Elissa Tierney (right) and her daughter (middle) met President Joe Biden (left) at an event in Philadelphia.
Elissa Tierney
Xylazine is an animal tranquilizer that’s been turning up in street drugs for nearly a decade.
Elissa Tierney is a former user who said she deliberately sought out fentanyl mixed with xylazine.
The first time she took the drug combo she woke up unable to see or hear and was gasping for breath.
Elissa Tierney said she had been using fentanyl for so long that she was no longer feeling the euphoric effects — just using to keep from experiencing withdrawals.
When she unknowingly took fentanyl with xylazine for the first time four years ago, she said she woke up gasping for breath, unable to see or hear.
“It was the scariest experience of my life,” said Tierney, who is now in recovery and working to found a nonprofit, Worth Saving, with her 9-year-old daughter.
What is xylazine and why Tierney sought it out
The drastic rise in xylazine-related deaths led the White House to declare it an “emerging threat.”
Pacific Press / Contributor / Getty Images
Xylazine, aka “tranq”, is an animal tranquilizer that has no approved use in humans. And yet, it’s increasingly found in street drugs, often with fentanyl, a powerful opioid.
Opioids contributed to 80,411 overdose deaths in 2021, up from 68,630 deaths in 2020, data from the National Institute on Drug Abuse shows.
While xylazine-laced fentanyl accounted for a small percentage of those deaths, the number of deaths involving the tranquilizer rose to staggering amounts between 2020 and 2021, leading the White House to label xylazine as an “emerging threat” last week.
The southern US had the sharpest increase of 1,127% more xylazine-related deaths in 2021 compared to 2020, and the region has also seen the largest rise (193%) in reported instances of the drug, according to the Drug Enforcement Agency.
But other regions across the US are also seeing a disturbing upward trend. In the West, the number of xylazine-related deaths increased 750%, the Midwest saw a 516% increase, and the Northeast experienced a 103% increase from 2020 to 2021.
Eventually, Tierney said she got help and went through an excruciating withdrawal process before getting sober.
But four years ago, she said she continued to seek out the animal tranquilizer despite its risks.
“The person I was using with liked that it had some effect, even if that effect was sleeping for hours,” Tierney said. “We figured it was better than feeling your emotions, plus it was cheaper.”
Xylazine is a sedative that can lead to respiratory and cardiac issues
Opioids, like fentanyl, contributed to more than 80,000 overdose deaths in 2021.
MediaNews Group/Orange County Register via Getty Images / Contributor
As a sedative, xylazine depresses the central nervous system, which can cause your blood pressure to spike, then drop, said Dr. Emily Kauffman, director of Emergency Addiction Services at The Ohio State University Wexner Medical Center, who frequently treats overdose patients.
It also interferes with your heartbeat and breathing, according to the DEA. Low blood pressure can lead to shock, and issues with breathing and heart rate can be fatal.
Tierney said she didn’t notice any effect on her heart when she took the drug. She would just fall asleep for hours at a time.
“It’s not the effect that I like, but it’s better than feeling like every second is impending doom,” she said.
As her body became tolerant of the drug —which can happen, according to the DEA — she said she didn’t experience the same scary side effects she had the first time. She also didn’t sleep as long and said she just felt mellow.
“Like you’re calm but you don’t feel like doing anything,” she said.
Mixing xylazine with fentanyl is particularly problematic
Mixing xylazine and fentanyl can amplify xylazine’s sedative effect and the associated health risks.
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Opioids, like fentanyl, act on receptors in the brain. That can produce a feeling of euphoria, but the main danger is that it can also suppress breathing.
“We know that opioids will kill you fastest by stopping your breathing,” Kauffman said.
Xylazine doesn’t affect your brain’s opioid receptors. Instead, it acts on the alpha-2 adrenoceptors, which control the heart and central nervous system, among other things.
That’s why a combination of xylazine and fentanyl can be particularly problematic, said Dr. Ben Nordstrom, chief medical officer with Behavioral Health Group, a network of opioid treatment centers. The DEA said that taking fentanyl and xylazine can increase the risk for fatal overdose.
“There is a ‘one plus one equals three’ effect,” Nordstrom said.
Despite the different mechanisms, both drugs have a severe toll on the body, and he said using them together can amplify sedation and the associated health risks.
Xylazine has been turning up in street drugs for years
Xylazine has recently been getting attention in the press, possibly because of the horrific skin ulcers that people who inject it often develop, Kauffman said.
Yet reports first identified a rise in illicit use of xylazine in Philadelphia in the 2010s. Tierney said she was living in Pennsylvania when she first used the drug in 2019.
“I truly believe there is a massive disconnect between what happens on the streets and when the public and authorities’ address it,” she said. “Four years ago I was trying to warn people about this new adulterant in the drug supply and only now is it being addressed.”
Tracking xylazine and other new drugs is difficult, Kauffman said. Fentanyl can be detected with a rapid urine screen, but she said testing for xylazine at Ohio State takes about 13 days on average.
Without real-time data, it’s hard to know how widespread the drug is.
Narcan won’t work on xylazine, but it can still help opioid overdose victims
A nurse demonstrates the application of the NARCAN nasal spray medication at a outpatient treatment center in Indiana, Pennsylvania, on August 9, 2017.
Reuters
The opioid overdose reversal drug Narcan, also known as naloxone, will not reverse the impact of xylazine, since the drug is not an opioid, according to the DEA. Even so, Kauffman said any suspected overdose victim who is having trouble breathing should be treated with naloxone.
“Naloxone is still the first line in response,” Kauffman said.
That’s because opioids account for nearly 75% of all drug overdose deaths in the US. So if a person has taken xylazine, chances are the drugs likely contained opioids, too.
“Xylazine won’t be reversed by Narcan, but the Narcan can help undo the fentanyl component of the overdose,” Nordstrom said.
People who take only opioids are often alert after being given Narcan, Kauffman said, but people who have also taken xylazine are still sedated.
“The patient will start breathing but may continue to be sedated and require some additional oxygen support,” she said.
If Narcan isn’t available, CPR can also help treat an overdose until emergency help arrives, Tierney said.
Test strips for xylazine were released last month
When Tierney first took fentanyl with xylazine in 2016, she said she didn’t know what she was getting and even called her dealer crying after that first time.
“He actually felt horrible,” she said.
Today, that might have been avoided. Test strips that can detect xylazine in drugs were released last month, but they’re not widely available the way that test strips for fentanyl are, and they’re illegal in some places, including Texas.
Although Tierney sought out the drug, many users don’t, Kauffman said.
“Many actually try to avoid the product due to the devastating wounds and profound sedation, and concern for missing out on the euphoric effects of fentanyl,” she said. Those people could use test strips to avoid xylazine.
And yet, Teirney said people who are dependent on fentanyl will take the drugs that are available, even if there’s a risk they contain xylazine.
“No one is seeking Xylazine; it just happens to be what is out there and what is available,” she said.