Doctors in northern Kentucky examined a patient who had been hospitalized for weeks as caregivers removed all the skin from his forearm to save it from amputation.
Dr. Mike Kalfas said the woman was using the opioid drug fentanyl, which was laced with an animal sedative that causes tissue death, a situation that is becoming increasingly common in the Cincinnati area.
“I’ve been educating patients,” Kalfas said. “I kept telling them there could be bad substances in the medicine that Narcan couldn’t save.”
It’s xylazine, often referred to as trunk dope, and it’s the latest challenge in the opioid epidemic. Because the drug is cheap and easily available, sellers add it to their supply of fentanyl to increase profits. The effects of euphoria in drug users are long-lasting, but cause a chaotic state of health.
xylazine They started popping up in the northeastern United States a few years ago, but exploded around 2020, with Philadelphia as their base. Almost every state has detected some level of xylazine, but hotspots are spreading to the West. Ohio, Indiana, and Kentucky are besieged. This trend is following the same path that fentanyl did a decade ago.
“It’s called a trunk. We call it a trunk because it’s one,” said Amandalyn Reese, chief program officer for Ohio Harm Reduction. It is a tranquilizer used for.”
The Cincinnati area is a place where issues such as: ‘quiet‘
Experts closely monitoring xylazine’s role in the opioid crisis are investigating the effects of xylazine as addiction doctors, harm reduction workers, public health and crime lab workers witness manifestations of the drug in the Cincinnati area. They warn that not enough testing is being done across the United States to understand.
In September, a San Diego-based drug testing laboratory called Millennium Health Published a report showing the drug epidemic in physician-ordered drug tests across the United States.
Researchers looked for xylazine in more than 160,000 samples that tested positive for fentanyl since April 12, the White House announced. nationwide warning They then ranked the states with the most positive xylazine tests. Ohio State, Indiana, and Kentucky took third, fifth, and seventh place, respectively.
Dr. Roberto Soria, CEO and medical director of Crossroads Center, a methadone and addiction clinic in Colleyville, said he first suspected xylazine was causing complications in some patients in April. ordered a test for this drug.
He said the analysis showed that one in four tests that tested positive for fentanyl also tested positive for xylazine. He followed these results by conducting an average of more than 500 tests per month. In September, that number jumped to more than one in two people, he said.
The Hamilton County Coroner-Crime Lab also reported that items testing positive for xylazine jumped from 1,541 in 2022 to 1,594 from Jan. 1 to Sept. 30. The department reported that the number of overdose deaths involving xylazine jumped to 48 from April to December. 2022-86 between January and September of this year.
“This is a further evolution of this fentanyl crisis,” said Eric Dawson, vice president of clinical affairs at Millennium Health and author of the report.
‘Scary’ health threat follows animal sedative xylazine
Health threats from xylazine range from slow heart rate, low blood pressure, and amnesia to catastrophic skin damage. Unknowingly ingesting the drug can lead to painful withdrawal symptoms that may deter people from seeking medical care.
Dr. Richard Ryan, an emergency medicine physician at the University of Cincinnati Medical Center, said his department is seeing an increase in patients suffering from xylazine-related health crises.
“Don’t feel safe,” he said. “Inhaling it or ingesting it won’t prevent complications.”
The drug, commonly used to sedate cattle, sheep, horses and dogs, is “very complex” because it attacks the body in multiple ways, Ryan said.
Xylazine reduces adrenaline and causes sedation, he said. This drop can cause dangerously slow heart rate, low blood pressure, and respiratory depression. The tiny arteries in the skin may also narrow, reducing the blood supply to the skin and causing gaping wounds.
Although scars can appear anywhere on the body, According to medical papers. Unlike the injection wounds that intravenous drug users may suffer from, xylazine wounds are a systemic effect of the drug itself. And as the open wound progresses, the affected tissue can become necrotic.
Brandi McNamee, a nurse with the Butler County General Health District, has noticed an increase in patients suffering from xylazine sores at the county’s safer drug use sites. She offers to clean the wound and the site provides wound care supplies.
However, the skin around the wound can become “hard and black.” It’s a dead organization. Seeing this, McNamee suggests his client go to the hospital. The doctor must remove all dead skin.
Soria also said there has been a “significant increase” in skin wounds and combined withdrawal of fentanyl and xylazine. “This makes it very difficult for my patients to stop using illegal street opiates,” he said.
Discontinuing the use of animal sedatives would be disastrous, Ryan said. Patients experience high levels of anxiety, increased heart rate, and high blood pressure, among other symptoms.
As xylazine spreads across the country, one of the biggest problems is lack of awareness, said Dr. Kelly Ramsey, director of medical services for the New York State Department of Addiction Services and Assistance.
People may not know that they used xylazine. Medical examiners don’t always test, and crime labs often don’t have the tools to do so. “There is a lack of best practices for treating xylazine wounds, treating xylazine withdrawal, and managing xylazine use disorder,” Ramsey says.
Xylazine overdoses are difficult to reverse because they do not respond to naloxone, and bystanders trying to resuscitate someone may not understand what is happening. Ryan said people should still use naloxone if they see someone who appears to be overdosing. They also frequently take fentanyl.
If that doesn’t work, “call 911,” Ryan said. “Please begin CPR.”
Xylazine test strips are available but often illegal
There is a simple way to find out if your personal medicine contains veterinary sedatives. That’s the xylazine test strips, which became available in March.But most states consider them illegal drug paraphernalia.
Crossroads Center’s Soria said xylazine test strips are considered a tool and cannot be provided to patients. “We have to change,” he said.
In the Cincinnati area, health departments in Hamilton County, Butler County and Northern Kentucky are distributing the strips at safer drug use sites, regardless of legal status.
“We encourage all of our clients to test all opiates,” said Sharona Bishop, a harm reduction specialist and advocate with the Butler County General Health District.
Ohio amended its drug paraphernalia law in April, making it legal for people to test their drugs for fentanyl. But Bishop said there needs to be comprehensive legislation to authorize testing, “so that whenever a test strip is released, it will be legal to possess and use it.”
federal bill A bill introduced in July would prevent states from banning the distribution or use of fentanyl and xylazine strips. The bill has not yet received a vote in Congress.
At this point? Triage.
Meanwhile, those monitoring the unfolding xylazine crisis in the Cincinnati area say they are working to keep people safe and save lives.
“Most of my patients still try to avoid xylazine, but this situation will go away as the fear goes away, just as the fear went away with the use of fentanyl,” Dr. Soria said.
McNamee closely monitors people who come to the Butler County site with unusual ulcers or skin discoloration.
“I just want to help whoever I can so the wound doesn’t get worse,” McNamee said. “I don’t want to see anyone lose a limb.”
