Paul LaKosky has about $30,000 worth of xylazine test strips sitting in a room next to his office at Tacoma Needle Exchange. The harm reduction group, which hands out clean syringes and other supplies to people who use drugs, has been testing illicit substances for xylazine since February.
But LaKosky, the needle exchange’s director, only knows of two test strips that have returned positive results.
Xylazine, a veterinary tranquilizer commonly used on horses, has infiltrated the fentanyl drug supply in pockets of the United States. Its rise marks a devastating twist in the country’s ongoing opioid crisis.
Also known as “tranq” or the “zombie drug,” xylazine can cause gruesome wounds when people inject it, sometimes even leading to amputations. The drug triggers stupor in humans that can last for hours and opioid overdose medications fail to reverse its effects.
Xylazine is widespread on the East Coast, particularly in Philadelphia, where up to 91% of purported heroin and fentanyl samples in 2021 had xylazine present. And in April, the White House designated fentanyl mixed with xylazine as an emerging threat in the United States.
But in Washington state, experts and advocates say they’re not yet seeing much xylazine in the drug supply — and some, like LaKosky, are worried that funding and resources will be redirected to xylazine, when fentanyl is still the state’s larger crisis.
“My fear with the whole panic over xylazine is that funding will be diverted away from something that is actually killing people to something that might be killing people,” LaKosky said.
Xylazine in Washington
Alison Newman of the University of Washington’s Addictions, Drug and Alcohol Institute, which works with Tacoma Needle Exchange to track drug trends in the state, said researchers are not yet prepared to publicly release numbers but have “not seen much xylazine yet.”
“What I can safely say given the data that we have is xylazine is present in Washington in small numbers compared to other parts of the country,” Newman said.
Xylazine has long been in Puerto Rico’s illicit drug supply, and records of the drug’s presence in Philadelphia date back to at least 2006. Deaths connected to the powerful sedative, which is mixed with fentanyl to prolong that drug’s short-acting high, skyrocketed in areas across the Northeast from 2015 to 2020.
But in Washington, both the Seattle and Tacoma police departments told the Standard their officers have not yet made any arrests or busts that involve xylazine. The federal Substance Abuse and Mental Health Services Administration’s Homeless and Housing Resource Center has recorded under 50 lab cases of xylazine in the state. Since 2019, the state Department of Health has recorded just 16 overdose deaths involving the drug.
In contrast, fentanyl is a main driver of overdose fatalities in Washington: 1,762 people died in 2022 alone from synthetic opioids, which largely refers to fentanyl. That’s 65% of drug overdose deaths in the state in 2022.
Narcan or naloxone, the lifesaving opioid overdose reversal medication, does not work to reverse a xylazine overdose because the drug is a sedative. Even so, fentanyl is the more lethal of the two drugs, said Libby Jones, program director of the Global Health Advocacy Incubator’s Overdose Prevention Initiative. Experts recommend using naloxone even when xylazine is present to reverse any effects from fentanyl.
“A fentanyl overdose — it’s lethal quickly,” Jones said. “The more imminent threat is fentanyl.”
Tacoma Needle Exchange runs the largest needle exchange distribution system in the United States and is leading Pierce County’s xylazine response — but to LaKosky’s knowledge, they haven’t confirmed a single xylazine case at a needle exchange site.
LaKosky’s team also hasn’t seen symptoms of xylazine use — like the scaly and painful open flesh wounds the drug is known for — at needle exchanges. In fact, LaKosky said because most people snort fentanyl and injecting heroin is on the decline, his team has seen fewer people overall with lesions or wounds from drug use.
A spreading threat
Olivia Sugarman, a drug overdose researcher at Johns Hopkins University whose work focuses on Midwestern and Eastern states, said it seems inevitable that xylazine will eventually end up in the West Coast drug supply. LaKosky’s fears of diverting resources away from the fentanyl response are reasonable, she said — but she hopes her West Coast counterparts will still prepare.
Drug trends often start on the East Coast and move west, and xylazine is now present in 48 of 50 states — so while it may not be as prevalent on the West Coast, Sugarman said it’s spreading.
Sugarman also pointed out that federal policy focuses on the xylazine-fentanyl mix, not pure xylazine. The White House’s blueprint for dealing with xylazine, for example, is called the “Fentanyl Adulterated or Associated with Xylazine Response Plan.”
“The fact that ‘fentanyl’ is the first word in that title tells me there’s acknowledgement that xylazine is part of the fentanyl cocktail,” Sugarman said.
LaKosky isn’t convinced.
“My bigger point is, we need additional resources to address both fentanyl and xylazine, not the same amount of resources (now) split to address the ‘combined’ problem,” he said in an email.
Newman, at the University of Washington, said it’s important to pay attention to drug trends in order to provide the right kinds of support.
The effects of xylazine use are uniquely difficult to care for. LaKosky and Newman have heard anecdotes of medical providers carrying oxygen tanks as the first line treatment of a xylazine overdose — just to keep people alive.
There are also very few means of helping people get off of xylazine, and Sugarman said she can’t even describe how excruciating xylazine withdrawal is. People who use drugs also report that xylazine wounds, unlike usual drug-associated wounds, happen regardless of whether they’re injecting or snorting the drug, Sugarman said.
Need for a holistic response
While xylazine presents unique challenges, advocates and experts say harm reduction and treatment are still the most effective ways of combating the drug crisis, regardless of what drugs are in the supply. Research suggests harm reduction and medication-assisted treatment are both highly effective and life-saving.
Sugarman said harm reduction tactics like providing clean needles can reduce the severity of xylazine wounds. LaKosky said much of the danger involving drugs — such as diseases transmitted through blood — can be mitigated if the supplies people use are hygienic and people can test their drugs to know what’s in them. And Newman said harm reduction helps keep people alive.
“We don’t need to be coming up with a new approach to xylazine specifically,” said Jones, with the Overdose Prevention Initiative. “What’s more important right now is everyone who needs treatment for their substance use disorder gets it.”
“That’s how we’re going to stop xylazine,” Jones added.
—-
This story was originally publishedby Washington State Standard.