Deadly, yes, but fentanyl has many ways to make users miserable even if it doesn’t kill them

Synthetic opioids, including fentanyl, are the most common drugs linked to overdose deaths in Stanislaus County and the rest of the nation, according to health agencies.

Most people know by now that a tiny amount of fentanyl is lethal — one pill can kill.

But what are the other health risks of illegal drugs containing fentanyl?

Health problems associated with fentanyl use include constipation, difficulty breathing, slow heart rate, drowsiness, respiratory trouble and decreased lung function. Prolonged use of fentanyl may eventually affect the liver and kidneys.

In addition, some studies have linked fentanyl addiction to cognitive decline and depression.

Drug cartels shifted to fentanyl because a small amount produces a high. The drug is cheaper to make and easier to smuggle in small packages than the laborious harvesting of opium poppies and production and transportation of heroin.

The National Institute on Drug Abuse says fentanyl, a synthetic opioid, binds to the receptors in the brain that control pain and emotions. Over time, the brain is not as sensitive to the drug. Only the drug activates the pleasure circuits in the person’s brain, leading to addiction and drug-seeking behavior.

People taking illegal fentanyl in counterfeit pills, methamphetamine and cocaine are at high risk of overdose, which keeps oxygen from reaching the brain. The medical condition, called hypoxia, may result in coma, brain damage or death.

An addicted person who stops using fentanyl will suffer physical withdrawal symptoms including muscle pain, vomiting and diarrhea, sleep problems, cold flashes, restless legs and severe cravings, NIDA says.

“In Modesto, like everywhere else, the illegal opiate supply is now fentanyl, not heroin,” said Ken Starr, an addiction medicine physician in San Luis Obispo and also medical director for New Hope Recovery House in Modesto. “Everything shifted toward that. Now, almost everyone in drug treatment for opioid use is on fentanyl.”

He said his addiction medicine practice serves people from all walks of life, including professionals and students. Fentanyl use may not be as hard on the body as alcohol or methamphetamine, Starr said, but the risk of overdosing on street fentanyl is extreme.

Xylazine, also known as ‘tranq,’ carries its own health threat

A dangerous mixture of xylazine and fentanyl sold on the streets has serious health implications for users. Illegal drugs containing xylazine cause overdose deaths but are especially known for open skin sores on users, posing another serious public health threat tied to fentanyl.

Public health agencies are conducting surveillance tests for xylazine in the illegal drug supply in California. The fentanyl-and-xylazine combination, called “tranq”, is not as prevalent in California compared to states on the East Coast and other regions, Starr said.

The White House in July released a response plan to the emerging threat of xylazine and fentanyl.

The California Department of Public Health alerted local health officers to the presence of xylazine in March, and in a June update reported one death in Santa Clara County related to xylazine. In San Francisco, retroactive testing between December 2022 and January 2023 found xylazine and fentanyl in four fatal overdose cases.

The state health department reviewed postmortem information in thousands of overdose deaths in 2021, including 5,059 toxicology reports. There were 23 positive tests for xylazine, and in 14 cases the drug was involved with cause of death.

The CDPH said xylazine is an emerging issue in California, but it doesn’t appear to be widespread at this time. Federal authorities have seized drugs containing xylazine mixed with fentanyl in 48 states, including California.

Veterinarians legally use xylazine as a tranquilizer and muscle relaxer for large animals, but the drug is not approved for use in people. Experts say it’s especially dangerous when combined with opioids like fentanyl.

It first was tracked in the street drug supply in Puerto Rico in the early 2000s, where tranq is known as “anestecia de caballo,” and later surfaced in Philadelphia, where 90% of illegal drug samples today test positive for xylazine.

Tranq also is called the zombie drug

California health officials say xylazine use in people causes damage to the central nervous and respiratory systems, dangerously low blood pressure, a slow heartbeat, drowsiness and lethargy. Tranq is known as the zombie drug because of the stupor exhibited by users.

Health experts have been puzzled that skin wounds caused by tranq may be close to injection sites, but some of the wounds are not, and they may even appear on people who smoke or snort the drug, according to the New York State Department of Health.

At first, small bumps develop on the skin, with a white or purple center and dark red fluid. Lack of treatment can lead to a serious bacterial infection.

Health departments in the Northeast, South and Midwest have reported severe skin ulcers, abscesses and necrosis in people who use xylazine mixed with fentanyl.

Xylazine might have been added to fentanyl to extend the shorter duration high of the opioid. Health agencies have found many users are not aware xylazine is in the drugs they are buying.

Another problem is that a xylazine overdose can not be reversed by naloxone/Narcan nasal spray. It’s not an opioid, and lifesaving measures probably will require artificial breathing for the patient. Health officials still advise people to try Narcan in those situations, along with calling 911, as the drug ingested most likely included fentanyl as well.