By: Sandra Jojo, PharmD Canddiate c/o 2024
The United States (US) is in the midst of an opioid overdose epidemic. All across the US, opioids continue to be abused regardless of strict laws. Communities suffer the consequences as more and more individuals become addicted to illicit drugs. The Philadelphia Department of Public Health reported that 91% of samples of purported heroin or fentanyl from the local area contained xylazine, making it the most common adulterant in the drug supply.1
Xylazine is an alpha-2 adrenergic receptor agonist that is a non-opioid sedative and muscle relaxant developed in 1962 as a tranquilizer for animals such as horses, cattle, and other non-human mammals.2,3 It is not approved for use in humans and, if used, can cause toxicities such as dangerously low blood pressure, respiratory depression, slowed heart rate, and severe withdrawal symptoms. Xylazine is often abused intravenously but can also be swallowed or snorted.3 Its sedative effect has given xylazine the name “zombie drug”. This drug is also associated with necrotic skin ulcerations. Xylazine-induced skin ulcerations appear diffusely throughout the body, even at sites distant from the injection site. These ulcers are typically progressive, large, and necrotic.2
Currently facing this epidemic is a neighborhood just west of the New Jersey border, Kensington, Philadelphia, where opioids such as heroin and fentanyl are the predominantly abused drugs.4 Scattered across the roads and sidewalks, you can find used needles, naming Kensington America’s largest open-air drug market. Public parks have become a major place for illicit drug use and exchange, one being McPherson Square Park, now known as Needle Park, because of the number of syringes covering the ground. City personnel and local businesses sweep up the needles from the streets and sidewalks every morning just to find even more the next morning. Xyalazine, also known as tranq, is often found laced within fentanyl, cocaine, and heroin to enhance its effects.4 Using data from the Philadelphia Medical Examiner’s Office (MEO), the Philadelphia Department of Public Health analyzed unintentional overdose deaths with heroin and/or fentanyl detections that occurred between 2010 and 2019 in Philadelphia. Between 2010 and 2015, xylazine was detected in 40 (2%) of the 1854 unintentional overdose deaths with heroin and/or fentanyl detections. This increased to 67 (11%) in 2016, 90 (10%) in 2017, 152 (18%) in 2018, and 262 (31%) in 2019.5 Additionally, the Drug Enforcement Agency issued a public safety alert warning the American public of a sharp increase in the trafficking of fentanyl mixed with xylazine. The DEA states, “they have seized xylazine and fentanyl mixtures in 48 of 50 states and reports that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills contained xylazine.”6 In 2018, xylazine use escalated throughout the Northeast, and although predominantly recognized in Philadelphia, other major cities such as New York City are not immune to the xylazine crisis. A study published in the Journal of Analytical Toxicology detected xylazine in the drug supply in 36 states and the District of Columbia. In New York City, xylazine has been found in 25% of drug samples, though health officials say the actual saturation is certainly greater.7
Because xylazine is not an opioid, it is resistant to standard opioid overdose reversal treatments, such as naloxone, making overdoses laced with xylazine even more deadly. Healthcare officials still advise the administration of naloxone because xylazine is often combined with fentanyl, heroin, or a benzodiazepine, which can be reversed by naloxone. If the individual seems to still be unconscious but is breathing after the administration of naloxone, this can be because of xylazine, and no more naloxone is needed.3 Fentanyl and xylazine test strips are available in Philadelphia through the Substance Use Prevention and Harm Reduction (SUPHR), which is a division of the Philadelphia Department of Public Health as a means for harm reduction and allows individuals to know what is in their illicit drugs before using and be aware of laced substances.8
Addiction, poverty, and violence have ripped the Kensington community apart, forcing families to the streets into inhumane conditions. From selling drugs to abusing them, mothers, fathers, and children are now in the cycle of addiction. In February 2023, Fox News interviewed a recovering addict for a firsthand perspective on the Kensington crisis. Rodriguez, a 42-year-old, was born in Brooklyn, New York, to heroin addicts and moved to Kensington with his mother at eight years of age, looking for a better life. Kensington turned out to be no better. He described both places as an “open-air drug market.” To help his mom pay the bills and buy clothes for school, he started selling marijuana, which quickly turned to heroin. After his mom tragically passed from a motor vehicle accident, he became addicted to Percocet, which turned to sniffing heroin and ultimately shooting heroin. It was only after overdosing during a relapse that he stayed clean. After realizing he was going to be a father and was highly unfit, he packed everything and moved out of Kensington. He said, “I told myself, I have to leave. If I don’t leave, I might not be alive to leave the next time that I want to.”9 Rodriguez is now on a mission to humanize addicts. He shows them love and respect because he states, “I still see a human being under there because I know at one time that was me.”9
Illicit drugs are destroying individuals as well as their communities. Those in Kensington, Philadelphia have suffered long enough with multiple unintended deaths from overdoses and opioids laced with life-threatening substances such as xylazine. City officials and private organizations coming together to provide resources to help these individuals on the road to recovery from addiction bring hope to restoring the community.
References:
- Risks of xylazine use and withdrawal in people who use drugs in Philadelphia. Health alert. Philadelphia Department of Public Health. March 16, 2022. https://hip.phila.gov/document/2524/PDPH-HAN_Alert_1_Xylazine_03.16.2022.pdf/.
- Warp PV, Hauschild M, Tookes HE, Ciraldo K, Serota DP, Cruz I. A confirmed case of xylazine-induced skin ulcers in a person who injects drugs in Miami, Florida, USA. Preprint. Res Sq. 2023;rs.3.rs-3194876. Published 2023 Jul 26. doi:10.21203/rs.3.rs-3194876/v1
- What you should know about xylazine. Centers for Disease Control and Prevention. Last Reviewed November 28, 2023. https://www.cdc.gov/drugoverdose/deaths/other-drugs/xylazine/faq.html.
- Hoffman J. Tranq Dope: Animal Sedative Mixed With Fentanyl Brings Fresh Horror to U.S. Drug Zones. The New York Times. Published January 7, 2023. https://www.nytimes.com/2023/01/07/health/fentanyl-xylazine-drug.html.
- Johnson J, Pizzicato L, Johnson C, Viner K. Increasing presence of xylazine in heroin and/or fentanyl deaths, Philadelphia, Pennsylvania, 2010-2019. Inj Prev. 2021;27(4):395-398. doi:10.1136/injuryprev-2020-043968
- DEA Reports Widespread Threat of Fentanyl Mixed with Xylazine. Public Safety Report. United States Drug Enforcement Administration. Updated November 2022. https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine.
- Kacinko SL, Mohr ALA, Logan BK, Barbieri EJ. Xylazine: Pharmacology Review and Prevalence and Drug Combinations in Forensic Toxicology Casework. J Anal Toxicol. 2022;46(8):911-917. doi:10.1093/jat/bkac049
- About SUPHR. Substance Use Philly. https://www.substanceusephilly.com/suphr.
- Barton E. Crisis in Kensington: opioids hit Philadelphia like an atomic bomb. This man is documenting the fallout. Fox News. Published December 28, 2022. https://www.foxnews.com/us/crisis-kensington-opioids-hit-philadelphia-like-atomic-bomb-man-documenting-fallout.
