A Dangerous Shift in the Street Drug Supply: What to Know About Xylazine

What do people using opioids have to say about the contaminated drug supply? "Nothing about Xylazine is Pleasant. I hate it."

Welcome back to another edition of Zach’s Research Roundup, where I write about important research in drug policy, harm reduction, public health, and other things I think you should know about.

This week, I’ll be going over a timely study that sheds some light on how America’s illicit opioid supply is shifting yet again, and what that means in the broader context of a catastrophe that’s killed more than 100,000 people in the last year alone. In addition to hearing from the study’s authors, you’ll also hear from people who actually use drugs and how their lives are impacted by a volatile, polluted drug supply.

The Study: “Xylazine Spreads Across the US: A Growing Component of the Increasingly Synthetic and Polysubstance Overdose Crisis”

Promised, as always, is a link to the study, which was published in the April 2022 issue of the journal Drug and Alcohol Dependence. Some of the authors of this paper are heavy hitters in the world of drug research (e.g. anthropologist Philippe Bourgois) and the other researchers are trusted sources, like Joseph Friedman. You’ll also hear from a co-author on the study, Rafik Nader Wahbi, if you keep on reading. 

(WARNING: This piece contains graphic photos of necrotic skin lesions resulting from injection of adulterated drugs) 

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The study on Xylazine is one of my favorite types of papers: it blends quantitative data (numbers and stuff) with qualitative interviews (talking to actual people). You get the best of both worlds: A birds-eye-view of the drug supply and overdose deaths using regional statistics, and a vivid, street-level account of drug market dynamics through interviews with people who actually use drugs and who interact with these markets everyday. Papers like these show that people who use drugs, people with addictions, have important knowledge and wisdom to share. 

The Results: The Emergence of “Tranq-Dope”

The study found that xylazine, a veterinary tranquilizer and sedative NOT DESIGNED FOR HUMAN CONSUMPTION, has quickly taken root in America’s illicit opioid supply. The emergence of xylazine in heroin markets can be traced back to Puerto Rico in the early 2000s. Drug sellers in the US, especially in Philadelphia, seem to have taken cues from the Puerto Rican xylazine experience.

From the study: 

“Xylazine was found to be increasingly implicated in overdose mortality, rising from 0.36% of deaths in 2015 to 6.7% in 2020.”

In some parts of the U.S. xylazine appeared in 1 in 5 overdose deaths.

Xylazine, so far, is definitely concentrated on the East Coast, and appears to be spreading West, which is how things seem to work in America (e.g., illicit fentanyl sprouted up in the Northeast in early 20-teens, and now it’s prevalent in San Francisco and, well, basically everywhere). “The highest xylazine prevalence in the recent data was observed in Philadelphia, (25.8% of deaths), followed by Maryland (19.3%) and Connecticut (10.2%),” according to the study.