In medical terminology, they are known as necrotic lesions. In layman’s terms, they are patches of dying and decaying flesh on living tissue. Dr. Sydnee Smirl McElory has seen enough of them during her patient visits at Harmony House to know the Tri-State has a new battle in the fight against illegal drug use.
In this case, it’s the drug xylazine — a sedative used by veterinarians on large animals such as horses. In the past few years, it has been added to heroin to boost its high. The same is true with fentanyl, which has received a great deal of public attention the past few years. Xylazine has been in the mix, too, but lesser known. Now its presence cannot be overlooked.
Xylazine — also known by the slang term “tranq” — is not approved for use in humans, but at the same time it’s not a controlled substance. According to the National Institute on Drug Abuse, xylazine “is a central nervous system depressant that can cause drowsiness and amnesia and slow breathing, heart rate, and blood pressure to dangerously low levels.”
According to the Drug Enforcement Administration, xylazine can be purchased online from Chinese suppliers. Its price is low enough that it can be used to reduce the amount of fentanyl or heroin in a mixture. Some users may ask for it because it has the same effects as opioids, but it lasts longer than fentanyl alone.
Smirl said she knows xylazine is in the area because she has seen its effects on her patients at Harmony House, which serves homeless people. Xylazine tightens blood vessels, which can cut off blood flow to tissue. When that happens, the tissue dies, and the black, dead areas of tissue can drop off, she said.
“If it’s in the drug supply my patients at Harmony House are getting, it’s in the drugs everybody else is getting,” she said.
Jan Rader, director of the mayor’s Council on Public Health and Drug Control Policy in Huntington, says she, too, knows xylazine is in the area.
“We know xylazine is here because of the toxicity reports coming back on overdose deaths,” she said.
Rader and Smirl said there is no antidote for someone who has overdosed on xylazine. Smirl said Harmony House gives out fentanyl test strips so drug users can test their heroin for the presence of fentanyl before they take their drug, but there is no such test material at present for xylazine.
“I haven’t talked to anyone who wants xylazine,” Rader said. “It just happens to be in the product.”
First responders can check an overdose victim for xylazine by looking for the necrotic sores, which can occur on any part of the body, not just at the injection site. If the first responder is treating an unresponsive person and naloxone does not wake that person, xylazine is probably in the system, Rader said.
Cabell County first responders have treated people with larger-than-normal amounts of naloxone, but because of the presence of xylazine in their systems, they remained unconscious and had to be taken to a hospital, Rader said.
Rader said Huntington is the City of Solutions, and local officials are looking for a solution to the growing presence of xylazine in the illegal drug supply and in fatal overdoses. As with any illegal drug, the best solution is to eliminate the demand, but as long as people want heroin, dealers will sell it, Rader said.
For decades now, as soon as medical and law enforcement authorities get a handle on one drug ravaging the Tri-State, another shows up to cause more and often worse problems. Crack cocaine, methamphetamines, prescription painkillers, heroin and fentanyl have had their turns as the primary drug threats in the region. Now xylazine is joining that list.
Huntington is not alone in this, of course. According to a DEA report issued in October 2022, “The prevalence of xylazine is increasing, spreading beyond the traditional white-powder heroin markets in the northeastern United States where it has been seen for several years. Xylazine vials have been encountered at locations operating as local stash houses or in the homes of polydrug dealers, indicating that the mixture with other drugs happens at the retail level, though it cannot be determined how frequently.”
And xylazine didn’t just arrive here recently. It’s been here, but it’s not received a large amount of public attention, although that is changing.
In August 2020, Charleston officials said a city firefighter and medic who had died the previous month had died from an overdose. They said the toxicology report showed he had ingested fentanyl and xylazine.
“Xylazine is not a drug that we are familiar with in this area,” Charleston Police Chief Tyke Hunt at the time in discussing the firefighter’s death.
As for the future, the local medical and first response community hopes the research community can find effective testing and treatment methods soon.
“My fear as the doctor who takes care of them is how many people are going to be harmed or lost until the science catches up with it,” Smirl said.
Jim Ross is development and opinion editor of The Herald-Dispatch in Huntington. His email address is email@example.com.