Animal tranquilizer makes street drugs more dangerous. Cape Codders explain what to know.

In Massachusetts, an animal tranquilizer called xylazine, often known as “tranq,” is making its way into the drug supply system.

Xylazine is generally mixed in with other drugs, such as fentanyl, heroin or cocaine, and users often don’t know it’s there, making the identification and the treatment much harder for an overdose.

About a third of New England’s drug supply now has xylazine in its system, according to new data released in February by Brandeis University’s Opioid Policy Research Collaborative.

The drug is only approved by the U.S. Food and Drug Administration for use in animals. In November, the FDA put out a warning about xylazine exposure in humans, saying it can result in “serious and life-threatening side effects.”

What is xylazine?

Xylazine has been around a very long time, Daniel Rodrigues, associate director of substance use disorder services at Duffy Health Center in Hyannis, said.

“It's intended to be used as a tranquilizer for larger animals, it’s not approved for human use,” Rodrigues said. “It is not an opioid, it works as a sedative.”

Xylazine usually starts working a few minutes after it's ingested and can last up to four hours depending on how much is in that particular substance, he said.

Xylazine can lead to a serious respiratory and sedative response. Additionally, there are wounds the drug can cause.

“Sometimes when people inject substances, there are skin infections, lesions and abscess, things like that,” said Eliza Morrison, assistant director of harm reduction services at the AIDS Support Group of Cape Cod. “The kind of wounds that we were seeing with xylazine use, are nothing like we had seen before.”

According to Morrison, these are often deep, pitting wounds, not only around the injection site, but it can also be seen all the way up the vein from the injection site, and usually taking a long time to heal.

In prior decades, xylazine use in the United States was generally limited to Puerto Rico, Rodrigues said. “The epicenter of the prevalence is the Northeast, especially Philadelphia, but it’s spreading now to other parts of the East,” he said.

Xylazine is present in the drug supply chain on Cape Cod, according to the AIDS Support Group of Cape Cod.

Xylazine is definitely present in the drug supply chain at the Cape, and AIDS Support Group is seeing clients who show up with severe skin tissue damage, Morrison said.

“What we're seeing is because these kinds of infections are not just occurring at the injection site, they are more like a systemic infection,” said Morrison. “Anytime it’s being injected in an area where there is infection, there’s a higher risk of spreading or worsening that infection.” Oftentimes, even after many months, it is not possible to keep those infections under control, and the wounds become very deep.

The AIDS Support Group has upgraded wound care supplies including nonstick gauze, wrapping tape, saline wash, and anything to manage a larger wound at home.

“We tell people to monitor the wound, draw a circle around it with a pen, if it grows within 24 hours outside of those bounds, come back to us and we can get you the proper care that you need,” said Morrison.

For overdoses, Narcan does not work for xylazine

The first response with an apparent opioid overdose is to use the medication Narcan to reverse its effects. The next step is rescue breathing and ensuring that the person can breathe on their own, and then calling for support from EMTs or first responders, said Rodrigues.

Narcan is the brand name for naloxone, a medicated nasal spray that can be used to reverse an opioid overdose. Narcan does not work for xylazine, several experts said.

Since fentanyl usually affects respiration, and the effects of the tranquilizer will also lead to respiratory problems, Morrison suggests when a person is not responding to Narcan, the best possible treatment is performing rescue breathing.

“Using more Narcan is not going to work; monitoring people's symptoms, making sure that their respirations are normal or becoming more normal, and knowing how and when to provide rescue breathing is one of the most important things,” Morrison said.

What are the next steps

There is a high chance that in the coming years more and more xylazine use will occur. Training, proper education and a game plan in the medical community to support people who are experiencing the wounds and effects of using substances with xylazine, Morrison said.

Additionally, educating friends and family on how to respond to an overdose and practice rescue breathing are the important steps.

“Part of responding to xylazine is treating the opioid use and we provide that resource at Duffy. We also have recovery support navigators and recovery coaches who can not only help our community getting to resources here at Duffy, but whatever their needs set is,” said Rodrigues.

Education is critical, said Shane Coutinho, outreach manager of Brightview Hyannis Addiction Treatment Center.

“I really believe that if we continue to educate in regards to xylazine and how to treat it correctly, and how to work together, whether it's dealing with necrosis, or seeking further medical help, we as a community can come together to deal with this epidemic,” Coutinho said.

Currently, there is a xylazine test strip that has been developed and is being used in Massachusetts, but they are expensive and extremely hard to obtain.

“It is a issue to be concerned about, but proper education and knowledge can help to get through this and we have enough resources available at the Cape to help those in need,” said Rodrigues.

“We have team members available to speak with anyone who feels they might be at risk with xylazine – we can connect them to available services and options so that they can remain healthy and have access to care,” said Dan Gates, CEO of the AIDS Support Group. “We have free Narcan available at our offices or mobile outreach vans for training on Narcan use."

More information about xylazine can be found here: https://www.info.streetcheck.org/general-8

Rasheek Tabassum Mujib writes about healthcare and education. Reach her at mujib@capecodonline.com.

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This article originally appeared on Cape Cod Times: Street drugs on Cape Cod made more dangerous with xylazine