The illicit use of the veterinary tranquilliser xylazine, often mixed with fentanyl, is spreading across the United States. Known as “tranq” or “tranq dope,” this drug poses significant challenges for healthcare providers. A recent report by Millennium Health underscores the alarming rise in xylazine use and its dire health implications.

The Spread of Xylazine

The Millennium Health Signals report highlights a sharp increase in the presence of xylazine in urine drug tests (UDTs) across various regions in the United States. This report, which monitors medication use for pain management, drug treatment, and behavioural and substance use disorder centres, reveals troubling statistics.

From November 2023 to April 2024, 16% of all national urine samples tested positive for xylazine, up from 14% in the previous six months. The highest rates were observed in the East and mid-Atlantic regions, but significant increases have also been noted in the western and Mountain West regions of the country.

Regional Data

In the Western United States, the percentage of xylazine-positive UDTs rose dramatically. In Washington, Oregon, and California, the rates increased from 3% in early 2023 to 8% by mid-2024, marking a staggering 147% increase. Similarly, the Mountain West region saw a rise from 2% in 2023 to 4% in 2024, a 94% increase.

New England experienced a more than 100% increase in xylazine use, jumping from 14% in 2023 to 28% in 2024.

In the mid-Atlantic region, which includes states like New York, Pennsylvania, Delaware, and New Jersey, there was a decrease in positivity rates from 44% to 33%. East North Central states such as Ohio, Michigan, Wisconsin, Indiana, and Illinois saw a slight decline from 32% to 30%.

South Atlantic states, including Maryland, Virginia, West Virginia, North and South Carolina, Georgia, and Florida, experienced a 17% increase in positivity rates, growing from 22% to 26%.

Localised Data

Pennsylvania reported state-level UDT positivity rates of 40%, while New York and Ohio had rates of 37% and 35%, respectively. However, Clermont and Hamilton counties in Ohio reported an alarming 70% positivity rate for xylazine. Approximately one-third of specimens in Maryland and South Carolina contained xylazine.

Health Implications

Xylazine is particularly dangerous because it does not respond to naloxone, the opioid overdose reversal medication. Its use is associated with severe necrotic lesions that can lead to amputation. The FDA and Drug Enforcement Administration have both issued alerts and taken steps to curb the trafficking of xylazine and its combination with fentanyl. Despite these efforts, the spread of xylazine continues unabated.

Millennium Health’s Chief Clinical Officer Angela Huskey, PharmD, emphasised the need for clinicians across the United States to recognize and address the consequences of xylazine use. These include diminished responses to naloxone and the emergence of severe skin wounds among people who use fentanyl.

Source: Medscape