Understanding Xylazine: A Harmful Adulterant in Street Drugs (GRAPHIC IMAGE WARNING)

Xylazine, often referred to as "Tranq," is a veterinary tranquilizer that has alarmingly infiltrated the illicit drug market across the United States. Originally intended for animal use, xylazine is now being found mixed with a variety of street drugs, particularly opioids like fentanyl.

This substance is not approved for human use and poses significant health risks. One of the most concerning effects of xylazine is its tendency to cause severe skin and soft tissue infections. Users may develop deep, painful wounds that closely resemble necrotizing fasciitis, a serious bacterial infection that destroys skin, fat, and the tissue covering the muscles. These wounds can occur regardless of how the drug is consumed—whether injected, snorted, smoked, or even taken orally.

The presence of xylazine in street drugs complicates not only the physical health of users but also their medical treatment. The risk of developing these dangerous infections makes it imperative for harm reduction programs to educate the public about xylazine and promote the use of drug testing kits to detect this harmful adulterant.

By understanding the dangers associated with xylazine, we can better prepare and protect our communities from its harmful effects. This substance's impact goes beyond just the immediate users, affecting public health systems, emergency responders, and the broader community. The spread of xylazine underscores the urgent need for comprehensive harm reduction strategies, including education, widespread testing, and accessible healthcare services.

The Rise of Xylazine in the Drug Supply

Xylazine has alarmingly infiltrated the street drug scene across the United States. It was first detected in Pennsylvania and has now spread to 49 states. In Philadelphia, over 90% of dope samples tested in 2021 and 2022 contained xylazine, according to the Everywhere Project's field guide, "Tranq aka Xylazine: A Field Guide."

During our time working alongside The Everywhere Project and other non-profits in Kensington, Philadelphia, we tested substances brought in by community members. Alarmingly, 100% of the fentanyl samples we tested were adulterated with xylazine. This firsthand experience underscores the critical need for reliable drug testing solutions.

That's a picture of Calen, our lab manager, doing some volunteer work while I was frustratingly trying to set up our FTIR drug-testing machine with our new computer.

Xylazine-Related Wounds.

One of the most alarming effects of xylazine is its propensity to cause severe skin and soft tissue infections. These infections can result in deep, painful wounds resembling necrotizing fasciitis, a serious condition that destroys skin, fat, and underlying tissue. These wounds can occur regardless of how the drug is consumed, whether injected, snorted, smoked, or even taken orally. The image portrayed is the progression and healing of a ‘tranq’ wound in a Philadelphia patient. Panels 5–6 show healing after a single surgical debridement during a hospitalization followed by months of outpatient care. Journal of Addiction Medicine

What Causes the Wounds?

The exact cause of these wounds is not fully understood. Research and harm reduction advocates have noted that xylazine has direct cytotoxic effects, meaning it can kill cells upon contact. This cytotoxicity creates pockets of necrosis under the skin, leading to the development of these severe wounds.

Additional Factors

• Vasoconstriction: Xylazine constricts blood vessels, which reduces blood flow to the skin and soft tissues. This vasoconstriction can lead to tissue death and the development of necrotic areas, which are particularly vulnerable to infection.

• Necrosis: Restricted blood flow starves tissues of oxygen and nutrients, causing them to become necrotic and slough away. This can happen with any form of xylazine exposure, not just injection, and can prevent the healing of other skin injuries like cuts and insect bites.

Diverse Perspectives

There is some debate within the scientific community about the direct association between xylazine and these wounds. Some researchers suggest that the wounds may result from a combination of fentanyl adulterants or drug use practices rather than xylazine alone. However, extensive fieldwork and published literature support the connection between xylazine and these severe infections, emphasizing the need for further research and harm-reduction strategies.

Overdose Management Challenges with Xylazine

According to "Tranq aka Xylazine: A Field Guide" by the Everywhere Project, xylazine significantly complicates overdose management. Here are some key points to understand:

• Non-responsive to Naloxone: Xylazine does not respond to naloxone, the standard treatment for opioid overdoses. This means traditional opioid overdose interventions may not be effective.

• Administer Naloxone Anyway: Naloxone should still be administered in cases of suspected opioid co-ingestion to address any opioid-related effects. The presence of opioids often necessitates naloxone, even if xylazine is involved.

• Alters Overdose Symptoms: Xylazine can alter the typical signs of an overdose, making it harder for first responders and healthcare providers to identify and treat effectively. Symptoms may not follow the usual patterns seen with opioids alone.

• Unresponsive but Breathing: Individuals affected by xylazine may appear unresponsive yet still be breathing, complicating the assessment and intervention process. This requires close monitoring and potentially different emergency responses.

• Sedative Properties: Due to its sedative properties, xylazine can cause prolonged periods of sedation, which may require extended care and monitoring.

By understanding these challenges and referencing the comprehensive guide by the Everywhere Project, harm reduction initiatives can develop more effective strategies to manage and mitigate the risks associated with xylazine.

The Importance of Drug Testing

The increasing prevalence of xylazine in the drug supply underscores the critical need for comprehensive drug testing. Accurate drug testing is a lifesaving measure, providing essential information about the substances individuals are consuming. This knowledge empowers users to make safer choices and avoid potentially fatal encounters with dangerous adulterants.

At TN Scientific, we offer state-of-the-art xylazine test strips designed to detect this harmful adulterant with high accuracy. Our test strips have been rigorously tested, and the effectiveness of our xylazine test strips has been evaluated in a detailed study, which you can read here. These test strips are now available for purchase on our website here.

Due to the widespread presence of xylazine, it is crucial for individuals to test their substances. The Everywhere Project and many other harm reduction non-profits and health departments provide these strips for free. We encourage our readers to obtain these strips however they can, whether through these organizations or by purchasing them directly from TN Scientific. By choosing to purchase our test strips, you help fund our ongoing research, development, and awareness efforts around the importance of drug testing. TN Scientific Xylazine drug test strips are available here.

Working Together for a Safer Harm Reduction Community

Xylazine's infiltration into the illicit drug market poses significant and multifaceted challenges to public health and safety. As a community, it is crucial to remain informed and proactive in combating these dangers. By understanding the severe health risks associated with xylazine, promoting comprehensive drug testing, and supporting harm reduction initiatives, we can make significant strides in protecting those most vulnerable to these harmful substances.

At TN Scientific, we are committed to providing the tools and resources necessary to detect and mitigate the risks of xylazine. Our xylazine test strips, rigorously tested for accuracy, are an essential component in this fight. We encourage everyone to use these test strips, whether through our website or by obtaining them from harm reduction organizations and health departments.

In addition to our efforts, there are numerous outstanding organizations dedicated to harm reduction and public health. Many of these organizations are non-profits that rely on the support of volunteers to carry out their mission. Notable among them are:

• Street Works in Nashville

• The Everywhere Project in Philadelphia

• Trystereo Harm Reduction Collective in New Orleans

• New Orleans Musicians' Clinic in New Orleans

These organizations would greatly appreciate any assistance, whether through volunteering or donations.

Together, through education, testing, and community support, we can address the challenges posed by xylazine and work towards a safer future for all. Thank you for supporting TN Scientific and our mission to enhance public health through effective harm-reduction solutions.