Could it be that xylazine, the latest hyped scourge of the opioid epidemic, might possibly lead to fewer opioid deaths instead of more?
The story line has been that xylazine potentiates the effects of fentanyl making the two drugs together a lethal combo. And there is no doubt that the two drugs have been found together in fatal overdoses with increasing frequency. Fentanyl depresses the respiratory drive, and xylazine, a horse tranquilizer, depresses consciousness, slows the heart, causes hypotension, and may also depress breathing. What could be worse than adding xylazine to fentanyl?
Yet a recent study published in Clinical Toxicology, Opioid overdoses involving xylazine in emergency department patients: a multicenter study, came up with a stunning conclusion.
Cardiac arrest and coma in emergency department patients with illicit opioid overdose were significantly less severe in those testing positive for xylazine.
How is that possible?
In its publication The Growing Threat of Xylazine and its Mixture with Illicit Drugs, The DEA reports:
A kilogram of xylazine powder can be purchased online from Chinese suppliers with common prices ranging from $6-$20 U.S. dollars per kilogram. At this low price, its use as an adulterant may increase the profit for illicit drug traffickers, as its psychoactive effects allows them to reduce the amount of fentanyl or heroin used in a mixture.
(Note: A kilogram of fentanyl can wholesale for several thousand dollars. No wonder dealers may wish to supplant fentanyl with xylazine.)
Fentanyl is far more dangerous than xylazine. If xylazine is added to replace a certain amount of fentanyl then the resulting mixture, containing less fentanyl, would be less dangerous.
Xylazine is also reportedly added because it gives “legs” to fentanyl, meaning it makes the high or stupor, last longer. People no longer need to redose every 3-4 hours. They can now wait for 6-8 hours. This means they are using fewer times a day and thus have less opportunity to overdose and die.
It actually makes sense that fentanyl with xylazine might be safer than fentanyl alone.
Now it is important to keep in mind that drug dealers are not very good at mixing drugs precisely. A typical $3 bag of fentanyl contains only 1-2% fentanyl. The rest is filler. No one knows how much xylazine is fatal since it hasn’t been fully tested in humans, but deaths with xylazine only appear rare. All of the xylazine deaths in the study also had opioids present. 98.9% of the patients who tested positive for xylazine had fentanyl present. The one did not have fentanyl was positive for methadone.
If xylazine is added on top of a typical bag of fentanyl, then it probably won’t help make that bag any safer, but if the dealers are adding xylazine so they don’t have to add as much fentanyl, then it could be saving lives.
Here in Connecticut, according to the Office of the Medical Examiner, 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.
Still we can’t be too overjoyed that xylazine is in the drug supply as it has been reported to cause severe skin necrosis. Here’s a picture of the ulcerations xylazine can cause.
Not pretty.