Fentanyl is Deadly, But the Next Big Overdose Threat is Already Here. It's Xylazine.

Fentanyl is 100 times more powerful than heroin and it killed more than 71,00 Americans in 2021, but another drug now sweeping the nation might prove deadlier.

It’s a potent veterinary tranquilizer called xylazine, known on the street as “tranq” and “zombie drug,” among other things. The U.S. Drug Enforcement Agency says drug dealers are cutting fentanyl, heroin and counterfeit painkillers with the animal sedative to prolong euphoria – and stretch supplies.

The drug can be snorted, smoked or injected. It is obtained from veterinary supply houses with a prescription, and from sketchy websites without one. If the “horse tranquilizer” story sounds familiar, that’s because back in the day, high-dose ketamine – used primarily in veterinary settings – gained notoriety as “Special K” on the national club scene. Today, it’s a Food and Drug Administration-approved treatment for depression.

Xylazine goes back a few years as well. It was approved by the FDA for animal use 50 years ago, and while safety concerns preclude human use, “anestecia de caballo” – “horse tranquilizer” in Spanish – has plagued Puerto Rico for the last decade.

With gruesome reports now coming in from around the country – and mostly from the Northeast – the FDA has warned healthcare providers about the drug, noting in November “severe, necrotic skin ulcerations” among users and open wounds at injection sites that can lead to life-threatening infections and even amputations.

By all accounts, xylazine is serious and spreading. A recent DEA Joint Intelligence Report notes that a “comprehensive count” of U.S. xylazine-positive overdose deaths is not currently possible, because not enough jurisdictions conduct postmortem toxicology screens for the drug. But xylazine, according to the DEA, has been identified as a contributing factor in “numerous fatal overdoses.”

A study published last year in the international journal Drug and Alcohol Dependence found xylazine involvement in a skyrocketing percentage of overdose deaths between 2015 and 2020, in several geographic areas. In Philadelphia – Ground Zero for the drug, and just three hours from Long Island – xylazine was implicated in 25.8 percent of overdose fatalities in 2020.

Sarah Laurel, who runs Savage Sisters Recovery, a nonprofit focused on street-level outreach to drug users in Northern Philly’s Kensington neighborhood, says xylazine is now found in 92 percent of local drug samples there, and that “fentanyl has become the adulterant” – second fiddle to xylazine, the secret ingredient added to stretch out highs and supplies.

Asked whether Long Islanders should be concerned, Laurel offers just one word: “Absolutely.”

Tennessee-based Aegis Sciences Corp. has some further disconcerting numbers from the field. In a study published last month, the private testing lab found xylazine in samples collected from adults in 25 of 39 tested states, including New York, New Jersey and Connecticut.

Aegis Sciences Regional Sales Manager Shanna Brown, whose territory covers Long Island, said she sees at least 10 to 15 xylazine-positive drug screens daily among samples collected from patients in local addiction clinics, pain management centers and internal-medicine practices.

But the zombie drug is largely unreported, Brown adds, because most labs don’t test for it.

“Xylazine is all over,” she adds.

Meanwhile, Suffolk County Chief Medical Examiner Odette Hall says her office routinely tests for – and finds – xylazine in the bodies of local overdose victims.

Lawmakers, both local and federal, are starting to pay attention. Governor Kathy Hochul noted the new threat in her Jan. 10 State of the State address. The White House Office of National Drug Control Policy recently held a listening session on the situation with public health leaders. And several House Republicans are pushing the DEA to schedule xylazine in hopes of mobilizing more federal action.

Xylazine is the latest phase of a modern drug epidemic that started with the overprescribing of prescription painkillers in the 1990s. Subsequent regulatory crackdowns led to wholesale user migrations to cheap, available heroin in the early 2000s, followed by a fentanyl crisis so widespread that it has reduced average American life expectancies to 20-year lows.

As public-health experts and law-enforcement professionals chase the next “drug du jour” threatening our families, friends and neighbors, we’re better prepared in terms of awareness and access to addiction treatment than we were when illicitly manufactured fentanyl arrived eight years ago.

But there will always be another drug – one that meets a market demand for even better and longer-lasting highs. That demand is fueled by anxiety, depression and despair, all of which have deepened in America post-COVID.

Let’s chase that.

This article first appeared on Innovate LI.