A Northern Kentucky doctor examined a patient who was hospitalized for weeks when caregivers removed all of the skin on her forearm to save them from amputation.
Dr. Mike Kalfas said the woman had taken the opioid fentanyl contaminated with an animal tranquilizer that causes tissue death, a condition that is becoming increasingly common in the Cincinnati area.
I am educating my patients,” Kalfas said. I told them, look, there are some bad things that could be in your drugs that Narcan won’t save you from.
That stuff is xylazine, commonly known as tranq dope, and it’s the latest challenge in the opioid epidemic. The drug is cheap and easy to get, so sellers add it to their fentanyl supply to multiply profits. It prolongs the euphoric effect for drug users but causes chaotic health conditions.
Xylazine started appearing in the northeastern United States a few years ago but exploded around 2020, with Philadelphia as the epicenter. And while some amount of xylazine has been found in most states, hot spots are spreading westward. Ohio, Indiana and Kentucky were surrounded. This trend is following the same path as fentanyl did a decade ago.
“It’s called a tranq because it’s a type of tranq,” said AmandaLynn Reese, program director for the Ohio Harm Reduction Foundation. It is a sedative used for pets.”
The Cincinnati area is a trouble spot for quiet
As addiction doctors, harm reduction staff, public health laboratory officials, and criminals witnessed manifestations of xylazine in the Cincinnati area, xylazine monitoring experts became involved in the investigation. Opioid crisis warns that there is not enough testing nationwide to understand its impact.
In September, a San Diego-based drug testing laboratory called Millennium Health released a report showing how common the drug was in drug tests ordered by doctors across the country. America.
Researchers looked for xylazine in more than 160,000 fentanyl-positive samples starting on April 12, the day the White House issued a nationwide warning about the drug, and ending on July 20. After that, They ranked the states with the most positive tests for xylazine. Ohio, Indiana and Kentucky ranked 3rd, 5th and 7th, respectively.
Dr. Roberto Soria, CEO and medical director of the Crossroads Center, a methadone and addiction clinic in Corryville, suspected xylazine was causing complications for some of his patients and for the first time requested a review. tested this drug in April.
He said analyzes showed that 1 in 4 tests positive for fentanyl were also positive for xylazine. He tracked these results, averaging more than 500 tests per month. In September, he said the ratio had increased to more than 1 in 2.
The Hamilton County Coroner and Crime Lab also reported the number of items testing positive for xylazine jumped from 1,541 in 2022 to 1,594 from Jan. 1 to Sept. 30. The same office also saw presence of xylazine in drug overdose deaths, from 48 between April and December of 2022 to 86 between January and September of 2022 now.
This is another development in this fentanyl crisis,” said Eric Dawson, vice president of clinical affairs at Millennium Health and author of the report.
Terrifying health threats follow the animal sedative xylazine
Health threats from xylazine are widespread, from slow heart rate, low blood pressure and dementia to serious skin damage. A person may take the drug without knowing it, leading to painful withdrawal and possibly discouraging people from seeking medical care.
Dr. Richard Ryan, an emergency medicine physician at the University of Cincinnati Medical Center, said his department is seeing an increase in the number of patients with xylazine-related health crises.
Don’t assume it’s safe, he said. Inhaling or swallowing it does not prevent you from complications.
The drug is commonly used to anesthetize cattle, sheep, horses or dogs and is complex because it attacks the body in many ways, Ryan said.
Xylazine reduces adrenaline, causing drowsiness, he said. That drop can lead to dangerously slow heart rate, low blood pressure, respiratory failure and more. It can also narrow microscopic arteries in the skin, reducing blood supply to the skin and creating open sores, which can become open wounds.
According to medical articles, ulcers can appear anywhere on the body. Unlike injection ulcers that intravenous drug users may experience, xylazine ulcers are a systemic effect of the drug itself. And as the open wound progresses, the affected tissue may die.
Brandi McNamee, a nurse with the Butler County General Health District, has noticed more clients with xylazine ulcers at the county’s safer drug use sites. She offered to clean the wound and the site provided wound care supplies.
But sometimes the skin around the wound is hard and black, she said. It’s dead tissue. When McNamee saw that, she urged the client to go to the hospital. Doctors must remove all dead skin.
Soria also said he’s noticed a significant increase in skin lesions and withdrawal from fentanyl and xylazine mixtures. “This makes it much more difficult for my patients to stop using illegal street drugs,” he said.
Ryan said weaning animals off tranquilizers is very difficult. People with the disease experience high levels of anxiety, rapid heart rate, and high blood pressure among other symptoms.
One of the biggest problems with xylazine spreading across the country is that it has not been recognized, said Dr. Kelly Ramsey, director of health services for the New York State Office of Addiction Services and Supports.
People may not know they have used xylazine. Medical examiners don’t always test for it, and crime labs often don’t have the tools. “We lack best practices for treating wounds with xylazine, treating xylazine withdrawal, and managing xylazine use disorder,” Ramsey said.
Xylazine overdose is more difficult to reverse because it does not react with naloxone and bystanders trying to save someone’s life may not realize what is happening. Ryan said people should still use naloxone if they see someone who appears to be overdosing. They also regularly took fentanyl.
If that doesn’t work, call 911, Ryan said. Start CPR.
Xylazine test strips are available but are often illegal
There’s a simple way to test for animal tranquilizers in your personal drug supply: xylazine test strips, which became available in March. But most states consider them illegal drug paraphernalia. France.
Soria, from Crossroads Center, said he cannot provide xylazine test strips to patients because they are considered personal items. He said that has to change.
In the Cincinnati area, the Hamilton County, Butler County and Northern Kentucky health departments are distributing these strips at safer drug use sites, regardless of their legal status.
“We encourage all of our clients to check all of their opioids,” said Sharona Bishop, harm reduction specialist and advocate with the Butler County General Health District.
Ohio in April changed its drug paraphernalia law to legalize people testing their drugs for fentanyl. But Bishop said there needs to be a general law authorizing testing, so whenever test strips are given, it is legal to possess and use.
A federal bill introduced in July would prevent states from banning the distribution or use of fentanyl and xylazine strips. The bill has not received a vote in Congress.
What now? Classify.
Meanwhile, those monitoring the evolving xylazine crisis in the Cincinnati area say they are trying to keep people safe and alive.
“Most of my patients are still trying to avoid xylazine, but this passes when they lose their fear, just as the fear passes with fentanyl use,” says Soria.
For his part, McNamee is vigilantly monitoring people arriving at Butler County locations with unusual sores or discolored skin.
“I just want to help anyone I can so the ulcer doesn’t get worse,” McNamee said. I would hate to see anyone lose a limb.
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