Consider This from NPR - The drug fueling another wave of overdose deaths

Episode Date: June 15, 2023

A deadly and addictive chemical normally used as a horse tranquilizer is being mixed into illegal drugs.Xylazine has been around for a while, but over the last year authorities have been seeing it turn up in higher quantities all over the country. In recent weeks, U.S. Drug Czar Rahul Gupta has been sounding the alarm, even acknowledging public health experts and police are mostly in the dark about how Xylazine took hold so quickly.NPR's Juana Summers speaks with addiction correspondent Brian Mann, who has been reporting on the mysterious and deadly emergence of the drug. In participating regions, you'll also hear a local news segment to help you make sense of what's going on in your community.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

This message comes from Indiana University. Indiana University performs breakthrough research every year, making discoveries that improve human health, combat climate change, and move society forward. More at iu.edu forward. Something deadly is happening on American streets. Xylosine, a chemical normally used as a horse tranquilizer, is being mixed into illegal drugs. Xylosine has been around for a while, but over the last year, authorities are seeing it turn up in higher quantities all over the U.S., mixed into fentanyl, methamphetamine, and other drugs. I'm deeply concerned about what does this threat mean for the nation. That's U.S. drug czar Raul Gupta. In recent weeks, he's been sounding the alarm.

He even acknowledged public health experts and police are mostly in the dark about why this latest drug threat is happening. Testing for Zarobene is uneven across the United States, which makes it hard to get the national picture. Many communities are not even aware of this threat in their backyard. And for people like Casey in Dover, Delaware, using drugs tainted with xylosine increased dependency and suffering. People who are in this are just getting sucked further and further and

further and it just feels kind of hopeless right now. Coming up, xylosine is making addiction deadlier and harder to escape. How are authorities tackling this problem? It's Consider This from NPR. I'm Juana Summers. It's Thursday, from NPR. I'm Juana Summers. It's Thursday, June 15th. This message comes from WISE, the app for doing things in other currencies. Send, spend, or receive money internationally,

and always get the real-time mid-market exchange rate with no hidden fees. Download the WISE app today, or visit wise.com. T's and C's apply. Support for NPR comes from NPR member stations and Eric and Wendy Schmidt through the Schmidt Family Foundation, working together to create a just world where all people have access to renewable energy, clean air and water, and healthy food. The Schmidt Family Foundation is part of the philanthropic organizations and water, and healthy food. The Schmidt Family Foundation is part of the

philanthropic organizations and initiatives created and funded by Eric and Wendy Schmidt to work toward a healthy, resilient, secure world for all. On the web at theschmidt.org. Support for NPR and the following message come from Carnegie Corporation of New York, working to reduce political polarization through philanthropic support for education, democracy, and peace. More information at carnegie.org. It's Consider This from NPR. When new street drugs emerge, they often blaze a path of destruction before policy experts and authorities even know what hit them. The latest one? Xylazine. Brian Mann is our addiction correspondent. He's been reporting on the mysterious and deadly rise of the drug in communities across the country.

I mean, Brian, for many of our listeners, this is possibly the first time they've even heard of Xylazine. So just to get started, what is it and when did we start to see it appear in street drugs here in the U.S.? Yeah, it's a bit of a complicated picture, but xylosine, which is known on the streets as trank, is a chemical that veterinarians have used for years with horses as a horse tranquilizer. And it has popped up occasionally here and there as something that's been abused on the streets. But all of a sudden, Trank or Xylosine has just exploded. We've seen a lot more of it in the South and the West where it was nearly unheard of before. And one of the startling realities here, Juana, is that we track street drugs so poorly in the U.S. that it's hard

to know exactly why this is happening, why Xylosine started surfacing in so many places, spreading so quickly. I spoke about this with Dr. Nabarun Dasgupta at the University of North Carolina, who tests street drugs collected from communities around the U.S. We only find out about what's in the street drug supply when it's too late, when people are either dead or arrested. And so that's what's happening now. People are turning up in emergency rooms all over the country with terrible injuries from this chemical. Can you tell us a little more about that? I mean, what does xylosine do to a person who encounters it as they're taking some sort of street drug? Yeah, this is devastating. You know, let me start by saying with the help of our colleagues at Delaware Public Media, we were able to connect with two people on the street struggling with fentanyl addiction, and they're finding xylazine in the drugs they buy.

It just eats your skin away and you just have a hole and then it leaves a scar. NPR agreed not to use Jessica's last name. She turned up at a harm reduction van on a street in Newcastle, Delaware, with bandages on her legs from xylosine-related wounds, which she says are really hard to treat. Because it goes fast. It just literally eats your skin away. Xylosine also makes it much harder to revive people after fentanyl overdoses, and the chemical adds another layer of intense addiction and cravings. KC uses street fentanyl overdoses. And the chemical adds another layer of intense addiction and cravings. KC uses street fentanyl in Dover, Delaware, and says xylazine is making addiction deadlier and harder to escape. People who are in this are just getting sucked further and further and further, and it just feels kind of hopeless right now. And this is so new, one of this

chemical being in the streets and hitting people that researchers are still scrambling to understand why exactly xylosine does so much harm to the body. This is new and the medical science for how to treat it and help people is still evolving. So Brian, I mean, that raises a lot of questions for me. One big one, what are policymakers and experts that you're talking to telling you about how and why xylosine is being added to fentanyl and other sorts of street drugs? So one of the things that's startling about this is that it's kind of a mystery. You know, we've spoken to the Drug Enforcement Administration, some of the top experts on street drugs around the country, and nobody really knows why this is happening or why it's spreading so quickly.

One thing we do know about fentanyl, right, which is the main drug that's killing people in the U.S., is that it's so powerful, drug dealers and cartels have to cut it with other substances, diluting its strength effectively. So one theory is that maybe xylazine just caught on suddenly as a good option, because in the past, this chemical hasn't been regulated very aggressively. Here's Dr. Nora Volkov, who's head of the National Institute of Drug Addiction. Xylosine is a perfect filler. It's basically very, very cheap. On top of that, it may be enhancing the duration of these drugs. But again, why so many drug dealers suddenly started including this ingredient in their street drugs right now, that's still a mystery. And I mean, Brian, that raises a question then about regulation. I mean, for years, fentanyl was charting this deadly path through communities across the country, and that was long before it

became a target for enforcement and interdiction efforts. Are authorities and government agencies already too late when it comes to tackling the xylosein problem? I think the government, the Biden administration and state officials around the country are pretty open about the fact that they are once again playing catch up here, right? They're just now trying to lock down the xylosine sort of ecosystem, the supply chain, which had been pretty unregulated in the past. And so yeah, I think this is another instance where we only realized there was a problem once a lot of people were being hurt badly. I mean, you mentioned the Biden administration. Are there plans for the administration to act to do more, for Congress to do more, to the degree that federal lawmakers can to help squelch this? You know, the Biden administration has done some things to try to improve the tracking of street drugs, new drugs coming online around the country, and also to better track overdoses. But the system

is still really primitive, Juana. I mean, you compare it, for example, to what we saw during the COVID pandemic, when you could really tell when and where hotspots were, where people were getting sick. Well, we just don't have anything like that for street drugs. And so one of the things that's alarming about this moment with the xylosine surge is people are worrying about what might come next, right? What new synthetic drugs that could be even more deadly and more dangerous that we could see next. Here's Dr. Rahul Gupta. He heads the White House Office of National Drug Control Policy. And he says, you know, this could be a sign of things to come. We're also looking ahead to what potentially come after xylosine as an additive to fentanyl

in order to get in front of the next additive in the drug supply. So again, this is a frightening moment with xylosine, but other deadlier drugs could emerge in the future. In fact, experts say they think that's really likely. And unfortunately, the most likely way that we'll say they think that's really likely. And unfortunately, the most likely way that we'll find out when that's happening is when, once again, more people turn up in emergency rooms or in morgues in communities around the U.S. So, Brian, given everything that you've just laid out here, what would it look like if authorities and policy experts actually

got ahead of this before another drug causes the type of destruction that we've seen from xylosine and fentanyl? So one of the answers here is just sort of a policy shift. Right now, there are, in fact, law enforcement agencies around the U.S. that are testing for what drugs are on the streets. But a lot of time, that information remains kind of siloed off in different communities and different places. It's not being shared with the public health community. And so that's one thing I hear from experts is if there were some kind of mandated reporting system where the police in Los Angeles or in Baltimore would say, look, here's something new that we're finding and feed that information in real time into some kind of

national database, that could be a game changer. Another thing people say they want to see more experimentation with is wastewater testing, where you can actually test the wastewater in a city or even in a rural community. And that can show a lot of new chemicals that are coming online. So there are possible policy responses, but so far those just haven't gained traction in Congress or in most state governments around the U.S. That was NPR's Brian Mann, who covers addiction. It's Consider This from NPR. I'm Juana Summers. Support for NPR and the'm Juana Summers.