Animal Sedative Mixed With Fentanyl Brings Fresh Horror to US Drug Zones


PHILADELPHIA — Over a matter of weeks, Tracey McCann watched in horror as the bruises she was accustomed to getting from injecting fentanyl began hardening into an armor of crusty, blackened tissue. Something must have gotten into the supply.

Switching corner dealers didn’t help. People were saying that everyone’s dope was being cut with something that was causing gruesome, painful wounds.

“I’d wake up in the morning crying because my arms were dying,” Ms. McCann, 39, said.

In her shattered Philadelphia neighborhood, and increasingly in drug hot zones around the country, an animal tranquilizer called xylazine — known by street names like “tranq,” “tranq dope” and “zombie drug” — is being used to bulk up illicit fentanyl, making its impact even more devastating.

Xylazine causes wounds that erupt with a scaly dead tissue called eschar; untreated, they can lead to amputation. It induces a blackout stupor for hours, rendering users vulnerable to rape and robbery. When people come to, the high from the fentanyl has long since faded and they immediately crave more. Because xylazine is a sedative and not an opioid, it resists standard opioid overdose reversal treatments.

But xylazine’s true prevalence is unknown. Hospitals don’t test for it. Some state medical examiners don’t routinely do so, either.

The drug exists in a legal gray zone. Approved 50 years ago by the F.D.A. as a veterinarian-prescribed analgesic, it is not listed as a controlled substance for animals or humans and so is not subject to strict monitoring. Thus, it has not been on the radar of federal law enforcement for diversion or abuse.

As with many trapped by tranq, Ms. McCann’s hellish descent began with prescription opioids. In 2009, when she was 27, she developed a dependence on painkillers prescribed after a severe car crash. A boyfriend she met at one of her six stays in rehab introduced her to heroin. Cheaper and more potent fentanyl elbowed heroin off the streets. Then, as the Covid-19 pandemic descended in 2020, tranq stormed Philadelphia.

Last July, she was evicted from her room in Kensington. “I was sleeping on the sidewalks crying every night, knowing that I was better than that,” Ms. McCann said. Someone next to her got shot. A man tried to rape her, but she defended herself with a box cutter. On the hot summer streets, she saw people whose tranq wounds were covered with fleas and maggots.

Even so, she said, “I could not pull myself away from that drug.”

On a recent chilly afternoon, hundreds of people filled the streets surrounding Prevention Point, carrying used syringes to exchange for sterile ones. Some then made their way to the center’s wound care clinic, which has seen a 313 percent rise in visits over the past three years, largely because of tranq.

Unsuspecting Kensington customers saw an advantage to the new mix: A bag of heroin ran about $10, tranq dope $5.

She made her decision.

Now in her fifth month of sobriety at an intensive outpatient program near St. Louis and at a healthy weight, Ms. McCann is both stunned by and proud of her progress. From wrist to elbow, her meandering pink and purple scars are a road map of being lost and found. “People out here might think my arms look really ugly, but they aren’t familiar with tranq wounds yet,” she said. “To me, my arms look really beautiful now.”

One afternoon, Mr. Westfahl, who coordinates Prevention Point’s overdose prevention team, walked along Kensington Avenue, handing out free nasal spray doses of Narcan, the opioid overdose reversal medication. He and another outreach worker visited encampments of people on the street, some shooting up tranq dope openly, as local residents and shop workers scurried by in the accumulating darkness. People slumped against parking meters and in doorways, heads lolling, necks twisting. Three huddled around a small bonfire, burning a blanket for fuel.

Within 45 minutes, the two men had given away more than 100 doses of Narcan. They hung blue opioid reversal kits on street poles for anyone to grab, filled with disposable gloves, Narcan and plastic mouth guards for mouth-to-mouth resuscitation.

Already overwhelmed by fentanyl, social welfare organizations, public health officials and clinics are in the early throes of figuring out how to withstand tranq. At least one state, Florida, has listed xylazine as a controlled substance. A comparable federal scheduling would prompt much stricter monitoring of prescriptions and suppliers of the drug, including in online transactions.

An official with the Drug Enforcement Administration who declined to be named said that the agency had been in contact with the F.D.A. and looks forward “to the completion of its scientific and medical evaluation and scheduling recommendation.”

Mr. Westfahl continued his journey down Kensington Avenue. Suddenly, at the intersection of Kensington and Allegheny, shouts went up from a gathering crowd: “Get the Narcan!”

A man was splayed out on the sidewalk, unconscious.

Announcing that he had first-aid training, Mr. Westfahl asked people to hold off on Narcan. He pulled on disposable gloves, checked the man’s pulse and opened his mouth to make sure it was free of food, syringe caps — anything he could choke on. Mr. Westfahl tilted the head back to check breathing and keep the airway open. Then, making a fist, he rolled his knuckles briskly up and down the man’s chest in a sternum rub; the surprising pain can jolt someone awake. The man began to come to, stupefied.

Mr. Westfahl and some onlookers hoisted him gently. Still heavily sedated, he lurched in the freezing wind, pants drooping. On either side, two women slipped their hands inside his open, flapping jacket.

They were fumbling for his zipper, which they secured to keep him warm. Then, arms around him, holding him up, the three headed back down Kensington Avenue.

Hilary Swift contributed reporting.



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