The California Department of Public Health is warning medical personnel about the increasing migration of the drug xylazine to the West Coast.
Known as ‘tranq’ or ‘tranq dope,’ xylazine is a powerful sedative that has been linked to an increasing number of overdose deaths nationwide, said Dr. Tomás Aragón, the department’s director and State Public Health Officer.
Although the drug is currently more widely found on the East Coast, the department issued the warning in anticipation of its spread to California and advised healthcare facilities and providers on best practices for handling xylazine cases in patients.
“While current data suggests that xylazine is relatively uncommon in California’s drug supply at this time, we are taking steps to reach our local partners, community-based organizations, healthcare providers, and all Californians to warn them of this evolving situation,” Aragón said in the statement.
San Francisco is on track to have its deadliest year in drug overdose deaths since 2020. There have been 692 overdose deaths from Jan. 1, 2023, to Oct. 31, 2023. Of those, 26 have been related to xylazine.
The San Francisco Department of Public Health issued a Health Alert in February when the Office of the Chief Medical Examiner found the drug in toxicology tests.
“While xylazine continues to be involved in fatal overdoses in San Francisco, it is still very uncommon (approximately 3% of decedents),” SFDPH told The Examiner in a statement Tuesday. “Additionally, there have been no known reports of people being seen with symptoms of xylazine intoxication or withdrawal. These data points suggest that xylazine may not yet be widespread.”
Despite the low numbers, the department said it is still monitoring xylazine in the drug supply and preparing its street-response teams to recognize it.
“We have been on the lookout for xylazine for the past year or more in observing trends and other parts of the country,” said Dr. Ayesha Appa, an addiction medicine physician and assistant professor at UCSF. “Eventually, it may make its way into our supply on the West Coast and in San Francisco specifically.”
Appa is one of The City’s many medical professionals who have been monitoring xylazine’s migration throughout the country’s fentanyl supply.
Though xylazine is not an opioid, it is often found mixed into opioid supplies, including fentanyl.
“In some areas of the country like Philadelphia, up to 90% of their fentanyl contains xylazine,” she said. “Traditionally, the West Coast and San Francisco had seen opioids like heroin come from the South and the East Coast.”
By region, the South has seen the highest uptick in overdose deaths related to xylazine, increasing from 116 deaths in 2020 to 1,423 in 2021 — a 1,127% increase. In contrast, the West saw an increase from 4 deaths to 34 deaths during that time, a rise of 750%, according to a recent report by the Drug Enforcement Administration.
However, whether or not xylazine is labeled as a cause of death varies across jurisdictions, according to a recent study published by the Centers for Disease Control and Prevention. From January 2019 to June 2022, the monthly percentage of fatalities from illegally made fentanyl that included xylazine rose from 3% to 11%.
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Statewide, there have been around 6,000 overdose deaths linked to opioids in 2021, the most recent year that data is available, according to the California Department of Public Health.
In response to the rising presence of the drug, California Gov. Gavin Newsom announced new legislation last week to heighten punishment for the illegal use of xylazine.
“Although California is not yet seeing tranq at the same rates as other parts of the country, this legislation will help the state stay ahead and curb dealers and traffickers while we work to provide treatment and resources for those struggling with addiction and substance abuse,” said Newsom in a statement.
The new legislation has designated xylazine as a controlled substance except for its intended use in veterinary treatment.
State officials have advised health facilities and clinicians how to spot xylazine exposure in patients who can present symptoms such as hyperactivity and anxiety. Xylazine isn’t responsive to opioid reversal treatment naloxone.
But naloxone is still helpful in combatting an overdose, and people should still use it, Appa said.
“If somebody overdoses and stops breathing, and you know, and you’re trying to save that person’s life, reverse the overdose,” she said. “Naloxone will kick that fentanyl off opioid receptors and should restore that person’s respiratory rate.”
Since xylazine is a sedative, people just might not be fully alert or awake even after the naloxone is administered.
Patients exposed to xylazine also often suffer from related skin issues such as infections and abrasions, which should be cleaned well with soap and water and antibiotics if needed.
“It raises a whole other health concern for people using xylazine or are exposed to it,” Appa said. “Soft-tissue infections are something that San Francisco has seen for a long time, either related to methamphetamines, cocaine and heroin.”
Treatment includes the use of oxygen and ventilation. While there is still not an available drug treatment for xylazine withdrawal, other forms of withdrawal management are available, including the use of alpha-2-adrenergic agonists, a drug that’s used to treat hypertension and anxiety disorders.
But for immediate needs, naloxone is the most critical tool in helping counteract overdoses, even if xylazine doesn’t respond to it directly.
“Ideally, we’d be in a place where you’d have naloxone on you, or it’s readily accessible on a street corner, and people would feel comfortable using it,” she said. “That’s still the main way that we should be responding to mixed fentanyl-involved overdoses.”
