the US are now characterized by polysubstance use involving a non-opioid drug such as xylazine.
What is Fentanyl?
Fentanyl is a very powerful substance. It has been used in the medical setting for decades to help with the treatment of severe and chronic pain relief. On the illicit drug market, fentanyl is a fully synthetic opioid that is about 50 to 100 times more potent than morphine. Fentanyl in general is one of the most powerful opioids. Illicit fentanyl is often found in counterfeit pills, which are made to look like and mimic prescription drug pills. It is also often mixed and cut with other substances to make the drug more potent.
Fentanyl has long been a leading cause of opioid overdose death in the US for decades. In a recent study between 2019 and 2022, researchers found the rise in fentanyl-related overdose deaths in the US across 21 different jurisdictions rose by over 200%.
What is Xylazine?
Xylazine is a non-opioid sedative analgesic and muscle relaxant substance only approved for veterinary use. It has not been approved for human use. It is not currently a controlled substance. Because of this, it makes it more difficult to control the manufacture and use of the drug. It is relatively easy and inexpensive for drug makers and users to get. It is now being added to other substances such as cocaine, heroin and fentanyl in order to increase the effects of the other drugs.
Xylazine can penetrate the blood-brain barrier and decrease the release of neurotransmitters and cause severe central nervous system depression, which can also lead to respiratory depression. Effects of xylazine include dry mouth, drowsiness, decreased heart rate, hypothermia, dysrhythmia, reduced body temperature, slowed breathing and coma. When xylazine is injected it can cause painful and difficult-to-treat skin conditions and muscle sores. Sometimes it can lead to the development of dying skin tissue and necrosis. The DEA reports that xylazine continues to be on the rise and spreading and the presence of the drug is still greatly underestimated.
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What happens when Fentanyl is mixed with Xylazine?
The combination of fentanyl and xylazine can have dangerous side effects. The common duo known as tranq dope is still a new polysubstance drug combination. There is some evidence that suggests not only does xylazine increase the side effects and effectiveness of fentanyl’s euphoria, but xylazine can also increase fentanyl’s morbidity. When fentanyl is mixed with xylazine, it can cause toxic leukoencephalopathy (a disease that affects the white matter in your brain) and severe hypoxic-ischemic injury (when the brain does not receive enough oxygen and blood flow) to the cortical and subcortical part of the brain region. This is caused by the drug’s rapid nervous system penetration and its interferences with the release of neurotransmitters in the brain.
Common side effects of Tranq Dope:
- Physical dependence
- Withdrawal symptoms
- Skin ulcerations
- Severe wounds
- Necrotic tissue that can lead to amputation
- Extreme sedation
- Central nervous system depression
- Vomiting so forcefully it can perforate the esophagus
- High blood pressure and heart rate
- Profusely sweating your clothes can become drenched
- Nerve sensitivity makes the softest of touch painful
- Prolonged panic attack
Mixing fentanyl with xylazine can cause an overdose that can be more difficult to identify and treat. When overdosing, naloxone will be able to treat the opioid effects. However, it does not treat the effects of xylazine. And because both substances produce sedative side effects, it can be difficult to tell which drug is the cause of the overdose. It is still unclear if the xylazine added to the drug combination can increase the risk of fatal overdose. Ultimately, traditional treatments for fentanyl or opioid overdose will not work on a fentanyl and xylazine drug combination.
Because this is a fairly new drug combination, there is very little data and information on its long-term effects on users.
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Treatment for Polysubstance Use Disorder
The opioid overdose epidemic continues to be a public health risk. Opioids such as fentanyl are often found mixed with other substances such as heroin, cocaine and meth. Now with a new drug combination making waves, the risks have only increased. Fentanyl mixed with xylazine is on the rise. The drug supply and drug market evolved so quickly that this polydrug combination has quickly spread across the US. Both produce sedative effects that can lead to respiratory depression, coma and death. As of recently, xylazine has been reported in association with many overdose opioid deaths. Professional behavioral treatment programs such as Hotel California by the Sea provide specialized care for substance use disorder.
We offer treatment in detox, residential, PHP and IOP. Our program utilizes treatment methods such as cognitive behavioral therapy, dialectical behavioral therapy, family therapy and group therapy. These rigorous techniques help our clients understand their addiction, learn new coping skills and practice such techniques as they navigate a world of sobriety. Hotel California by the Sea is dedicated to providing our clients with the tools, resources and support they need to overcome their addiction.
References:
https://nida.nih.gov/research-topics/xylazine
https://pmc.ncbi.nlm.nih.gov/articles/PMC10557575