Harrowing 'Zombie Drug' Tranq Sparks Alarming Crisis in American Cities

Xylazine. The general public may not be familiar with the drug, but it is currently wreaking havoc in cities across the country. Xylazine is an extremely powerful sedative typically used on horses and other large animals for surgeries in veterinary clinics, but drug dealers are now marrying it with fentanyl or heroin and selling it to users nationwide. The results of this concoction known on the streets as “Tranq” is causing acute anemia, skin infections, and death at an alarming rate.

In the past several years the name “Zombie Land,” has been ascribed to cities plagued with the drug Tranq due to users with gaping abscesses and skin crawling off of their bones seen folded over or dragging themselves aimlessly around the streets of Kensington Beach in Philadelphia, and the infamous Skid Row in Los Angeles, among others. In 2020, xylazine was found in 25.8% of fatal overdoses in Philadelphia alone. Unfortunately, these are not the only cities that have begun to see the zombie dope in their communities.

Tranq users are usually fairly easy to identify. The potent sedative often induces users to frequently nod while seated, standing, or even walking. This range of symptoms manifests in users varying from appearing drowsy to being completely unconscious. Tranq tends to permeate the user's skin, leading to the formation of pustules that eventually rupture. These pustules represent a type of necrosis, and due to the negligence of proper hygiene by many users, the exposed cavities frequently become infected. Furthermore, numerous users experience a compromised immune system, making it considerably more challenging for their bodies to combat infections. If left untreated, these open lesions often necessitate the amputation of limbs.

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Xylazine acts as a potentiator to whichever illicit drug it is mixed in with, causing a more intense high for the user. Frequent fentanyl and heroin users often remain unaware that they have obtained the drug blended with xylazine until they encounter a significantly more calming euphoria than their usual experience, accompanied by the subsequent emergence of these pustules on their skin. In certain cases, the pustules manifest on the opposite side from where the user has administered the injection, almost as if the drug itself settles and subsequently attempts to escape the body through the pores. Other users have recounted these skin lesions appearing on areas of the body far removed from the injection site.

The tranquilizing agent xylazine, employed by veterinary practitioners since the 1960s, is reasonably priced and conveniently accessible on the internet through numerous chemical enterprises, a significant portion of which operate in China. In the case of individuals vending fentanyl or similar substances such as heroin, cocaine, or methamphetamine, diluting the illicit drugs with xylazine extends their product's potency to a far greater extent than previously, thereby bolstering profits by a substantial margin. The inclusion of this animal sedative also heightens the overall euphoria induced by the substance, enticing customers to return at a much accelerated pace compared to the unadulterated drug. 

The drug xylazine works by relaxing the transmission of neural impulses in the central nervous system and is one of the most common components of ketamine. Ketamine has been used for years as a muscle relaxant and sedative in smaller animals like mice and hamsters but has been abused by clubgoers for many years. Ketamine is one of many “designer drugs” that have been readily available for years on the nightclub scene along with  MDMA (Ecstacy), GHB (Gamma-Hydroxybutric acid or Xyrem), and Rohypnol (flunitrazepam).

Although the medication is sanctioned by the FDA for veterinary purposes, it lacks approval from the Food and Drug Administration for any form of human utilization. Apart from its impacts on the nervous system, xylazine can also induce respiratory depression, hypotension, or hypertension. The drug itself, capable of permeating the blood-brain barrier, can be insufflated,ingested orally, administered intravenously, or intramuscularly, with its effects manifesting within 15 to 30 minutes after intake. Nonetheless, the duration of xylazine's effects is relatively brief, typically ranging from one to four hours as reported by most users. Consequently, users experience a quicker descent from their state of intoxication compared to the norm, prompting them to return to street dealers for additional purchases.

According to the National Institutes of Health, the majority of deaths attributed to xylazine are from polydrug usage, meaning, in conjunction with other drugs that cause respiratory depression or other central nervous system depressants. 

This polysubstance is causing a huge issue for first responders as well as emergency room physicians due to symptoms of xylazine toxicity presenting so closely with that of an opioid overdose. Narcan or naloxone is often used when someone is having an opioid-based overdose, such as heroin or Fentanyl, but with Tranq, Narcan is ineffective since xylazine is a sedative, not an opiate. Many first responders keep Narcan even on their person in cities with high rates of opiate overdoses and are often able to revive a patient by using the opioid antagonist, but this will not save someone in respiratory arrest from a sedative such as xylazine.

The FDA released a statement in November 2022 saying that because xylazine has not been approved in humans, they don’t know if “reversal agents regularly used in veterinary medicine (e.g., yohimbine hydrochloride, tolazoline hydrochloride) are safe or effective.” The DEA echoed the FDA’s findings confirming that there is currently no known antidote for those who are overdosing on xylazine in their 2022 report. 

The DEA also recently issued a Public Safety Alert saying, “Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” said Administrator Milgram. “DEA has seized xylazine and fentanyl mixtures in 48 of 50 States. The DEA Laboratory System is reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.”

There are instances where certain ER technicians lack awareness about the need to screen for xylazine when attending to a patient displaying overdose symptoms. However, in hospitals where the prevalence of the tranquilizer has increased, a practice has emerged to conduct tests specifically for xylazine with every potential overdose patient under their care. The detection of xylazine can be accomplished through urinalysis or by performing chromatography tests after obtaining a blood sample.

The drug’s usage has been reported as early as 1962 in Germany, according to epidemiologist with the Philadelphia Department of Public Health, Jewell Johnson, but started to gain popularity in the U.S. and Puerto Rico in the early 2000s, with a large number of deaths in inmates being reported in the Guerrero Correctional Institution in Aguadilla, Puerto Rico. Since around 2006, the sedative has become popular on the streets of Philadelphia, Los Angeles, and other metropolitan cities. Unfortunately, the idea of extending your profits by mixing the sedative in heroin, fentanyl and sometimes cocaine has become highly sought after by drug dealers across the country.

In April, the Biden Administration referred to the rise of fentanyl adulterated or associated with xylazine (FAAX)in cities across the country as an “emerging threat,” which was the first time an illicit substance was referred to as such. This declaration was made by Dr. Rahul Gupta, Director of the White House Office of National Drug Control Policy (ONDCP) based on criteria the ONDCP set in its directive Dir. No. 2022-002 under 21 U.S.C. § 1708, which is used to monitor a drug that qualifies and to then strategize media campaigns to inform the public of such threats.

“As a physician, I am deeply troubled about the devastating impact of the fentanyl-xylazine combination, and as President Biden’s drug policy advisor, I am immensely concerned about what this threat means for the Nation,” said Dr. Gupta. “That’s why the Biden-Harris Administration is using this designation authority for the first time since it passed Congress in 2018. By declaring xylazine combined with fentanyl as an emerging threat, we are being proactive in our approach to save lives and creating new tools for public health and public safety officials and communities across the Nation. To parents, loved ones, community leaders, and those affected by xylazine use: I want you to know that help is on the way.”

The Substance Abuse and Mental Health Services Administration (SAMHSA) announced on January 6, 2023, that there would be 24 grants available each with up to $18,200,000 for each awardee to “help expand and enhance access to Medications for Opioid Use Disorder (MOUD).” The grants would span the length of five years and awardees would receive up to $750,000 per year during this period.

Regrettably, the ongoing War on Drugs has yielded minimal success in effectively halting the continuous influx of drugs through our borders, postal services, and alternative channels. As long as substances remain accessible to individuals seeking their consumption and exploitation, we will witness the emergence of novel compounds, consequently contributing to a rise in addiction and fatalities. The perpetual cycle of supply and demand within the drug trafficking network is nothing novel, nor is the proficiency of drug suppliers in devising methods to maximize their product's distribution while minimizing costs. This entails exploring more economical substances to blend with these illegal drugs, offering users comparable or heightened effects. 

Addressing the current drug crisis solely from this perspective represents only a fraction of the solution. Until we undertake a comprehensive examination of the intricate factors that lead individuals towards substance abuse, and formulate strategies to address these deeply entrenched issues, tackling the crisis from a unidirectional approach will inevitably give rise to new complications elsewhere.