The Journal. - Fentanyl Is Bad. ‘Tranq’ Might Be Worse.

Episode Date: February 21, 2024

The animal tranquilizer xylazine, also known as “tranq,” is finding its way into opioid supplies and wreaking havoc all over the country. It’s rotting people’s flesh, leading to amputations and complicating drug treatment. WSJ’s Julie Wernau takes us to Robeson County, N.C., the new “ground zero” for xylazine addiction. Further Reading: - Flesh-Rotting ‘Tranq’ Undermines Fight Against Fentanyl  - Recovering From Drug Addiction Was Hard. Tranq Made It Worse.  - Nurses Make House Calls to Treat ‘Tranq’ Wounds for Users at Society’s Edge  Further Listening: - Why Some Opioid Victims Are Challenging Purdue’s Settlement  - How a Drug Maker Plans to Cut Off Money for Opioid Victims   Learn more about your ad choices. Visit megaphone.fm/adchoices

Hey, booty! You coming to see me? In a parking lot in Robinson County, North Carolina, Carissa Collins-Cattle is hustling, handing out health supplies to drug users. Did you overdose when you got home? Damn, girl, most people do. Carissa is in drug recovery herself, sober nine years.

And on this crisp morning in December, she's working for a nonprofit, helping people addicted to drugs, including fentanyl. Our colleague Julie Wernow recently traveled to go meet with her. Carissa is like everybody's southern mama. Like this woman is smoking constantly, swears when she needs to, hugs freely. You don't need no test kits? No.

What about wound care? And she goes around this big county in North Carolina handing out all kinds of supplies for people who use drugs. Carissa has been doing this work for several years. But a couple years ago, something strange started happening. Drug users were getting these horrible wounds, unlike anything they'd seen before. It was like their flesh was rotting. Looking for help, they started texting Carissa.

And then the next thing that happens is she starts to get these photos. Carissa showed some of them to Julie. Is that her leg? Her arm. Her arm. Like, right here? Like, drug users that she works with were sending her photos of these wounds and saying, what is this? I've never had this before. In some cases, people were looking at things that had started as something that looked like a cigarette burn and had blown up to the size of a grapefruit on their arms. Some wounds were so deep

that people's bones or tendons were exposed. I've never seen anything like it. In a lot of cases, people think they're just taking fentanyl. But fentanyl doesn't cause wounds like this. Instead, they're actually being caused by a different drug, a drug that's getting mixed into the supply. It's a sedative called xylosine, also known as Trank. And as this new drug sweeps across the country, Chris is watching it ravage her community. Personally, to me, it's scarier than fentanyl.

We know what to do with opioids. We know what drug works to reverse opioid withdrawals. We have no damn idea about how to treat xylazine. Welcome to The Journal, our show about money, business, and power. I'm Ryan Knudson. It's Wednesday, February 21st. Coming up on the show, the scary new chapter in the opioid crisis. See you next time. Fresh adventure, becoming the hero of your own night. Unapologetically full-flavored cocktails with a 13% punch. Seagram 13, dare to make your own luck. Must be legal drinking age.

Please enjoy responsibly. Available at the LCBO. This new addictive drug that's infiltrating the opioid supply, xylosine, was never meant for humans. Julie's been covering its rise for months. So xylosine is an animal tranquilizer. Some people call it trank, and there's a lot we don't know about it. It's the kind of thing that you'd use to, like, put down a horse. Tranquilize it.

Illegal drug makers try out lots of different additives to see if they can make opioids like fentanyl more potent or cheaper to make. And xylosine, or trank, check those boxes. So you get this sense that there is a little bit of drug manufacturers throwing spaghetti at a wall and seeing what works, what's cheapest, what's most powerful, what will keep people coming back in the way that any big business would do with any product, right? But in this case, it's killing people. Zalazine is not an opioid like fentanyl. It's a sedative. It's not meant for human consumption, so there's really not very much known about what it does to humans.

It's always been legal. It's something that, you know, people could buy online. Philadelphia was the first big hotspot for xylazine. But late last year, the Drug Enforcement Administration said xylazine samples were turning up all over the place. They said that it's actually present in all the states, almost in the entire country, very quickly. So I wanted to know where it had just emerged,

where it was the worst, and go to that place and see how they were managing. I got in touch with a company that tests the urine samples of drug users, and they pointed me to North Carolina. This one county, Robeson, was ground zero. That's where Julie spent time with Carissa Collins' cattle, the chain-smoking southern mama you heard from earlier.

Robeson County is about a thousand square miles, much of it rural farmland. The county is ranked among the least healthy counties in North Carolina, and it was hit hard by the opioid crisis. One thing I want to say about Robeson is that you don't go there and immediately see there's any drug problem. There's not people sprawled out on the streets. The drug use there just happens in homes at the ends of these long driveways where people don't even have a car to drive on their driveways because of how much poverty there is.

So a lot of this is hidden. Oh, now, where are we now? Okay, so... So Carissa's driving me all around the county, and her phone just keeps blowing up. It's people texting her, looking for supplies, drug users who are looking for a visit. One person texting her was Ashley Locklear. She's 27, and she's been getting wounds from xylosine. Julie and Carissa went to go see her.

Nice to meet you. Nice to meet you both. We pulled up to Ashley's house, where she lives with her mom, Kelly. Her mom's saying to her, show Carissa, show her what's going on with you. I'm sitting here. My mom will tell you. It's been two days and I've been hoping and hoping my leg get better and it ain't getting any better.

Ashley came outside in her bathrobe and pajamas. She lifts up one leg of her pajama pants and it's like the surface of the moon. It's just getting bigger and bigger. And like I said, now I wasn't having any problems with my hands, and now I'm having problems with my hands.

And she's smoking like it's her last cigarette and telling Carissa how badly it hurts. And her mom's in the background saying, I don't want to lose my baby. I can't lose my baby. She's my younger all over. She's made some bad mistakes, I don't want to lose my baby. I can't lose my baby. She's my younger, I love her. She's made some bad mistakes and she's made some bad choices, but she's still my younger, and I love her. Ashley was 13 years old when a doctor gave her opioids for a broken foot. For years, she was prescribed those pills and became dependent.

A new doctor came, cut her off those drugs, and she had intense withdrawal for the first time in her life and turned to the illicit market. Ashley went from heroin to fentanyl, and now she's also addicted to xylosine. And her other leg she won't show us because she has a compression sock on it to try what she thinks might keep it from hurting. But it hurts so bad, she says, that when the dogs brush up against her leg, it feels like knives. Oh, man. What was Carissa's reaction when she saw it? Love.

Love and kindness. saw it. Love. Love and kindness, just saying. Trying to gently coax her into the idea that she might need care from a hospital. But Ashley didn't want to go. Yeah, no, that's it. Let me see. And I'm procrastinating about it. You know what I mean? Why is she so afraid to go to the hospital? Because she's had bad experiences at the hospital. She's been treated like someone who just needs to kind of straighten up and fly right. Her withdrawal symptoms have been ignored or not taken care of. So there's trauma there from visiting hospitals. And then now on top of that, she has this new kind of withdrawal from xylosine.

I would say she's also afraid that she's going to lose her leg. Xylosine users sometimes lose so much flesh to rot that their limbs have to be amputated. Later that day, Julie checked back in and asked if Ashley was heading to the hospital. Ashley's mom, Kelly, texted back. We're not going to make it, she wrote. She's high and I can't get her up. The wounds from xylosine are one thing, but there are other big concerns, like how life-saving drugs like Narcan don't seem to work as well. Xylosine is baffling hospitals. There's so much they still don't know about it. Xylazine has just made everything so much more complicated. People feel like they're back to square one.

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how it affects people? There's still a lot of things that aren't known. To give you an idea, every time I call the medical community to ask for advice about how much we've learned about xylosine, they send me to the exact same person, which is this guy named Jason. My name is Jason Boehner. I am a certified wound care nurse. And so I was kind of the Pied Piper of xylosine. Jason is a senior research nurse at Johns Hopkins. He calls himself the Pied Piper of xylosine because he was one of the first people to identify the drug's emergence and sound the alarm. He first encountered xylosine around 2020, when he was working in rural Maryland,

and he quickly learned how dangerous it is. Opioid users told Jason that they weren't just getting high, they were suddenly blacking out for hours, missing whole chunks of their day. They didn't know it at the time, but it was because of xylosine. whole chunks of their day. They didn't know it at the time, but it was because of xylosine. There's horror stories of, you know, people waking up with their pants down around their ankles or naked, all their stuff stolen off of them.

People that go out, I mean, they become like a rag doll. It's sad. You can just drag them around and they don't wake up. That is the most vulnerable a human being can be. And people are also getting these horrible sores, right? Why is xylosine causing people's flesh to rot? They don't know yet. Again, it hasn't been tested on people.

It doesn't cause wounds in animals. So there's something unique to human beings that's causing this. The interesting part is they're not infected initially, and they usually don't get infected. It takes a while. The horrible pictures you're seeing that make the news, the terrible, terrible ones, they don't start like that. They start like small little purple blisters or like a little bruise. It expands out.

Do our typical ways of combating opioid overdoses work when xylosine is involved? Like, can you administer naloxone or Narcan? With the overdose, naloxone does not work to reverse the sedative effects of xylosine, but you always give it. It works for fentanyl. So you need to reverse those effects on the body, the decreased respiratory rate and everything else. But the patient might not wake up. They're laying there. They don't respond to stimuli. You can squeeze their fingernails or sternum rub them all you want. It doesn't do anything. Another thing that makes xylazine stand out is the withdrawal. It's an anxiety that is above and beyond that can actually lead to lashing out,

like a fear behavior with folks. Some people think it can actually cause massive spikes in your blood pressure coming off of it. I mean, people say that withdrawal from regular opioids is awful, and this is worse. Yes, this trumps it. You know, everybody's like, you can make the choice not to do it. It's not really that much of a choice when like xylosine is being pumped into the drug supply and people aren't asking for it. like xylosine is being pumped into the drug supply and people aren't asking for it. In Robeson County, xylosine now seems to be almost impossible to avoid.

It's estimated to be in about 77% of the county's drug supply. At a motel parking lot, Julie met a woman named Amber Melvin, who says she's been doing all she can to avoid xylosine. She's been trying to get her hands on xylosine test strips. And I'm going to tell you, five out of six dopes that I get is full of xylosine. It's full. Once you're on tranquilizer, the xylosine dope,

the methadone and the suboxone does not help. You are still sick as a dog. Amber wraps her sweater tight around her. She says she and her partner don't want to buy dope with xylosine anymore, but it's not really an option. You know, you do dope to get high. You don't do dope to just pass out. You do it to feel something, you know, not go directly out.

And that's what the xylosine does. Our colleague Julie says once a drug like xylosine takes hold in a drug market and becomes part of people's addiction, like with Amber Milvan, it's really hard to stamp it out. Is there any hope? I think there's hope if people really take this seriously. Early intervention actually does seem to work with the xylosine wounds. We met a lot of people who, they sent these pictures to Carissa. Carissa

like got in there, gave them the wound supplies. They took care of it. They started questioning their drug dealer. They are okay right now, and they know what they're looking at. You can heal from this. You can get better. But it's a harder and more complicated and more difficult road than recovering from fentanyl. And we never thought we'd see something that was harder and more difficult and complicated than recovering from fentanyl addiction. In the meantime, a lot of the actual work on the ground is being done by people like Carissa

Collins-Cattle, one woman in a van, trying to hold up an entire county. But Carissa's now going to be out on her own. The North Carolina nonprofit she worked for didn't renew her contract, citing restructuring. She's in the process

of starting her own syringe program, and she's looking for funding. Oh yeah. People call me all the time. They're not going to stop calling me. They're not. Because they're going to call me every time, and every time I'm going to help them. I don't care if I get paid for it or not. Because, I mean, this is somebody's life we're talking about. February 21st. The Journal is a co-production of Spotify and The Wall Street Journal. Additional reporting this episode by Alyssa Shukar. Thanks for listening. See you tomorrow.