Tranq, an animal sedative, is spreading through the United States illicit drug supply and is thought to be responsible for the surge in overdose cases. The drug is now posing a new threat in the country's ongoing battle against drug overdoses.
Tranq is appearing more frequently in synthetic opioids, particularly fentanyl, causing deaths and severe side effects. Although most jurisdictions don't routinely test for tranq in postmortem toxicology, the DEA estimates the drug was involved in at least 1,423 overdose deaths in the south and 1,281 in the Northeast in 2021. And while the full nationwide scope of overdose death involving the drug is unknown, surveys show deaths associated with tranq have spread westward across the US.
Tranq, also known as Xylazine or tranq dope, is a sedative used to tranquilize large animals during procedures and diagnostic testing. Initially, the drug was given for household pets, but it's now typically used for large animals like elk, cattle, sheep, and horses. The Food and Drug Administration (FDA) approved the drug in 1960 for animal use, but not humans.
Despite this, the drug has become increasingly common in the US illicit drug supply. It is now sold on the streets, usually mixed with other drugs like heroin, cocaine, alcohol, benzodiazepines, methadone, and fentanyl. According to officials, drug dealers and suppliers lace these drugs with Xylazine because it's powerful, cheap, and easy to get. So, in most cases, those who buy these street drugs may be using tranq dope unknowingly.
Now, drugs like heroin and fentanyl are dangerous enough on their own, but Xylazine is making them even more dangerous. Tranq is a powerful sedative meant for animals and can leave users unconscious for hours.
It also causes more complex and potentially more deadly overdoses. And the worst part is users cannot easily detect its presence in the drug supply. Fentanyl test strips that reliably measure fentanyl in street drugs can’t detect tranq presence.
In legal sales, Xylazine is sold directly through pharmaceutical distributors and online platforms for vets. It comes in solid and liquid form or preloaded syringes, with concentrations that match the weight and size of the species. It is not classified as a controlled substance, but people need a valid prescription from a licensed veterinarian to purchase it.
Those without licenses can still obtain tranq in powder and liquid forms through other online sites. These sites often have no association with the veterinary profession and do not require buyers to prove legitimate needs.
According to the DEA, a kilogram of tranq powder can go for as low as USD 6 to USD 20. At this low price, using tranq to lace other drugs may increase profit margins for drug dealers. And the psychoactive effects may also attract buyers looking for prolonged euphoric effects.
The first cases of Xylazine misuse were reported in Puerto Rico in the early 2000s through DEA reporting and lab analysis. But it's unclear when tranq first appeared in the illicit drug market in Philadelphia. Still, public health officials say that the drug seems to be concentrated in Philadelphia, making it the ground zero for tranq dope in the US.
Its uptick in the city's drug market is primarily due to its ability to enhance the potency and duration of a fentanyl high. This has a substantial effect considering fentanyl ranked first ahead of heroin as the city's opioid of choice.
According to researchers, tranq is in 91% of the fentanyl and heroin supply in Philadelphia, and the prevalence is heading west. Reports have also shown that the state of Michigan had an 87% increase in Xylazine-related deaths between 2019 and 2020. Other affected states include Maryland, Delaware, New Jersey, and New York, all of which have seen an increase in drug overdose deaths in 2021.
Tranq is a central nervous system depressant, so it slows down the process in the body's nerve cells. It causes drowsiness and lowers blood pressure, slows the heart rate and breathing to dangerously low levels. Mixing Xylazine and opioids like fentanyl can induce hours of sleep, making it harder to determine whether the user is experiencing an overdose. The risk of life-threatening overdose is also higher when tranq is mixed with other CNS depressants like benzodiazepines or alcohol.
Besides, tranq is highly addictive and can cause physical and psychological dependence. Regular use of the drug can lead to open wounds and skin ulcers. These wounds may result in dead tissue or necrosis and, eventually, amputation of affected limbs.
That's why it's essential for anyone using tranq to seek help before the addiction worsens. Medical experts provide wound care and emergency services to counter the effects of tranq use.
According to experts, tranq is unsafe for humans, and even a small amount can be deadly. Humans are 10-20 times more sensitive to the drug than animals. And as mentioned earlier, tranq is not an opioid and therefore does not respond to naloxone.
Those who overdose on the drug may need breathing assistance in addition to naloxone. Naloxone is given because Xylazine is often mixed with opioids like fentanyl or heroin.
Tranq use can range from mild to severe and cause fatal and non-fatal overdoses. The following are some of the signs and symptoms of Xylazine use:
Tranq addiction presents a different form of challenge to medical professionals. Experts have raised concerns about the limited treatment for tranquilizer withdrawal for those who want to quit using the drug. According to the experts, some medical examiners have no idea what to look for or what to do if they recognize tranq withdrawal.
They may start to treat opioid withdrawal, but other unpleasant symptoms like agitation, anxiety, restlessness, and sweating start to show. Currently, there aren't any FDA-approved treatments specifically for tranq withdrawal, but there are protocols in development to help ease patients' symptoms.
In response to the influx of tranq overdoses, many government and health agencies are taking action. Local health departments are offering public education programs to help people understand the dangers of using tranq. They advocate for the safe and proper disposal of the drug and harm reduction efforts such as needle-exchange programs.
Medical examiners are also working to increase their understanding of tranq overdose to better recognize and respond to its signs and symptoms. Furthermore, The US House of Representatives is looking into ways to schedule the animal tranquilizer. However, this may hinder efforts to study the drug's effects and find a solution to help patients who are overdosing.
The number of drug overdose deaths in the United States has skyrocketed in recent years, with opioids leading the way as one of the most deadly and addictive substances. Many even consider it a drug overdose epidemic. According to the CDC, there were approximately 107,000 overdose deaths in 2021. In the same year, SAMSHA identified 141,529 unweighted drug-related ER visits from its analysis of 52 hospitals.
If these numbers are anything to go by, it's evident that addiction is a major problem in the US.
And yet, despite this alarming trend, many US hospitals and emergency departments lack dedicated addiction specialists who can help those suffering from substance or opioid use disorder. This is a glaring omission, especially given how critical an early intervention can be for someone in the throes of addiction.
Without access to addiction specialists on staff, people with substance abuse problems may not get the help they need at a crucial juncture. As a result, they may go through multiple hospitals or ER visits. A lucky few will be connected with a treatment facility while they're still at the hospital.
For everyone else, they walk out with a phone number to call, or often, nothing at all. Once they leave, many of these people go back to their old habits and never make the effort to call the number they've been given.
There's a clear need for hospitals to do better when it comes to addiction treatment. So why is it that so many don't have addiction specialists on staff?
If you go to a hospital with a kidney problem, you'll likely be seen by a nephrologist. If you have a heart condition, you'll be seen by a cardiologist. But if you're struggling with addiction, chances are you won't see an addiction specialist.
Only a few hospitals have someone who specializes in addiction medicine on staff. A majority of hospitals focus on primary care. Addiction is left untreated.
This is a problem because addiction is a disease requiring specialized care. Without access to an addiction specialist in ERs, people with substance use disorder are often left at the mercy of whoever happens to be on call. This could be a general practitioner, an ER doctor, or even a social worker, most of whom have very little training in physiology, medications, and other aspects of treatment.
For years, addiction prevention and treatment services have been delivered separately from other general and mental health care services. Drug and alcohol abuse has traditionally been viewed as a criminal or social problem. As such, prevention services were not typically considered a responsibility of health care systems. For this reason, those struggling with substance use disorders have had access to only a limited range of treatment options that were generally not covered by insurance.
In a nutshell, most hospitals don't have specialists because:
For a long time, addiction has not been seen as a medical problem but rather a social or psychological one. Some medical staff still see it as a moral issue and not something that requires formal medical treatment. This attitude can make it hard to justify dedicating staff and resources to addiction treatment.
Additionally, many hospitals are already understaffed and overstretched, so it could be difficult to add another specialist.
And finally, there's the question of reimbursement. Addiction treatment is notoriously underfunded, and many insurance companies don't cover the cost of specialized care. Hospitals can find it hard to recoup the cost of hiring an addiction specialist.
NPR shared a story of a 63-year-old heroin addict, Marie, who was admitted to Salem Hospital, north of Boston, for COPD. The next day, she was told she was ready for discharge after the doctor had confirmed that her oxygen levels were good. But the woman was experiencing heavy withdrawal symptoms and could not move. She didn't want to leave the hospital but felt like she had no choice.
Sadly, most hospitals would still let her go despite her pain and condition. Sometimes, she'll be issued a list of detox programs or rehab centers to call. But more likely, she'll be sent on her way with no real plan or hope for recovery.
This is a typical story of what's happening in many US hospitals. Marie was lucky to have found a doctor who administered her some medications that helped. But every day, people with addiction walk into ERs across the country only to be discharged without real help or support.
This is dangerous because it increases the likelihood of patients relapsing and overdosing. In fact, research shows that patients have a higher chance of overdosing within a few days or weeks of being discharged from the hospital.
An addiction specialist is a medical professional specifically trained to diagnose and treat patients with substance use disorders. These specialists can provide critical support to patients who walk into the ER for various reasons but have an underlying addiction problem. Salem Hospital is one of the few hospitals that has succeeded in naming addiction as a specialty and hiring people with training in the disease.
And despite reservations from some staff, the addiction specialists get overwhelmed many days with referrals - a clear sign of the need for their services. The trend is similar in five other Massachusetts hospitals that added addiction specialists in the last three years. These facilities are funded by HEALing Communities study. Addiction specialists can help patients in several ways, including:
Addiction specialists are vital in helping patients get the treatment they need. They can also refer them to a reputable treatment facility for specialized care. Hospitals can provide a much-needed service to their communities by having these professionals on staff.
According to the National Institutes of Health, effective integration of addiction prevention, treatment, and recovery solution across healthcare systems can help address drug abuse and related issues. This is also the most promising way to improve access to and quality of treatment.