The latest drug scourge invading American cities is called “tranq,” the street name for xylazine, a tranquilizer approved for animal use. Tranq is most often found mixed with fentanyl, the powerful synthetic opioid that is behind most overdose deaths. 

Of the more than 100,000 overdose deaths between August 2021 and August 2022, 66% involved fentanyl or other synthetic opioids. Testing on fentanyl seized in drug raids in 2022 indicated 23% of the fentanyl had been mixed with tranq.

In a recent Public Safety Alert, the U.S. Drug Enforcement Administration (DEA) found tranq in samples of seized fentanyl from 48 states. “Xylazine and fentanyl drug mixtures place users at a higher risk of suffering a fatal drug poisoning,” according to the DEA. But that’s not all. Tranq has a uniquely gruesome impact on injection sites. According to the DEA alert:

People who inject drug mixtures containing xylazine also can develop severe wounds, including necrosis — the rotting of human tissue — that may lead to amputation.

In a stunning piece of in-depth journalism, Drew Hawkins at the Gulf States Newsroom recently followed homeless services provider, Suzanne Smith, around downtown Birmingham, Alabama, as she made nightly rounds checking on “her people.” Twenty years in recovery, she has never abandoned the people who live under bridges or sleep in alleys. She was fired from the University of Alabama for taking cleaning room supplies to distribute to the unhoused: bandages, wipes, blankets, etc. She now uses her own meager resources plus donated supplies.

The article focuses on the search for Jeff, one of Suzanne Smith’s regulars who has gone missing. Here’s the reporter’s description of Jeff:

Jeff had a serious infection on his leg, caused by injecting xylazine, a sedative intended for veterinary use that is sometimes mixed with other drugs, like heroin or fentanyl. It can cause skin ulcers that turn necrotic… Suzanne could see his femur bone. But Jeff wouldn’t go to the hospital because he was worried he’d be labeled as a drug user and wouldn’t receive pain medication. He was worried about the withdrawals.

This creates a life-threatening situation for addicts. If they cannot get buprenorphine or similar withdrawal drugs at the hospital, they will stay on the street and self-medicate their serious wounds. And how do they self-medicate, Hawkins asks? Maggots! 

As a last resort, Jeff had turned to a practice used for centuries to treat wounds. He slept near a dumpster with flies nearby, letting them land on his leg to lay their eggs and allow the maggots that developed to eat at the dead flesh.

Wow, that sounds extreme, and yet Jeff isn’t the only one of Suzanne Smith’s people to use the technique: “Roy suffered a bad infection in his leg after being attacked by another unhoused person. He had to resort to using maggots to clean the infected wound,” Hawkins reports. At the end of the piece, Jeff is found living in a shelter after having entered a methadone program.

A major complication with tranq is that it is not an opiate, and its effects are not reversed with naloxone. Naloxone is still recommended for opioid overdoses, as the tranq is usually mixed with opiates. However, naloxone will have no impact on the sedative powers of tranq, which can slow breathing to life-threatening levels.

Treating the necrotic wounds characteristic of tranq was the subject of the first-ever educational symposium on the subject in Philadelphia on November 23, 2024. Reporting on the event for MedicalXpress, Aubrey Whelan wrote:

Xylazine also appears to cause severe skin lesions. At Saturday’s symposium, doctors said that it’s believed the drug is toxic to skin cells and may also constrict blood vessels, slowing the circulation of oxygen in the body and making wounds slower to heal.

The symposium dealt with the problem of patients leaving treatment facilities without completing treatment. On an optimistic note, Dr. Lisa Rae, head of the burn unit at Temple University Hospital, showed how synthetic skin can be applied and wounds continue to heal even when patients leave care prematurely or continue using drugs. Sadly, the topic of amputation was also covered; in many cases, it is the only alternative for tranq wounds.

The FDA encourages healthcare professionals and patients to report “adverse events in humans” associated with possible illicit xylazine exposure. Reports can be made to the MedWatch Adverse Event Reporting program at www.fda.gov/medwatch/report.htm; or download and complete the form, then submit it via fax at 1-800-FDA-0178.

Written by Steve O’Keefe. First published December 3, 2024.

Sources:

“DEA Reports Widespread Threat of Fentanyl Mixed with Xylazine,” DEA Public Safety Alert, retrieved November 27, 2024.

“What You Should Know About Xylazine,” a YouTube video from the Centers for Disease Control, February 22, 2024.

“Where’s Jeff?: Unhoused and struggling with opioid addiction in Birmingham,” WBHM Gulf States Newsroom, November 1, 2024.

“In a first-of-its-kind meeting, Philly doctors discussed how to treat tranq wounds,” The Philadelphia Inquirer, November 27, 2024.

“In a first-of-its-kind meeting, doctors discuss how to treat addicts’ tranq wounds,” MedicalXpress, November 27, 2024.

Advertisement for “The Xylazine Crisis” symposium courtesy of The Rothman Institute, used under fair use: Commentary.