SAN FRANCISCO — When the city’s medical examiner announced in February that four people who had recently died of overdoses had the animal sedative xylazine in their systems, public health workers across the state sprang into action.
Drug dealers on the East Coast had in recent years begun mixing xylazine, which can have devastating effects on people, with the opioid fentanyl, prompting a spike in emergency room visits in Philadelphia and other cities. But there wasn’t much evidence of it in California.
Now, state and local officials are stepping up efforts to combat xylazine, commonly called “tranq,” by monitoring its spread, distributing test strips, and pushing to “schedule” it—that is, classify it as a controlled substance. Still, some worry it will be difficult to prevent the noxious drug, which has also started showing up in Los Angeles, Santa Clara and San Joaquin counties, from worsening the state’s overdose epidemic.
“Unless there’s a significant change in xylazine programming and it really reduces its availability, we might be on top of what’s happening on the East Coast,” said Jeffrey Hom, director of population behavioral health at the Department of San Francisco Public Health.
Hom, who previously directed overdose prevention services in Philadelphia, said the San Francisco public health department is collaborating with the medical examiner, the San Francisco AIDS Foundation, the city’s fire department and agencies homeless and supportive housing, and methadone clinics and hospitals to collect data, share updates, and perform regular xylazine testing.
“We’re trying to think about how we develop a system that can detect drugs like xylazine, or whatever the next drug is,” Hom said.
The California Department of Public Health is monitoring news reports on xylazine and has released a report on the subject, but a spokesperson told KFF Health News that it does not yet have a “uniform, standardized monitoring system across the state.” “.
Xylazine is a cost-effective way to prolong the strong but short-lived high of fentanyl, said Philippe Bourgois, a UCLA professor of anthropology and social medicine and co-author of the book “Righteous Dopefiend,” the product of a 10-year immersion in heroin and San Francisco crack street culture. But the tradeoffs can be catastrophic.
Taken alone, xylazine is so powerful that it can knock a person out for up to 18 hours, Bourgois said. In Philadelphia, people who use tranquilizers get “cement burns,” which are similar to bed sores but are caused by lying passed out on the sidewalk for long periods, he added. Xylazine also has necrotizing effects that rot the skin and cause amputations.
Most worrisome of all, Bourgois said, is that xylazine restricts breathing, which increases the risk of an overdose when mixed with fentanyl. By itself, it does not respond to the overdose reversal drug naloxone, which has been one of the state’s key tools in trying to reduce overdose deaths. But since xylazine is often mixed with fentanyl and other opioids, health authorities recommend using naloxone to respond to suspected overdose.
“Xylazine is a disastrous drug,” Bourgois said. “Public health has to get ahead of this tragedy.”
About a dozen people who smoke or inject fentanyl and live on the streets of San Francisco told KFF Health News that they are at the mercy of what drug dealers are selling and have little idea what the drugs actually contain. They said they had never knowingly used xylazine and did not want it in their medications.
Kris Franklin, 41, has been buying fentanyl in San Francisco for five years and acknowledged that she is gambling with her life. He has lost count of the friends and acquaintances who have died from overdoses or street-related illnesses, but he estimates around 40 people.
“I’m afraid I’m on my drug,” Franklin said of the tranquilizer. “You don’t know what you get. … It’s not like a prescription from a doctor.”
Rep. Jimmy Panetta (D-Calif.), whose district includes Santa Cruz and Monterey, introduced federal legislation in March to make xylazine a controlled substance.
“It gives our police the tools they can use to crack down and hopefully remove this type of deadly combination of fentanyl and xylazine from the streets,” Panetta said of the bill. “I think we have a good chance of getting this passed this year.”
The governors of Pennsylvania and Ohio are using their executive powers to restrict access to xylazine. In California, lawmakers are wrestling with several measures that would increase penalties for fentanyl traffickers, but none address xylazine.
One potential downside of any crackdown is that it could make it much more difficult for vets and other customers to get the drug for their animals. And the FDA said late last year that it was not known whether the tranquilizer was being diverted from animal supplies or manufactured illicitly.
Siddarth Puri, associate medical director for prevention at the Los Angeles County Department of Public Health, noted that data was sparse, but xylazine was probably more widespread than is known.
Puri and her public health colleagues recently learned from a Los Angeles Times report that county law enforcement officials had been detecting xylazine in the fentanyl supply for years. The county Sheriff’s Department recently launched a pilot project to track the presence of the drug.
“There are probably hundreds of other illicit synthetic substances that are being incorporated into drugs that we don’t know about yet, and we don’t know how they’re going to affect people,” Puri said. “Right now, the focus is on xylazine.”