xylaZINE: what is xylazine and why is it in the drug supply?

Part of a series of zines on the drug supply. Presented by testRI.

Xylazine is a long acting veterinary sedative developed in the 1960s not
approved for human use. Xylazine is not an opioid — now it is showing up in the drug supply and can cause some problems. Download the .pdf or read it below to learn more.

For your own printing; materials are available here — in booklet form and in foldable single page form.

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(1) xylaZINE

An image of a black and white pedestrian crossing with people walking on it.

What is xylazine and why is it in the drug supply?

Presented by: testRI

(2) Xylazine is a long acting veterinary sedative developed in the 1960s not approved for human use. Xylazine is not an opioid.

The chemical structure of xylazine is shown.

(3) Wait.. why is it in the supply?

Xylazine or often referred to as “tranq-dope” has been found in drug supply across North America. It is mostly appearing in the fentanyl supply but also in cocaine.

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Xylazine can be hard to distinguish from fentanyl and other drugs. In the drug supply, it can be white or brown powder, mixed into pills, or in other forms, making it hard to identify based on appearance.

testRI participants shared:

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“[It was] no dope. I couldn’t tell you what was in it. [Interviewer: What was the feeling?] Like woozy. Like taking a sleeping pill or something.” (P024)

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“Made me feel like, drowsy, like, I was like, sleepwalking, I don’t know. It was weird.” (P029)

(4)

But is xylazine in Rhode Island?!

Xylazine has been found in the local drug supplies in Rhode Island.

We tested 61 samples from May — August 2022 and xylazine was found in 28 of those samples.

• Samples containing xylazine were from:
• Providence (47%, 13 samples)
• Central Falls (14.5%, 4 samples)
• Pawtucket (10.5%, 3 samples)
• Warwick (7%, 2 samples)
• Coventry (7%, 2 samples)
• East Providence (3.5%, 1 sample)
• Rumford (3.5%, 1 sample)
• North Kingston (3.5%, 1 sample)
• West Warwick (3.5%, 1 sample)
• 72% of the samples (20 out of 28 samples) that contained xylazine were sold as fentanyl
• The other samples that contained xylazine were: dope with fentanyl (10.5%, 3 samples), crystal meth (7%, 2 samples), percocet (3.5%, 1 sample), crack (3.5%, 1 sample), and carfentanil (3.5%, 1 sample)

(5)

Xylazine Health Effects

-Sedation, unresponsiveness

-Low blood pressure

-Slow heart rate

-Decreased breathing

[icons of a face that looks sleepy icon of a blood drop with a minus sing on it, icon of a heart wave, icon of someone receiving oxygen through a tank via face mask]

Content Warning for Next Page: Wounds and Skin Lesions!

(6)

Xylazine Health Effects

-Can increase risk of overdose when used with other sedating drugs like opioids

-Injecting xylazine can cause skin lesions, abscesses, and cellulitis

Graphic images of wounds can be seen.

image from: Reyes JC, Negrón JL, Colón HM, Padilla AM, Millán MY, Matos TD, Robles RR. The emerging of xylazine as a new drug of abuse and its health consequences among drug users in Puerto Rico. J Urban Health. 2012 Jun;89(3):519–26. doi: 10.1007/s11524–011–9662–6.

(7)

Harm Reduction & Xylazine

Xylazine is relatively new to the supply and harm reduction is constantly evolving, below are some initial ways to mitigate risk when using drugs possibly contaminated with xylazine

If xylazine is involved in an overdose the person may still appear sedated even after breathing returns.

• Check for normal breathing and pulse
• Use naloxone if slowed or stopped breathing

[icons of someone looking sleepy, icon of a hand holding out a heart with a heart rate on it, icon of nasal naloxone]

(8)

Harm Reduction & Xylazine

• Recovery position to keep the airway clear (place on side, hand supports the head, knee stops body from rolling onto stomach) rescue breaths are important if slowed or stopped breathing after naloxone

[Image of someone in the recovery position. Laid down with their hand supporting their head and knees stopping their body from rolling over on to their stomach]

(9) Harm reduction & xylazine

When treating a skin infection possibly due to xylazine use

Do not inject at the site of infection

Avoid direct pressure to the site if possible

Keep the area clean and dry

(Icon of a hand holding a needle under a prohibited circle, icon of a hand pressing a button to imply pressure under a prohibited circle, icon of a folded cloth to imply dryness]

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If the area becomes more painful, hot, red, swollen, there is pus leakage, you develop a fever, or with any feelings of numbness please seek medical care right away.

(9)

Brought to you by testRI & the People, Place, and Health Collective at the Brown University School of Public Health.

By: Claire Macon & Abdullah Shihipar

All testRI work is on the traditional and ancestral lands of the Narragansett peoples.

Works Cited

Friedman J, Montero F, Bourgois P, Wahbi R, Dye D, Goodman-Meza D, Shover C. Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis. Drug Alcohol Depend. 2022 Apr 1; 233:109380. doi: 10.1016/j.drugalcdep.2022.109380.

Ruiz-Colón K, Chavez-Arias C, Díaz-Alcalá JE, Martínez MA. Xylazine intoxication in humans and its importance as an emerging adulterant in abused drugs: A comprehensive review of the literature. Forensic Sci Int. 2014 Jul;240:1–8.doi: 10.1016/j.forsciint.2014.03.015.

Reyes JC, Negrón JL, Colón HM, Padilla AM, Millán MY, Matos TD, Robles RR. The emerging of xylazine as a new drug of abuse and its health consequences among drug users in Puerto Rico. J Urban Health. 2012 Jun;89(3):519–26.doi: 10.1007/s11524–011–9662–6.

Nunez J, DeJoseph ME, Gill JR. Xylazine, a Veterinary Tranquilizer, Detected in 42 Accidental Fentanyl Intoxication Deaths. Am J Forensic Med Pathol. 2021 Mar 1;42(1):9–11. doi: 10.1097/PAF.0000000000000622

Torruella RA. Xylazine (veterinary sedative) use in Puerto Rico. Subst Abuse Treat Prev Policy. 2011 Apr 11;6:7. doi:10.1186/1747–597X-6–7.

Fyffe JJ. Effects of xylazine on humans: a review. Aust Vet J. 1994 Sep;71(9):294–5.doi: 10.1111/j.1751–0813.1994.tb03448.x.