A horse tranquilizer showing up in street drugs, linked to amputations

A powerful tranquilizer primarily used on large animals has been found in a small number of opioid-related deaths in Lafourche. Officials warn the number could increase.

Known on the street as "Tranq" or in mixtures as "Zombie-Heroin," the medical name is xylazine, and its primary use is as a horse or cattle tranquilizer. The United States Department of Justice Drug Enforcement Administration released a report in October of last year that estimates that xylazine is related to 1,423 deaths in the Southern United States in 2021.

The use of the drug is surrounded by many unknowns because it is rarely used on humans. For instance, reports of repeated use are linked to skin ulcers that turn necrotic, often requiring amputation to save the user. The addictiveness of the drug hasn't been tested, but anecdotal evidence suggests it is.

Questions aside, one thing is certain from health officials and first responders, treating an overdose involving xylazine is currently difficult because it is not opioid-based and therefore, naloxone, the common treatment for overdoses has no effect on it.

What is the intended use for xylazine?

"I'm not really an M.D. so I don't really want to comment too much on the human side of it but yes, people should not be taking it at all. It definitely could cause death," Veterinarian Lane Breaux said.

"I really don't know why people are cutting it with that, it would cause bradycardia, and respiratory depression, and hypotension in people, so you are going to have respiratory arrest, you know, so I don't really understand why. It decreases the heart rate and if you take too much you are going to be in trouble."

Breaux explained that xylazine is often combined with ketamine for surgical procedures in larger animals such as horses and cattle, but also causes vomiting in cats. He uses it primarily as a sedative for standing surgical procedures in horses. He did not want his place of employment named because he worried of people trying to steal the drug.

Scheduled drugs such as opioids are monitored much more and he said because xylazine isn't, it doesn't have to be as strictly logged. Breaux speculated that's probably how people are getting it.

Xylazine is not completely unheard of for human use, but only under medical supervision. According to Louisiana State University's Associate Professor of the Department of Pharmacology, Toxicology and Neuroscience, Dr. Kevin Murnane, it is used under close medical supervision to treat symptoms of tetanus. He stressed that it is incredibly dangerous without supervision.

The danger, like that of opioids, is in the drug's ability to inhibit breathing, and according to the Drug Enforcement Agency there is no approved antidote for human overdoses.

How many local deaths have been related to its use?

The Lafourche Parish Coroner's Office found four deaths related to the drug in the last four years. Terrebonne Parish Coroner's Office found none, but Chief Investigator Danny Theroit said he was still searching at the time of this writing.

While comprehensive numbers for Louisiana are not available at this time, the Louisiana Addiction Research Center is gearing up to get more comprehensive numbers for the state.

"The individual users often do not know what they are taking, and it is a difficult topic for them to feel safe discussing. Because of these difficulties, estimates throughout the country report that xylazine is present in 5% to 90% of the illicit opioid supply, which varies by region and state," Murnane said via email. "That is why the Louisiana Addiction Research Center has developed an objective means of tracking substance use patterns in Louisiana using the testing of wastewater samples. We have not yet applied this to xylazine, but intend to do so soon."

Are spontaneous wounds linked to its use?

Instances of spontaneous wounds forming on limbs, and that of the following necrosis, have been found linked to the usage. Necrosis is when the skin begins to die, and this often requires amputation to save a patient's life.

Ohio Governor Mike DeWine released images of severe wounds in an executive order which can be seen here: https://content.govdelivery.com/attachments/OHIOGOVERNOR/2023/03/29/file_attachments/2451030/Signed%20EO%202023-08D.pdf.

Murnane said it is not yet known if it is a side effect of xylazine abuse or if it is a surrounding factor causing it.

"We do not yet know if this is a property of the drug, related to patterns in which it is used, or the conditions and paraphernalia available to individuals using Tranq – many of whom come from some of the most marginalized and neglected communities in our society," he said.

Law enforcement believes xylazine is likely already in the area.

The low instances of deaths found locally does not mean it isn't here, law enforcement from both parishes said, it's just not prominent yet.

Terrebonne Parish Narcotics Commander Major Neal Blades said xylazine comes in liquid and powder form, but the threat is people often don't know what they are buying. Even the dealers don't know what is actually in the product, and often they will cut their product to stretch their profit. This means most overdoses occur because the user has no idea exactly what a substance is until after they have consumed it, and by that point, it can be too late.

If xylazine turns out to be the new hot commodity, Blades said, it will come to Terrebonne and Lafourche.

"Look, it's going to get here… I read about heroin many times before we actually ever saw it… now, s***, I see it all the time," he said. "If it's trending, if it's not in your neighborhood it will eventually get there."

Members from both Lafourche and Terrebonne Parishes' narcotics divisions suspect the drug is likely mixed into the fentanyl to stretch out the product, and because it changes the high. Xylazine is not regulated like other prescription drugs so it's cheap and easy to obtain.

Take action and call for help.

EMTs throughout the area are aware of its existence but still respond with the same playbook. Nationwide, xylazine is mixed with fentanyl and heroin and this means naloxone still neutralizes the opioids in someone's system that lead to an overdose. Where the difficulty sets in is that xylazine suppresses the effects of naloxone and increases the risk of death, and because xylazine is not opioid-based, naloxone has no effect on it.

"Nevertheless, please give the person Narcan as soon as possible. It is very safe and will reverse any opioids in their system, and give them a better fighting chance to live," Murnane said. "Also, please immediately call 911 and get the person to the emergency room. The clinicians in the ER can provide supportive care through ventilation and others means that can save the person’s life."

Local EMTs from Acadian Ambulance and from Bayou Cane Fire Department said they have to increase the number of doses of Narcan, a brand version of naloxone, to counter the opioids and hope the patient stabilizes, or rush the patient to a hospital for further treatment.

This article originally appeared on The Courier: Xylazine: Horse tranquilizer mixed in fentanyl increases overdoses