As if we needed more bad news on the drug front: A common livestock sedative, street name “Tranq,” has made its way into other dangerous drugs like fentanyl. Also called xylazine, Tranq was first manufactured in 1962 by Bayer Pharmaceuticals and is used by veterinarians on cattle and horses to relieve pain, relax muscles, and sedate them for procedures. It is not FDA-approved for any purpose in human medicine.
Last week, the government formally designated xylazine as an “emerging drug threat.” The DEA indicates that 23 percent of tests for fentanyl in 2022 revealed evidence of Tranq in the sample. In the two-year period from early 2020 through late 2021, positive lab results grew 112 percent in the West and 193 percent in the South.
Tranq’s low cost is the reason it’s being mixed in with batches for more expensive drugs, including heroin. You might be surprised to find out that it’s not illegal (yet). A prescription from a vet is all you need to get your own supply.
Xylazine is not an opioid, but acts like it. Like opioids, it’s highly addictive, slows breathing and heart rate, and increases the risk of fatal overdoses. It causes the user to black out for hours, rendering them vulnerable to rape and robbery. Once they come to, they immediately crave more.
Tranq is unlike other drugs in one major way: It also causes the formation of skin ulcers and abscesses, some quite horrific. Many harden into painful, crusty, blackened tissue called “eschar.” Indeed, some call xylazine “the zombie drug” for the way its users appear. The skin effects may be so severe as to require amputation.
Doctors are still confounded by how xylazine causes wounds so severe that they initially resemble acid burns. The skin effects may not even appear at the injection sites; some users get them on their shins and other areas far from the needle puncture.
Withdrawal from the drug is as bad as many narcotics. Symptoms include migraines, double vision, severe anxiety, and more. But Xylazine is not an opioid: This is significant because you can reverse a fentanyl, heroin, or oxycodone overdose with the drug naloxone (brand name: Narcan), now available over the counter. You might not be able to fully revive a user of Tranq with it.
It’s uncertain where street xylazine is originating today, but China, Mexico, India, and Russia are prime suspects. Some also may come from domestic manufacturers who supply veterinarians.
Because the recognition of xylazine abuse in humans is relatively new, there are still few protocols to guide physicians on how to counteract the drug. No one yet knows which are the best rehabilitation therapies. In addition to addiction services, intensive wound care strategies are required to deal with the skin manifestations of Tranq use.
One of the difficulties associated with controlling Xylazine distribution is the widespread nature of its use in veterinary practices. It is frequently used in large-animal medicine to allow vets to stitch wounds, grind down molars, and treat damaged or infected hooves. Preserving the drug’s access for veterinarians while shutting down supplies to dealers may be problematic.
Although the drug is in a legal gray zone at present, laws are evolving in some states to restrict access to it. The formal designation of “emerging drug threat” given last week means that the administration must put together a plan of action to combat its use within 90 days. That plan of action will hopefully expand testing, devise treatment strategies, and give federal law enforcement the authority to act against suppliers.
In any case, it’s clear that a porous Southern border has allowed the easy transport of dangerous substances like Tranq, fentanyl, and more into the United States. Is there an answer for the latest emerging threat? As long as we fail to control its importation, the prognosis is grim. Without major changes at the border, we can expect many more lives lost or ruined from the scourge of illegal drugs.
Joe Alton MD
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