Visible bones and tendons. Wounds infested with maggots. A putrid odor emanating from decaying flesh.
As stronger drugs continue to surface in the streets, the flesh-eating animal tranquilizer xylazine remains a devastating force across the United States. Commonly referred to as “tranq,” this unlawful sedative is often blended with fentanyl to enhance and prolong its euphoric effects.
According to the DEA, in 2023, 30% of fentanyl powder samples and 6% of fentanyl pills contained xylazine.
In Philadelphia, often dubbed “ground zero” for the tranq epidemic, this drug accounted for 38% of unintentional overdose fatalities in 2023.
A Philadelphia orthopedic surgeon has issued a caution that the tranq crisis shows no signs of diminishing, even as stronger veterinary sedatives like medetomidine and industrial chemicals like BTMPS increasingly enter the fentanyl mix.
“Five years ago, we didn’t see any patients suffering from xylazine-related injuries,” said Dr. Asif Ilyas, an orthopedic surgeon and researcher on opioid use at Rothman Orthopaedics and Drexel University in Philadelphia. “Now it’s a daily occurrence at larger university hospitals in Philadelphia.”
Xylazine, initially synthesized in Germany by Bayer in 1962 to manage blood pressure, was found to produce significant adverse reactions. These side effects, including CNS depression and dangerously low blood pressure, led to its repurposing for veterinary applications.
“Patients arrive with their limbs practically mummified or experiencing auto-amputation.”
Dr. Asif Ilyas
This tranquilizer emerged as a street drug in Puerto Rico in the early 2000s. Fentanyl’s brief high often led to the addition of xylazine to extend the effects.
Upon injection, xylazine induces muscle relaxation, alleviates pain, and creates a trance-like state by inhibiting norepinephrine in the central nervous system.
The side effects for users can be dire: a reduced norepinephrine level may slow the heart rate, lower blood pressure, and complicate breathing.
Furthermore, xylazine significantly constricts blood vessels, resulting in the grotesque skin injuries now associated with its use.
“As an animal sedative, xylazine is known to cause local tissue damage and vasoconstriction, ultimately reducing blood flow and oxygen to the area, making tissues more prone to necrosis,” Ilyas detailed.
Xylazine-inflicted wounds can resemble injuries from flesh-eating bacteria and may necessitate amputation.
“Most users inject into their arms and legs, where most damage occurs,” said Ilyas. “In severe cases, the limbs may auto-amputate, leaving patients in a mummified state or missing significant soft tissue.”
The severity of injuries hinges on the xylazine concentration in the injection, the frequency of use, and individual physiological factors.
One of the pressing challenges, Ilyas noted, is that many patients do not stay in the hospital long enough to receive necessary surgical care or addiction treatment.
“We can perform wound debridement and possibly reconstruct them depending on the injury’s extent,” Ilyas explained.
“However, if the individual resumes drug use, any surgical intervention becomes ineffective, leading to further costs and recovery time.”
Timely treatment can help patients regain function before vital tissue loss becomes irreversible.
Yet, if essential muscle, tendons, or nerves are permanently lost, full recovery might not be viable.
The positive aspect is that overcoming xylazine addiction is possible. A woman in her 40s, who divides her time between Philadelphia and St. Louis, successfully achieved sobriety in 2022 following a 45-day rehabilitation program.
Tracey McCann faced severe bruising, infections, and necrotic sores after becoming addicted to street drugs prescribed after an accident, leading her to self-surgery.
She sought help upon realizing her dependency on xylazine. Now, she shares her recovery journey on social media, celebrating life post-addiction.
Stories like McCann’s raise awareness about the perils of xylazine.
However, it remains impossible to determine if fentanyl has been tainted with xylazine just by examining it. Though xylazine test strips exist, they cannot indicate the drug’s potency, limiting users’ ability to assess potential risks.
“What’s crucial for individuals to understand is that if they are injecting illicit substances like fentanyl, there is an increasing risk it’s mixed with xylazine, which heightens the high but also leads to the severe complications associated with these wounds,” cautioned Ilyas.
