Republic fiile photo Dr. Kevin Terrell is shown in an interview at his office in Columbus.
An animal sedative that federal law enforcement officers says is being increasingly mixed with fentanyl and other illegal drugs could increase the chances of unintentional overdoses and death.
Xylazine, also known by its street name “tranq,” is a veterinary drug first developed in the 1960s as a sedative and muscle relaxer for animals like cattle, horses and elk, according to the Drug Enforcement Administration.
However, the drug, which is not approved for human use, is now popping up in “an increasing number of illicit drug mixtures” and “has also been detected in a growing number of overdose deaths,” according to a DEA report published in October.
“People who use the contaminated drugs would not know they’re taking substances that are cut with xylazine,” said Dr. Kevin Terrell, medical director at Columbus Regional Health’s Treatment and Support Center, or TASC. “This clearly puts them at increased risk of unintentional overdose and death, particularly because naloxone doesn’t reverse xylazine.”
Drug users often are not aware that the drugs they are consuming contain xylazine, officials said. Though not an opioid, xylazine can have similar effects, including sedation, a slowed respiratory rate, among others. Users who inject xylazine or drug mixtures with xylazine also can develop soft tissue injuries that can lead to necrotic tissue and may result in amputation, the DEA report states.
Adding another danger to the drug, xylazine overdoses cannot be reversed by naloxone because it is not an opioid and does not target the same receptors in the body. Naloxone is a nasal spray often sold under the brand name Narcan that can temporarily reverse an opioid overdose.
Currently, xylazine is most commonly found in combination with fentanyl, a synthetic opioid that is up to 50 times more potent than heroin that officials say is largely responsible for a historic rise in overdose deaths across the country, including Bartholomew County. The veterinary drug also has been detected in mixtures containing cocaine, heroin and several other substances, according to the DEA report.
Unknown prevalence
Currently, it is hard to say how prevalent the animal sedative is in the illegal drug supply. There is no comprehensive count of xylazine-positive overdose deaths in the United States because not all states routinely test for the drug when they suspect someone has died from a drug overdose. Testing procedures also can even vary within states.
However, the DEA says that testing done at its field divisions across the country show that xylazine-positive overdose deaths “have experienced a significant jump from 2020 to 2021,” according to the report.
The agency reported “a minimum” of 3,089 xylazine-positive overdose deaths across the U.S. in 2021, up from 808 in 2020, the report states.
While the South experienced the largest percentage increase of any region of the country, from 198 in 2020 to 580 in 2021, the Midwest saw a six-fold increase from 57 deaths in 2020 to 351 in 2021, according to DEA figures.
Mike Gannon, assistant special agent in charge at the DEA’s Indianapolis Field Office, said it is hard to know how prevalent the drug is in Indiana, but emphasized that it is often found with fentanyl and other illegal substances.
In 2021, almost every xylazine-related death reported in Marion County also involved fentanyl, Gannon said.
“For evidence that we’ve submitted in the last year to our DEA laboratory, we’ve determined that there have been probably 29 different exhibits that have contained xylazine,” Gannon told The Republic. “It’s not just xylazine. It’s contaminated with other drugs.”
Local testing
Locally, xylazine is included among the substances that the Bartholomew County Coroner’s Office tests for, said Bartholomew County Deputy Coroner Jay Frederick.
The Bartholomew County Coroner’s Office said xylazine has been detected in some local toxicology testing but has not been common.
“In our toxicologist’s words, ‘it doesn’t belong in a human being,’” Frederick said.
Terrell said he does not know if any of his patients have knowingly or unknowingly used xylazine because TASC’s urine drug screen does not detect the drug “and the drug screen at CRH, and other hospitals, wouldn’t detect xylazine either.”
The lab that TASC uses could send the specimen to another lab to test for xylazine, but “the results would not be back to me for 1.5 to two weeks, which lessens the usefulness of the test,” Terrell said.
“Given the under-testing that occurs in both living and deceased people, we can be sure that reported numbers for xylazine use are much lower than reality,” Terrell said.
Pending legislation
However, testing for xylazine could become more common in Indiana. A bill pending in the Indiana House of Representatives would require a coroner to test for the drug if he or she “reasonably suspects” that the person died from an overdose.
The bill, HB 1286, was authored by Rep. Jennifer Meltzer, R-Shelbyville. Rep. Ryan Lauer, R-Columbus, has signed onto the legislation as a co-author.
As of midday Friday, the bill was pending before the House Committee on Local Government.
“This legislation is another step in our fight to protect Hoosiers and combat drug addiction in our communities,” Meltzer said in a statement. “…We do know that xylazine has been traced to heroin used in Shelby County, and can be linked to a local death. …By screening for this substance when there is an overdose death, as my legislation proposes, we can get a clearer picture of the drug’s prevalence, ramp up public warnings and make changes to response plans.”
In the meantime, xylazine has grabbed the attention of officials across the country, including the White House. Earlier this month, the director of White House Office of National Drug Control Policy held a meeting with the Biden administration’s Evolving and Emerging Threats Committee to discuss, among other things, the emergence of fentanyl adulterated with xylazine in the illegal drug supply, the White House said.
Gannon said that while fentanyl currently remains the “devastating” threat in Indiana, drug users often have no idea what they’re consuming.
“What people have to understand is that when a drug comes into the country — whether its heroin, methamphetamine, cocaine, fentanyl — any person that gets ahold of those drugs can do whatever they want to it, and they can put in whatever they want,” Gannon said. “So, by the time it gets to the streets of Indianapolis or Indiana, that could have changed hands three, four, five times.”
“When you add anything to a drug, you don’t know what you’re getting,” Gannon added. “There’s no quality-care control.”
