It’s the new silent killer in Mississippi.
Since 2020, the state has seen at least 27 overdose deaths from the animal tranquilizer xylazine, either alone or combined with fentanyl, said Col. Steven Maxwell, director of the Mississippi Bureau of Narcotics.
“It’s a crisis,” he said. “We’re not experiencing the crisis as much as places like Philadelphia, Atlanta, San Francisco and Los Angeles, but we are experiencing a crisis with regard to the lacing of fentanyl with other drugs, such as xylazine.”
The number of drug overdose deaths in Mississippi have nearly tripled since 2018, reaching 754 in 2021, according to the most recent state Department of Health statistics. The overdose deaths of Black Mississippians have catapulted from 37 to 165.
Nationwide, drug overdose deaths have doubled between 2015 and 2022, according to provisional data from the U.S. Centers for Disease Control and Prevention. Synthetic drugs, such as fentanyl, now make up more than two-thirds of those fatalities.
At HMP Global’s recent RX Summit in Atlanta, Dr. Rahul Gupta, director of the Office of National Drug Control Policy, announced that his office had designated the fentanyl-xylazine mix as an emerging drug threat.
“If you thought fentanyl was dangerous and deadly before, it has become even more lethal and destructive now,” he said. “We all must act.”
Xylazine is a non-opioid animal tranquilizer, typically administered by veterinarians to horses, cattle, deer, elk and moose.
Illicit use of the sedative has been skyrocketing in recent years. In 2015, the drug was involved in 2% of overdose deaths in Pennsylvania; now it’s involved in more than a fourth of those deaths.
The biggest growth has come in the South, which saw the highest increase in seizures of xylazine (193%) between 2020 and 2021, according to the Drug Enforcement Administration.
“Xylazine is not safe for human consumption,” Gupta said, “and it has potentially deadly consequences when used.”
Advocacy groups such as Drug Abuse Resistance Education have called xylazine “worse than fentanyl,” which is already involved in more deaths of Americans under 50 than any cause of death, including heart disease, cancer, homicide, suicide and other accidents, according to the DEA.
Because xylazine is designated for use in animals that may weigh significantly more than the average American, the effects on the human body are far greater, said William Lynch, a New Jersey clinical pharmacist who spoke at the RX Summit.
Xylazine not only slows breathing and the heart rate, but can cause the blood pressure to plummet, especially when used in combination with fentanyl, he said. In addition, users injecting the drug can develop severe skin ulcers that can resemble horrific burns, leading to skin grafts, possible amputation or even death.
When someone overdoses on fentanyl, emergency responders can use naloxone to try and revive that person. But when someone overdoses on a combination of fentanyl and xylazine, the naloxone has no effect on the xylazine, Lynch said. But it should still be given to reverse the effects of fentanyl, he said.
If naloxone does revive someone, “they have to go to the hospital,” because they could suffer from what he called “flashback pulmonary edema. They could possibly stop breathing and essentially drown in their sleep from fluid that accumulates in the lungs.”
On the streets, xylazine alone is known as “tranq,” or “tranq dope” when it’s mixed with fentanyl, he said. Experts say both dealers and drug users may mix the pair to prolong the opioid high.
Fentanyl has virtually replaced heroin on the streets because of its price tag, he said. While heroin costs about $23,000 a pound, according to a 2020 study, fentanyl is 10 times cheaper. Xylazine can run less than $10 a pound, according to a DEA report.
With regard to the suspected heroin seized in New Jersey, he said, 98% tested positive for fentanyl; only 2% had heroin alone. In New Jersey in 2022, of the 98% drug seizures that tested positive for fentanyl, 36% of those samples tested positive for xylazine.
In nearby Philadelphia, xylazine is supplanting fentanyl. In seizures there, Lynch said, there are 24 parts of xylazine to every one part of fentanyl, and the purity of the xylazine has gone up while the purity of the fentanyl has gone down.
Xylazine has long been easy to obtain, he said, and anyone could have had it delivered to their homes, not just veterinarians. To combat this, the FDA recently started tracking xylazine shipments.
Because it can be purchased cheaply in a powder or liquid form, dealers can mix this sedative with other drugs, which makes fatal overdoses a real possibility, he said.
Unlike fentanyl, xylazine isn’t illegal, which means there are no laws that give police the power to arrest.
Making xylazine a controlled substance would enable authorities to arrest those possessing or trafficking xylazine, Maxwell said. “It would be treated like any illicit drug.”
To attack this problem, governors in Ohio and Pennsylvania have declared xylazine a controlled substance. There is also a push in Congress to make it a controlled substance federally and also in some state legislatures, although not so far in Mississippi.
Asked if Gov. Tate Reeves supports the state making xylazine a controlled substance, Press Secretary Shelby Wilcher replied that there is currently legislation pending in Congress that would make the drug a Schedule 3 substance under federal schedules.
“The Office of the Governor works closely with the Mississippi Department of Health and Mississippi Department of Public Safety on an annual basis to update the state’s drug schedules,” she said. “Xylazine will certainly be part of the discussion.”
Lynch said one advantage to taking this step is veterinarians and their practices would be required to track the drug, just as they do with opioids and other controlled substances they use. “If you ever waste any of it,” he said, “you have to document the destruction with a witness.”
One concern about making xylazine a controlled substance is how it might affect veterinarians, who have used the sedative for half a century, said Bill Epperson, professor and head of the Department of Pathobiology and Population Medicine at Mississippi State University’s College of Veterinary Medicine.
The drug is typically used for pain relief and to “calm fractious animals,” he said. “There is not a good substitute for xylazine in large animal general practice.”
Given that veterinarians have used xylazine responsibly for decades, the drug should still be used “to support the legitimate practice of veterinary medicine,” he said. “We are strongly in favor of harsh penalties for those suppliers engaged in illicit activity.”
In March, Congress introduced the Combating Illicit Xylazine Act, which would make illicit use of xylazine fall under Schedule III penalties and allow legitimate veterinary use to continue. The American Veterinary Medical Association supports the bill.
Lynch warned that xylazine “is just the drug de jure,” and others are certain to follow. For example, he said, the synthetic opioid isotonitazene (known as “ISO”) “is approximately three times more potent than fentanyl and has already been seen in New Jersey and other parts of the country.”
This ever-changing chemistry puts authorities “in the position of playing whack-a-mole,” with new synthetic drugs certain to follow, Maxwell said. “We’ve got to find a way to loop in any lethal cocktail or any drug that’s enhanced beyond its potency.”