A new mixture of drugs hitting the streets has been linked to several overdose deaths across the region. Xylazine, reported as an adulterant in an increasing number of illicit drug mixtures, commonly encountered in combination with fentanyl but has also been detected in mixtures containing cocaine, heroin, and a variety of other drugs.
Xylazine is a non-opiate sedative, analgesic, and muscle relaxant only authorized in the United States for veterinary use according to the U.S. Food and Drug Administration. It is not currently a controlled substance under the U.S. Controlled Substances Act. Xylazine was first noted as an adulterant in Puerto Rico in the early 2000s through DEA reporting and laboratory analysis, and around a decade later it was documented on the island as a drug of abuse on its own, which has continued to present. Xylazine, a large-animal tranquilizer not approved for human use, started showing up routinely in the drug supply in 2019, but didn’t take off until the coronavirus pandemic began in 2020.
When combined with fentanyl or other synthetic opioids, xylazine can increase the potential for fatal overdoses, as the similarity in pharmacological effects can further reduce the already decreased respiratory function. Because Xylazine is not an opioid, traditional treatment for drug related overdoses such as Narcan/Naloxone is not only not effective, xylazine may actually render naloxone less effective.
Drug Enforcement Administration (DEA) reporting indicates that the prevalence of xylazine is increasing, spreading beyond the traditional white-powder heroin markets in the northeastern United States where it has been seen for several years. Xylazine vials have been encountered at locations operating as local stash houses or in the homes of polydrug dealers, indicating that the mixture with other drugs happens at the retail level, though it cannot be determined how frequently.
Toxicology and law enforcement reports indicate that drug dealers are legally purchasing xylazine online as a cheap heroin and fentanyl filler.
North Carolina is leading the charge in terms of research surrounding the drug and its effect on the human body. Researchers at the University of North Carolina at Chapel Hill are able to test drug samples using a device known as a gas chromatograph-mass spectrometer. The research at the UNC lab is part of a strategy known as harm reduction, which aims not to lead users to abstinence but to give them the tools to use drugs safely, keeping them from infections, injuries and death.
According to a report by the New York Times, UNC reported a sample submitted for testing from a harm reduction coalition in western North Carolina lead to a report being issued by the CDC. The sample, which had been received from a drug user just across the border in Tennessee, was found to contain metonitazene, a potentially danger opioid that most were unaware of at the time it was found.
Among the roughly 600 samples the team at UNC has checked since the program launched, they have found over 100 different substances. Only a small number were what he referred to as the “intended” drugs, such as THC, cocaine, heroin, ketamine, MDMA and methamphetamine.
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