As San Francisco struggles to deal with its fentanyl overdose crisis, authorities are on high alert that another drug colloquially known as “tranq” – an animal sedative typically used in large cattle – could seep into the street supply and cause more death and disability.
The pharmaceutical drug xylazine has already appeared in East Coast cities, further devastating those communities. The drug may increase the risk of overdose, worsen withdrawal, and increase the risk of injury resulting in amputation for those who inject it.
Although it hasn’t yet landed on any obvious scale in San Francisco or California, the Office of the Chief Medical Examiner told The Chronicle on Tuesday that it is developing a universal testing method for xylazine that it will begin for use early this year for all fatal overdoses. The office also plans to retrospectively test all 2,022 suspected overdose cases to see if the drug was present in any of the deceased.
“It’s definitely on our radar,” a spokesperson for the medical examiner said in an email. “We have been in communication with our colleagues at the San Francisco Department of Public Health as well as colleagues at other forensic laboratories in California.”
San Francisco sees an average of one to two overdose deaths a day, largely from fentanyl, the highly addictive super-potent opioid. The introduction of xylazine into the city’s drug supply could be a catastrophic new phase in the city’s opioid epidemic, which has already overwhelmed public health officials and divided city leaders over how. to face it.
Those on the ground say they are watching for any reports of xylazine mixing in the drug supply, and several addicts interviewed Tuesday in the Tenderloin – a neighborhood with the highest concentration of drug use, trafficking and overdoses – have stated that they are aware of the risks and are increasingly concerned about them.
Cosmo, 65, who lives in the neighborhood and declined to give his full name, said he plans to be more careful about injecting because his drug of choice – crack cocaine mixed with fentanyl – is what xylazine is commonly mixed with in the East. Coast.
“If it’s in the East, you can bet it’s already there,” he said. “I’m going to have to be very careful what I buy.”
In East Coast hotspots like Philadelphia, the vet tranquilizer is laced with fentanyl and has made the impact of the high-powered opioid even more gruesome. The sedative, which is also a pain reliever and muscle relaxant, can cause devastating skin wounds which, if left untreated, can lead to amputation. Because xylazine is not an opioid, the overdose reversal drug Narcan does not work for this.
This means that if someone overdosed both fentanyl and xylazine, Narcan would reverse the effects of the fentanyl, but not the xylazine.
Entering recovery could also be more difficult if xylazine enters the supply. A report from the Drug Enforcement Administration states that “users may develop physical dependence on xylazine itself, with some users reporting withdrawal symptoms from xylazine as severe or more severe than from heroin or methadone; symptoms include sharp chest pain and seizures.
With reports circulating of xylazine seeping into the East Coast drug supply, San Francisco officials are in a tricky position to both not overestimate — or underestimate — the potential risk. Since it hasn’t manifested in a noticeable way, officials are still in the early stages of planning and are mostly focused on increasing surveillance and education.
At the same time, however, the East Coast drug crisis tends to be an indicator of what’s to come on the West Coast. For example, fentanyl appeared on the East Coast a few years before it took over San Francisco’s drug supply.
Now, the opioid has been found in the majority of all overdose deaths in San Francisco.
“Because we’re in the later stages of the fentanyl epidemic…people are becoming tolerant and (drug dealers) are going to combine it with other drugs,” said Daniel Ciccarone, professor of family and community medicine at the UCSF. He said it was particularly alarming because “we still haven’t understood the overdose crisis we find ourselves in.”
The San Francisco Aids Foundation, a nonprofit harm reduction organization, said its drug control program tested a sample of a street drug this fall that contained a “traceful amount” of xylazine. While it was just one sample of hundreds tested over the past six months, the discovery led the foundation to increase its education and monitoring, knowing that the drug supply could change at any time. .
Xylazine “is something we’re very aware of and monitoring,” said Ro Guliano, senior director of health services for people who use drugs at the San Francisco AIDS Foundation. “Just like what happened when we had this big shift to fentanyl, it would inform how we do health education for people who use drugs, including overdose prevention.”
Currently, the San Francisco AIDS Foundation has two machines that people can use to test their medications before taking them. These machines, which cost around $70,000 each, give people a clear picture of what’s in the illicit drugs they’re using and also provide officials with insight into trends over time. One of the machines is in a mobile van, while another will be operating at their SoMa site in February.
The Department of Public Health said in a statement that it is “closely monitoring the situation” and also continues to work with organizations in the city and “prepare in case it becomes more endemic.” Authorities are also working to develop care options, including specific xylazine treatments.
Yet, as the city prepares for the potential new phase of the opioid epidemic, the shortcomings of the current system have become even more apparent. San Francisco doesn’t have enough treatment options, and the city’s law enforcement and criminal justice system struggles to crack down on drug dealers who operate openly.
The mayor of London Breed is also said to have backtracked on opening a safe drinking site in the city. Such a site would provide a place for people to use drugs around medical professionals who would help reverse overdoses and save lives.
Guiliano, of the San Francisco AIDS Foundation, said the risk of xylazine adds more urgency to the need to open one of these sites.
“The bigger issue is how does the city provide health care to this large number of people who are also homeless?” she says. “We can’t talk about one without the other.”
The DEA report says the presence of the drug in fatal overdoses may be more prevalent than reported because many labs do not include it in their toxicology tests.
The San Francisco medical examiner’s decision to retroactively test overdose cases from 2022 will help authorities better understand the current extent of drugs in the city, if at all. But increased real-time testing of the current supply would help outreach workers respond more quickly to any changes, Guliano said.
In the Tenderloin, Andy Berger, 31, said on Tuesday he feared he had injected himself with xylazine – which he said is sometimes referred to as a “zombie drug”. While it’s unclear if he took the drug inadvertently, he said he’s developed widespread oozing abscesses along his legs, arms and hands over the past few months, which are different of everything he had before.
He said he’s been to three different hospitals or clinics since September for wound treatment, “and they always tell me it’s cellulitis or something.” They say they’ve never heard of zombie drugs.
Berger sat in a red tent near the corner of Leavenworth and Ellis streets and rolled up his left trouser leg to show a cluster of deep, angry red abscesses. He held a syringe ready for his next shot in one hand, but it was difficult to grasp because of the gaping, swollen wounds on his fingers.
“I’ve been using for a long time and never had anything like it,” he said, referring to his injuries. “I know other people who have this too…I don’t know what to do. It’s pretty weird, man.
Trisha Thadani and Kevin Fagan are writers for the San Francisco Chronicle. Email: tthadani@sfchronicle.com, kfagan@sfchronicle.com Twitter: @TrishaThadani, @KevinFagan
