Drug dealers on the East Coast had in recent years begun mixing xylazine, which can have devastating effects on people, with the opioid fentanyl, causing a surge in emergency room visits in Philadelphia and other cities. But there had not been much evidence of it in California.
Now state and local officials are ramping up efforts to combat xylazine, commonly called 鈥渢ranq,鈥� by monitoring its spread, distributing test strips, and pushing to 鈥渟chedule鈥� it, meaning classify it as a controlled substance. Still, some worry it will be hard to prevent the pernicious drug 鈥� which has also begun appearing in Los Angeles, Santa Clara, and San Joaquin counties 鈥� from worsening the state鈥檚 overdose epidemic.
鈥淯nless significant change happens in scheduling xylazine and really reducing its availability, we could be on the heels of what鈥檚 happening on the East Coast,鈥� said Jeffrey Hom, director of population behavioral health at the San Francisco Department of Public Health.
Hom, who previously led overdose prevention services in Philadelphia, said San Francisco鈥檚 public health department is collaborating with the medical examiner, the San Francisco AIDS Foundation, the city鈥檚 fire department and homeless and supportive housing agencies, and methadone clinics and hospitals to collect data, share updates, and conduct regular testing for xylazine.
鈥淲e鈥檙e trying to think through how do we develop a system that can surveil for drugs like xylazine 鈥� or whatever the next drug will be,鈥� Hom said.
The California Department of Public Health is monitoring news reports of xylazine and has posted an about it, but a spokesperson told KFF Health News it does not yet have a 鈥渟tandardized and uniform statewide monitoring system.鈥�
Xylazine is a cost-effective way to extend the strong yet short-lived fentanyl high, said Philippe Bourgois, a UCLA anthropology and social medicine professor and co-author of the book 鈥淩ighteous Dopefiend,鈥� the product of a 10-year immersion in San Francisco鈥檚 heroin and crack street culture. But the trade-offs can be catastrophic.
Taken on its own, xylazine is so powerful it can knock a person out for up to 18 hours, said Bourgois. In Philadelphia, people who use tranq are getting 鈥�,鈥� which are similar to bedsores but are caused by lying passed out on the sidewalk for long periods, he added. Xylazine also has that rot the skin and lead to amputations.
Most troubling of all, Bourgois said, is that xylazine constricts breathing, increasing the risk of an overdose when it鈥檚 mixed with fentanyl. By itself, it doesn鈥檛 respond to the overdose reversal drug naloxone, which has been one of the in trying to reduce overdose deaths. But since xylazine is often mixed with fentanyl and other opioids, health authorities advise using naloxone to respond to suspected overdoses.
鈥淴ylazine is a disastrous drug,鈥� Bourgois said. 鈥淧ublic health has to get ahead of this tragedy.鈥�
About a dozen people who smoke or inject fentanyl and live on the streets of San Francisco told KFF Health News they are at the mercy of what drug dealers sell and have little insight into what鈥檚 actually in the drugs. They said they鈥檝e never used xylazine knowingly and didn鈥檛 want it in their drugs.
Kris Franklin, 41, has been buying fentanyl in San Francisco for five years and acknowledged she鈥檚 gambling with her life. She鈥檚 lost count of the friends and acquaintances who have died from overdoses or street-related illnesses but estimates it at around 40 people.
鈥淚鈥檓 scared it鈥檚 going to be in my dope,鈥� Franklin said of tranq. 鈥淵ou don鈥檛 know what you鈥檙e getting. 鈥� It鈥檚 not like a prescription from a doctor.鈥�
Rep. Jimmy Panetta (D-Calif.), whose district includes Santa Cruz and Monterey, introduced federal legislation in March to make xylazine a controlled substance.
鈥淚t gives our law enforcement the tools that they can use to crack down and hopefully remove this type of deadly combination of fentanyl and xylazine off the streets,鈥� Panetta said of the bill. 鈥淚 think we got a good chance of getting this passed this year.鈥�
Governors in Pennsylvania and Ohio are to to xylazine. In California, lawmakers are wrestling with several measures that would increase penalties for fentanyl dealers, but none address xylazine.
One potential downside to any crackdown is that it could make it much harder for veterinarians and other customers to obtain the drug for their animals. And the FDA said late last year that it was not known whether tranq was being diverted from the animal supply or manufactured illicitly.
Siddarth Puri, associate medical director of prevention at the Los Angeles County Department of Public Health, noted that the data was sparse but that xylazine was likely more widespread than is known.
Puri and his public health colleagues learned only recently, from , that county law enforcement officials had been spotting xylazine in the fentanyl supply for years. The county Sheriff鈥檚 Department recently to track the presence of the drug.
鈥淭here are probably hundreds of other illicit synthetic substances that are being cut into the drugs that we don鈥檛 know about yet, and we don鈥檛 know how they鈥檙e going to impact people,鈥� Puri said. 鈥淩ight now, the spotlight is on xylazine.鈥�
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