“XYLAZINE, A DEADLY SKIN-ROTTING ZOMBIE DRUG, OFTEN MIXED W FENTANYL, IS ON THE DOORSTEP …ALREADY FUELING A HORRIFIC WAVE OF OVERDOSES.””
America has a history of hysteria over the drug war. From Reefer Madness to the insanity of telling people they could die from just touching fentanyl or that dealers are giving rainbow fentanyl to kids for Halloween, the country has used fear to spark a crackdown against people who use drugs, fund law enforcement and political grandstand to win votes.
Above is the headline from a press release of US Senator Charles Schumer, a press release in which he promises to “supercharge” funding for law enforcement and interdiction to battle the xylazine threat (while also mentioning support for treatment).
The press release cites two recent deaths caused by Xylazine, but when you go to the article cited, it’s headline says deaths “could be linked to xylazine.” The article goes on to tell how 7 people on the scene and later 3 additional people at the hospital felt ill and had to be treated for possible exposure, but in the end it was decided that none of them had been exposed to fentanyl or xylazine.
Other headlines and news stories abound proclaiming the horrors of the ZOMBIE DRUG.
Don’t get me wrong, Xylazine is bad news and we should take it seriously. It is not meant for human consumption, it causes severe skin necrosis and could if taken in sufficient quantities kill someone. It also can lead to severe withdrawal.
Xylazine has been around for many years in Philadelphia and for at least several years here in Connecticut. While purportedly in Philadelphia, it can be sold by itself as “Tranq” or mixed with opioids as “Tranq-dope,” here In Connecticut it is almost exclusively seen as an additive to fentanyl. It is added to give opioids “legs.” Fentanyl doesn’t last as long as heroin, losing its effects after 2-4 hours, where heroin usually lasts twice as long. Xylazine prolongs the patient’s high with its sedative effect. It may not be as pleasing as fentanyl, but it is better than withdrawal sickness until the user uses fentanyl again.
In Hartford a number of years ago, we noticed some people appeared catatonic after naloxone revival. A paramedic used the words they were like zombies to describe several people he had resuscitated. A user told me she called the drug “mindfuck” because she felt trapped inside herself. We thought at the time, dealers were putting PCP in the fentanyl because it had that dissociation we often see with PCP. I occasionally see this, but for the most part, patients respond as they always have.
I have learned that there is a problem with using the word ZOMBIE to describe people. It increases the stigma people already face. I respect and understand that. Photos of people with horrible skin wounds nodding off as they stand with the headline Zombie DRUG emblazoned across the top of the paper does little to offer help to people whose lives are already difficult enough.
I have seen an increase in skin abscesses in my patients, but admit I have seen nothing like the grotesque pictures that highlight news of limbs with the flesh looking like it has been torn off by an animal and infected with disease.
My issue with the sensationalization of xylazine, particularly when the words lethal are applied to it, is that we do not know how much it is contributing to overdoses or overdose deaths. Here in Connecticut Xylazine was found in 24% of all fatal overdoses in 2022 — roughly the same proportion of xylazine in the drug supply according to local testing. While the presence of xylazine rose 16.6% in fatal overdoses last year, fatal overdoses decreased by 4.7%.
Just because xylazine is present in the toxicology results of a dead person doesn’t mean xylazine caused or even contributed to the death, particularly when the toxicology results identify the presence of the proven killer fentanyl.
The other misleading headline is that xylazine is naloxone-resistant. That is true. Naloxone works only on opioids and xylazine is not an opioid. Naloxone doesn’t work on xylazine, just like it doesn’t work on benzodiazepines, alcohol, or many other substances that are not opioids. But most of the overdoses are caused by fentanyl and naloxone works on fentanyl. People die of opioid overdoses because the opioids stop their breathing. If given in time, naloxone will knock the opioid off the brain receptors that control breathing and the patient will begin to breathe again, which is our goal. The xylazine may keep the patient sedated, but that is okay. I have not seen evidence of deaths caused only by xylazine. I am sure if you take enough xylazine, it is possible to die, but this doesn’t seem to be the issue in Connecticut, and certainly not one anywhere near the monumental scale of fentanyl. While xylazine can cause respiratory depression, it is not in the same league as fentanyl.
Bottom line. If an overdosed patient is not breathing or has severe respiratory depression, give naloxone and provide rescue breaths until the patient begins breathing satisfactorily on their own or EMS arrives to take over. If they are breathing okay, do not give more naloxone. Don’t refer to people as zombies. Don’t let politicians or law enforcement agencies hystericalize xylazine to increase their law enforcement budgets to continue the failed War on Drugs. Support Harm Reduction. Support Treatment. End Stigma.
Finally, it we really want to stop the deaths and eliminate all these unsafe additives like xylazine, then we should move to safe supply, offering medically supervised legal drugs with consistent doses free of additives.