‘Tranq Dope’ Arrives In W.Va.

Appalachia’s ever-present and ever-evolving opioid epidemic has a new cutting agent on the block: xylazine, a sedative medication meant for veterinary use, that is now being mixed into illicit supplies of opioids and fentanyl.

The U.S. Drug Enforcement Administration recently issued an alert warning of a “sharp increase in the trafficking of fentanyl mixed with xylazine,” which is also known as “tranq” or “tranq dope.”

In January of this year, the New York Times reported from Philadelphia, an epicenter of xylazine use, on the devastating reality for people who shared first-hand accounts of using the drug, whether intentionally or not.

Xylazine is a non-opioid agent linked to a growing number of overdose deaths across the country. As a non-opioid, the drug poses a threat to humans, in part because it does not respond to typical revival methods like Narcan.

Leigh Brooks, medical director of the medically assisted treatment program at Bluestone Primary Care in Princeton, West Virginia, said she has seen positive xylazine tests in her patients since August 2022, noting that she never sees xylazine without fentanyl also present.

“When I talked to the patient about it, she had no idea that what she ingested was xylazine,” Brooks said. “So that kind of sparked my interest. As far as you know, if one patient’s got it, I’m probably going to have multiple patients that are going to come back with that xylazine.”

Brooks said her biggest concern is how to educate her patients to handle the side effects of xylazine, given its resistance to Narcan.

“It creates a longer lasting high when people do ingest it with fentanyl, even though we don’t think that they’re actually going out on the street saying, ‘I want xylazine,’” Brooks said. “On the streets, it is called tranq dope. What is happening is it’s just being cut with some of these illicit drugs. So people don’t really know that they’re ingesting them.”

Joshua Schrecker is the senior director of Clinical Affairs at Aegis Sciences Corporation, a toxicology and medication monitoring laboratory that has been tracking the use of xylazine for years.

“We had the prescription opioid epidemic, and then it became the illicitly manufactured fentanyl epidemic,” Schrecker said. “And now we’re seeing adulteration of illicit opioids, traditional illicit substances, like cocaine, with sort of a hodgepodge, or mixing of drugs, kind of at its foundation. The reason that these substances are oftentimes added to other drugs is they have somewhat similar effects on the end user.”

Some who obtain the mixture think they’ve purchased an opioid and are surprised to wake hours later, craving the opioid high more than ever, according to Brooks. The drug has also been shown to cause large open wounds when used by humans, sometimes leading to amputation.

“We do know that some of the side effects that happens is dry mouth, they get drowsy, at first, an increase in blood pressure and increase in heart rate, then heart rate, lowers blood sugar goes up, patients develop hypothermia, and then they go into respiratory distress,” Brooks said. “And also at the injection site, they can get necrotic tissue at those injection sites.”

Necrotic tissue means dead body tissues. Xylazine kills the tissue where the drug was injected.

“Where it’s not a human drug that was never designed for human use, it’s not on the controlled substance list, because it’s a veterinary medicine,” Brooks said. “And that’s another reason why it’s kind of like appealing for the illicit market to use xylazine in a mixture is because the fact that it’s not controlled, it’s lower costs, but also lower risk of law enforcement scrutiny.”

Federal lawmakers including Sens. Shelley Moore Capito, R-W.Va., and Joe Manchin, D-W.Va., recently introduced the “Combating Illicit Xylazine Act” to classify the drug as a controlled substance, among other measures.

“Prescription drugs very much stay the same over time, you know, there might be one or two new drugs that are approved, that we’ll begin testing for, but within the kind of subset of these novel and synthetic illicitly manufactured compounds, they shift and move all the time,” Schrecker said. “When a drug is either internationally or nationally scheduled, the pattern that we typically see is that scheduling occurs, that positivity will drop off, and it becomes replaced with a new substance that’s very similar, acts in a similar manner.”

While most experts agree that scheduling the drug as a controlled substance is the next step, researchers, scientists and physicians alike brace for the next new filler agent to emerge on the illicit market.

“No matter what they take off the street, what drug taskforce takes off the street, how they re-schedule, different medications, that illicit market is so financially driven from, like the cartels, and other illegal activity, that they bounce back with something with bigger, stronger, faster,” Brooks said.

Brooks said her clinic would be most helped by obtaining Clinical Laboratory Improvement Amendments (CLIA) status. To be CLIA waived means being able to test for all substances in the sample in a timely manner, in the office. 

“In the state of West Virginia, I cannot do a point-of-care urine drug screen for fentanyl,” Brooks said. “We’re very much behind the curve, that right there is of the utmost importance that gets changed to where just my standard drug test cups will have fentanyl in it so I can be able to test for fentanyl because you never see xylazine without fentanyl.” 

In medically assisted treatment settings, like Brooks’, these tests are vital to caring for her patients. A full panel would allow Brooks to treat her patients in a timely and effective manner. 

“The illicit markets going nowhere,” Brooks said. “It’s here to stay. It’s one of the things where we have to manage it. And I really do think that you have to kind of look at it from an economic perspective of how to manage that market.”