New test strip detects opioids laced with veterinary sedative xylazine: ‘They give us the ability to curb that exposure’
With his 8-year-old dog Maverick— Maeve for short — curled up under the table at his feet, Taylor Wood opened a small blue bag and dumped out a sample of dope.
Wearing black rubber gloves, he carefully picked through the mixture searching for traces of xylazine, a sedative known colloquially as the “zombie drug” or “tranq.”
He placed the samples — “beautiful pressed pills with vibrant colors,” he called them — on the scope of his infrared spectroscopy machine he’s nicknamed “Louise,” and waited a few minutes until data popped up on his computer monitor.
He dragged the spectrum lines to see how they interacted with each other. His face lit up.
“Xylazine was detected in the dope sample, so I can comfortably consider it tranq,” Wood told the Tribune. “But I don’t know if it was sold as tranq. It could be a situation where someone sold it as heroin and then it came up like that.”
As the lead technician and drug checking manager at Chicago Recovery Alliance, Wood is using a drug test strip that detects the presence of xylazine, one of the newest tools available to public health workers in their efforts to thwart the growing danger of xylazine, a veterinary tranquilizer increasingly found in people who die of opioid overdoses.
First approved last month by the city of Philadelphia’s Department of Public Health, CRA is one of the first organizations in the country to distribute them to the public following the test strip’s developing stages, said Iqbal Sunderani, chief executive officer of biotechnology company BTNX, one of the largest providers of fentanyl test strips in North America.
Some states consider testing strips to be “paraphernalia,” said Sunderani, while others, like Illinois, have legalized and distributed them. Wood affirmed that using drug testing strips is a harm reduction technique still in its infancy in the United States.
“These xylazine test strips are phenomenal because they give us the ability to curb that exposure and also provide a better supply to some degree,” Wood said.
The target audience for test strips are people who are already using opioids either for pleasure or for the sake of managing pain or discomfort, said Wood, who is adamant that drug use isn’t going away any time soon. Samples are either mailed in through a syringe services program or dropped off by users at one of the pickup locations around the city.
Originally used on urine samples, the test strips work in samples in which the substance is mixed with water, Wood said. A 10 mg sample is crushed and diluted with 5 ml of water, and the strip is placed in the capsule to absorb moisture for 10-15 seconds.
After putting the strip on a nonabsorbent surface for five minutes, the results pop up on the strip like a COVID test. Strips are highly sensitive and can pick up a small amount of xylazine: one line for negative and two for positive.
Once Wood receives the results, he contacts the person who sent in the sample to let them know if their supply is safe.
Pronounced “ZY-la-zeen,” the drug is a relatively new adulterant in the supply, said Dr. Neeraj Chhabra, a medical toxicologist and an emergency physician with University of Illinois Chicago, who reviewed fentanyl-related death reports in Cook County from January 2017 to October 2021 and found an alarming number of overdose victims had xylazine in their systems.
“It’s a completely unregulated market, so the assumption has to be that there’s going to be something dangerous in there,” he said.
Veterinarians use xylazine as a potent substance to put animals to sleep, but a coalition of 39 attorneys general is urging Congress to reclassify xylazine as a controlled substance.
Xylazine isn’t an opioid, it’s a sedative, said Lindsay Allen, professor of emergency medicine at Northwestern University’s Feinberg School of Medicine. It is part of a class of adulterants, or cutting agents, but it looks and feels like an opioid when you’re taking it.
“That’s what drug creators are counting on, because it’s a lot less expensive for them to add xylazine, or to cut their drugs with xylazine,” Allen said.
Last month, the Drug Enforcement Administration issued a public safety warning about the sharp increase in the trafficking of fentanyl mixed with xylazine. The DEA has reported that xylazine-positive overdose deaths have risen by 1,127% in the South.
Locally, xylazine was present in 8% of cases of those who died in 2022 from opioid overdoses, resulting in 162 deaths, according to data pulled from the Cook County medical examiner by the Tribune. There were almost 50 more deaths in 2022 than the previous year, and the majority of the victims were Black.
[Opioids laced with veterinary sedative xylazine a growing threat to Chicago drug users]
Wood said adding xylazine to fentanyl can extend an individual’s high.
“It’s like extending that hour and a half high to six or seven hours,” he said. “So that individual only has to maybe inject or snort or boof twice a day rather than nine times a day.”
But when xylazine is mixed with fentanyl, it causes horrible necrosis, or death of tissue cells, Wood said. The wounds that emerge from those who use xylazine are grotesque. Originally, doctors didn’t know what they were looking at so they would amputate, Wood said.
“Oxygen stops getting to those parts of the body. It dies off and starts to rot. You have to scrape away the dead skin to make room for some of the better healing and growth,” Wood said.
Typical overdose-reversing drugs like naloxone don’t work on xylazine, and many labs can’t detect it, Allen said. However, if an individual overdoses on a substance with xylazine, she said, they are a lot more likely to die.
That’s where the testing strips can make a difference, harm reduction advocates say.
Wood, who openly shared that he is a drug user, first got involved with CRA during the pandemic when he would bring his own cocaine to have it checked for safe use. Now, he spends 40 hours a week testing drug samples with his FTIR machine and logging data about levels of adulterants in dope that individuals from Illinois mail to him or that he picks up at their van locations in about 30 different places across the city.
CRA also holds drop-in hours at a warehouse in the Garfield Park neighborhood on Mondays, Wednesdays and Saturdays.
Wood said he even receives samples from out of state, which help him understand the broader landscape of adulterants in the country.
While volunteers sit in a large room outside his office and package safe usage kits with test strips, cookers, water capsules and paper instructions for those who don’t have a smartphone, Wood crushes up the drugs he receives in packets from users across the state.
But test strips are not always accurate, said Wood. Indeed, xylazine strips can give false positives when used in lidocaine, typically found in cocaine, but not fentanyl, said Sunderani, of BTNX.
So Wood compares test strip results with the results on his machine, which provides a more precise reading using a beam splitter, two mirrors, a laser and a detector. He tests about 50 samples a month with the help of two other technicians, he said.
“I’ve watched Illinois’ dope supply evolve over time,” he said. “Some of the things that have always been a constant are the diphenhydramine, lactose and fentanyl. The other things have increased and decreased over time. There’s a lot more quinine.”
He pointed to the glass vial of newly approved xylazine test strips that sat on the counter. CRA also offers fentanyl and benzyl strips.
Sunderani said that BTNX began to search for a specific antibody to detect xylazine after overdoses with xylazine present skyrocketed across the nation, specifically in Philadelphia. The company is poised to ramp up production if needed, Sunderani said.
“Because the need was so great, we thought that for harm reduction purposes, the evaluation was sufficiently strong for us to go to production,” he said.
CRA is waiting on a shipment of xylazine testing strips that will be distributed to the public before the end of June, and Wood said he expects to be inundated with thousands of strips. He’ll circulate them on his vans and in other harm reduction centers around the city, he said.
Chris Balthazar, executive director of TaskForce, a grassroots organization that focuses on the health and well-being of LGBTQ+ youth in Chicago, said testing strips in general are an important tool for harm reduction strategies. TaskForce currently stocks its bathrooms with fentanyl strips.
“Just like we do with condoms in our bathrooms, people are using them (test strips),” Balthazar said. “For us, that’s a win. At least you’re knowledgeable about what you’re putting in your body.”
But Wood stressed that test strips don’t negate the health treatment needed for the populations affected and touched by xylazine over the past two to three years. Indeed, Allen said harm reduction conversations from an early age are vital.
“We need to stop thinking about harm reduction as saving a life that many people view isn’t worth saving, and instead think of it as an innovative way to connect people to necessary care,” Allen said.
Wood provides a comprehensive rundown of CRA’s data to the Centers for Disease Control and Prevention, Cook County Hospital, the Cook County Department of Public Health and the Chicago Department of Public Health.
“I’m focusing on presentations and bringing awareness on what we’re seeing in the supplies and keeping them up to date,” Wood said.
He would like to figure out a way to incentivize participants of drug-checking programs, he said.
Sometimes, Wood gets a sample that has led to an overdose, which affects him, he said. A lot of volunteers at CRA have lost a loved one to overdose, he added.
“It is kind of a heavy weight,” he said. “I just hope that someday there will be enough people in this role doing this job so that there’s a wider safety net.”
Wood sits in his office in the warehouse and carefully looks through bags of samples. He looks tired all the time, he said, and his hair is falling out.
“The amount of conversations that can be had, the amount of stigma-decreasing engagements and outreach that can be provided. (Drug checking) opens up so many more doors in that way,” he said.
A volunteer came in at around 7 p.m. and hugged Wood. An end of the day tradition, he said.
The two men stood in the doorway of Wood’s office in an embrace for almost a full minute.
