'Enormous problems:' Animal sedative found in local drug supply increases overdose risk

A powerful animal tranquilizer that can increase the risk of overdose and cause serious skin wounds has been found in the local drug supply, the Rhode Island Department of Health warns.

Xylazine, used to sedate large animals such as horses and cattle, is not approved for human use and has been linked to "an increasing number of overdose deaths nationwide," according to the National Institute on Drug Abuse.

Also known as "tranq," xylazine can cause long-lasting, deep sedation, low blood pressure, a slowed heart rate and decreased breathing in humans. Injection can also cause severe skin and soft tissue wounds and ulcers that can lead to infection and even amputation.

More:Information on xylazine from PreventOverdoseRI

"The presence of xylazine in the drug supply creates enormous problems for the people we serve," said Colleen Daley Ndoye, executive director of Project Weber/RENEW in Providence, an organization that works to protect drug users from harm. "Xylazine does not respond to naloxone, so our standard response to overdoses is not always effective."

The organization has also seen "an increase in serious wounds developing from xylazine, which can lead to hospitalization and even death if not properly treated," she said.

In Rhode Island, xylazine has been found in multiple drug samples in combination with fentanyl, a synthetic opioid responsible for most of Rhode Island's accidental drug overdose deaths, according to PreventOverdoseRI.org, which tracks data on addiction and overdose in Rhode Island as part of the state's effort to address the problem.

Is xylazine an opioid?

Unlike fentanyl, xylazine is not an opioid.

"When xylazine is added to fentanyl/heroin the risk of overdose is higher," according to testRI, which is studying the local drug supply. "Narcan (naloxone) will reverse the effects of opioids but has not been documented to reverse xylazine’s sedating effects. If a person overdoses from a substance cut with xylazine they might still be sedated after Narcan administration."

Part of a two-year study, testRI tests drugs and used equipment like pipes and syringes to find out what's in the Rhode Island drugs supply and how changes to it affect drug users.

In September, testRI analyzed five counterfeit pills billed as Percocet and found that all five contained fentanyl and xylazine. In December, xylazine and fentanyl, along with other substances, were detected in a syringe found at Roger Williams National Memorial Park in Providence, according to testRI. PreventOverdoseRI also reported the presence of xylazine in 28 of 61 samples tested around the state between May and August.

The test RI study notes that samples are "not being tested in relation to overdose so outcomes from use, like overdose, are unknown." The state Health Department tracks accidental overdose deaths, but their online information doesn't indicate whether xylazine has played a role in overdose deaths in Rhode Island.

Is xylazine causing overdose deaths in Rhode Island?

Driven by fentanyl, the number of accidental overdose deaths in Rhode Island has increased dramatically since 2009 when 138 died, with 5% of those deaths fentanyl-related, according to the Rhode Island Department of Health. In 2021, Rhode Island had a record 435 accidental overdose deaths, with 77% of them, or 334, fentanyl-related.

The state has not finalized the number of accidental overdose deaths for 2022. As of now, the state's website shows 334, but the numbers for July through December are incomplete. It's unclear how many of the 2022 deaths are fentanyl-related.

The National Institute on Drug Abuse says "the full national scope of overdose deaths involving xylazine is unknown," but "research shows overdose deaths linked to xylazine have spread westward across the United States, with the largest impact in the Northeast."

Dr. Rachel Wightman, an assistant professor of emergency medicine at Alpert Medical School of Brown University, and Alexandra Collins, an assistant professor of epidemiology at the Brown University School of Public Health, are leading the testRI study as co-principal investigators.

"Xylazine has been reported in some U.S. drug supplies for decades, but over the last few years we have seen a steady increase in xylazine reports," Collins said. "In Rhode Island, we have just really started seeing an uptick of xylazine in the local drug supply, with it presenting alongside fentanyl."

Nationally, the problem has been especially prevalent in Philadelphia. For example, the number of fatal overdoses involving xylazine in Philadelphia increased from 15 in 2015 to 434 in 2021, according to Wightman. Data from Philadelphia shows that overdose deaths involving xylazine are predominantly associated with opioids, she said.

In Rhode Island, health officials are warning drug users of the dangers of xylazine. Unlike with fentanyl, there's no easy way to test for its presence in drugs.

"We are doing our best to educate the people we serve and the general population about the health risks of this drug," Daley Ndoye said. "We also connect people to medical care as a way to prevent infections from becoming deadly."

PreventOverdoseRI offers this advice: "Never trust yourself to determine if a purchased or shared pill is legitimate. The best way to avoid counterfeit medications is to take only medications prescribed by a licensed healthcare professional and dispensed by a registered pharmacist."

For those who use drugs obtained illegally, PreventOverdoseRI advises carrying naloxone and making sure they're not alone when using.

"Drugs that have xylazine in them very often have fentanyl, too. This means it is important to always give naloxone if you think someone is overdosing," PreventOverdoseRI says. "However, since naloxone doesn’t reverse the effects of xylazine, it’s important to always call 911 if you think someone is overdosing."

This article originally appeared on The Providence Journal: Animal sedative xylazine in RI drug supply is increases overdose risk