‘Zombie’ drug of horse tranquilizer-laced fentanyl ravages US and alarms health officials
Amy DeLaura Anna Giaritelli
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EXCLUSIVE — Public health officials are fighting a losing battle to save the lives of people who overdose from a new and extremely lethal drug concoction that puts users in a zombielike state of consciousness.
As fentanyl-related deaths in the United States reached an all-time high last year, and the Biden administration has vowed drastic actions to quell the latest iteration of the opioid epidemic, an even more harmful drug combination is spreading across the country.
Fentanyl laced with the horse tranquilizer xylazine threatens to upend U.S. government efforts to stomp out the opioid epidemic because it will not succumb to emergency overdose medicine Narcan.
“We need to take it very seriously,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, during an interview with the Washington Examiner. “The more we find these drug combinations, the more challenging it is clinically on the one hand to reverse overdoses, to treat the opioid use disorder, and also to treat all the complications that are emerging.”
The lethal drug combination, which Volkow calls a “tsunami reaction,” is spreading like wildfire across states unbeknownst to many drug users and cannot be detected by the public through individual test strips, according to Dr. Susan Sherman, a professor at Johns Hopkins University who studies Baltimore residents who use fentanyl.
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Fatal overdoses from xylazine-laced fentanyl have been reported in Washington, D.C., and 36 states. According to NIDA research, Pennsylvania has seen the highest increase in overdose deaths involving xylazine, jumping from 2% of all drug overdose deaths to 26% over the past five years. That’s compared to 19% of all drug overdose deaths in Maryland and 10% in Connecticut.
Philadelphia has long been documenting xylazine, which is also known as “tranq,” in toxicology reports and drug samples. By 2021, more than 90% of the city’s lab-tested dope samples contained the tranquilizer.
The Drug Enforcement Administration sent out an intelligence report warning about the rise in overdose deaths connected to xylazine. The Northeast region of the U.S. had the most xylazine overdose deaths over the two-year period of 2020 and 2021, followed by the South. The October report warned use will likely increase and “be commonly encountered in the illicit fentanyl supply.”
Xylazine can extend the length of the opioid high and enhance feelings of euphoria. Combining xylazine with fentanyl can take an even greater toll on the human body than when taken alone. Fentanyl slows breathing and xylazine drops blood pressure, according to Volkow.
People who consume xylazine and fentanyl, either by injecting, snorting, swallowing, or inhaling it, can experience unique physical symptoms not seen among users of other types of drugs, prompting the “zombie” name. Xylazine causes blood vessels to constrict, limiting blood flow. Without adequate blood supply, the skin takes on the appearance of lesions at the injection site and throughout the body. The skin stretches out and disintegrates, posing a risk of amputation of the limbs.
Volkow was adamant people who use this combination drug should not be thought of as some apocalyptic description or “frightening people.”
“We really need to fight that stigmatizing language,” Volkow said. “They are already very much discriminated, and we need to do everything we can to actually be respectful to them. That is crucial in order to bring them forward … to seek treatment or be part of our society.”
In her interviews with drug users, Sherman found isolation can fuel the dependency.
“Someone actually said … fentanyl felt like a warm hug,” Sherman said. “And you know, that’s so profound because we all want hugs.”
Naloxone, also referred to as Narcan, is an antidote for opioid overdoses, but because xylazine is not an opioid, the emergency medicine only stops the effects of fentanyl, not the tranquilizer, making those who overdose more likely to have lethal repercussions.
“You’re combining two very different mechanisms of action,” Volkow said of the opioid and tranquilizing effects that “create a tsunami reaction.”
“They come together and escalate the severity of the dangers,” she said.
The DEA reports that the illicit xylazine is entering the U.S. through online purchases from Chinese suppliers. Volkow and Sherman were unsure at what point xylazine is being added to fentanyl. Volkow suspected it was happening within the U.S., not south of the border. Until now, fentanyl had itself largely been used as the filler in fake versions of prescription drugs, including Percocet and Xanax.
The Food and Drug Administration has only approved xylazine as a sedative for large animals, such as horses and deer. As a medicine that veterinarians use, it is not a controlled substance, which has made it easier to acquire in the U.S.
Amid the increasing prevalence of xylazine in illicit drugs, the FDA moved in late February to clamp down on importations of the pharmaceutical by ensuring the medicine and related ingredients coming into the U.S. are headed to legitimate veterinary entities, manufacturing facilities, and state-licensed compounding pharmacies.
“Restricting access to xylazine will make it harder for drug dealers to sell these products. And so it will be helpful, but it will not be sufficient,” Volkow said. “We also need to be very proactive in terms of prevention and therapeutics because really, at the end of the day, where we need to expand is to educate people about the dangers of these drugs and also to encourage them to seek out treatment.”
Sherman wants to see drug-checking test strips for xylazine get validated quickly so people can test drugs beforehand.
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Rebecca Kiessling, a mother whose two adult sons died from fentanyl in 2020, said the prevalence of fentanyl in the U.S. must be attacked head-on by restricting its importation.
“Nobody’s demanding fentanyl,” Kiessling said in an interview with the Washington Examiner in early March. “This is not what kids think they’re getting. It’s homicide and it’s a war.”