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Unveiling the Hidden Threat: Xylazine in the Drug Supply · Talking FACS

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  Welcome to Talking FACS, what you need to know about family,
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  food, finance, and fitness.
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  This nationally recognized, award-winning podcast is hosted by the University
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  of Kentucky Family and Consumer Sciences Extension Program.
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  Our educators share research knowledge with individuals, families,
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  and communities to improve quality of life.
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  Hello and welcome to Talking FACS. We have information you can use to strengthen
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  your family, your community, and our state.
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  I am your host, Mindy McCulley, Extension Specialist for Instructional Support
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  with Family and Consumer Sciences Extension at the University of Kentucky.
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  We are housed in the Martin-Gatton College of Agriculture, Food, and Environment.
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  It's pretty common knowledge that overuse of opioids is a problem in Kentucky and nationwide.
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  But today, my guest, Dr.
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  Alex Elswick, our Extension Specialist for Substance Use Prevention and Recovery,
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  is here to share with us about a non-opioid sedative called Xylazine that is
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  being found in the drug supply in increasing numbers.
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  Welcome, Alex. Welcome.
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  Good morning, Mindy. And that's a tremendous amount of pronunciation.
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  You have to do all at once from the introductions to the Martin-Gatton College
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  to my title, all the way to Xylzzine, which I've now heard you pronounce correctly
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  like a dozen times. And that's great because it's a hard one to say.
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  Well, now I'm feeling a little bit tongue-tied.
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  So we'll see if I can make it through the rest of the conversation.
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  But let's start with what is Xylazine? Sure.
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  So Xylazine is, you'll sometimes hear it referred to as trank or like trank dope.
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  That's kind of the colloquial term for it. But Xylazine is a non-opioid sedative
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  that actually was never intended for human consumption.
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  It's right, as some drugs are, it's primarily used in veterinary medicine to
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  help to date and calm and even provide a little pain relief to animals for diagnostic
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  procedures and surgeries and what have you.
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  So not intended for human consumption, but it's increasingly being found in
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  our drug supply in the US and in Kentucky.
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  Okay. So how does it affect that a human when it is ingested?
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  Because I'm guessing that it's probably given to an animal by syringe.
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  Yeah. And given to big animals too, right? I mean, not little animals,
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  big of cattle and horses.
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  So yeah, it's a great question. So it's a powerful sedative, but it's a non-opioid.
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  So we've been hearing a lot about opioid overdoses, things like prescription
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  medication, heroin, fentanyl.
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  It's not an opioid like that, but it does give a sedative effect.
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  What's interesting about it
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  is it's not in the drug supply because people who use drugs want it there.
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  And that's what makes this in some ways kind of different from some of the other drug trends.
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  Xylazine is really only being put into the drug supply by people who sell drugs
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  as a way to increase profit.
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  It'll increase kind of the net weight of a product, which will increase its
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  value. And also because it gives a sedative effect, it kind of gives users the
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  perception of a stronger drug.
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  If they think it's fentanyl, it may be thinking it's stronger than it is.
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  And so that might also increase its value. But that's what makes it a little
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  bit of a kind of a curious trend because it's really only drug sellers who are
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  forcing it into the drug supply.
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  Okay. So it seems to me that that's doubly problematic then.
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  Yes, for a number of reasons.
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  But one of the primary reasons is because fentanyl is most often contaminated
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  with Xylazine, meaning that people don't know that they're taking Xylazine.
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  It's giving them different effects and a different profile of risk, really. Sure.
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  I can see that. So how common is it? Are we seeing it a lot in Kentucky or?
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  Unfortunately, yes. We're seeing explosive growth across the United States,
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  across the Midwest, across the South.
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  It's only recently that our Office of Drug Control Policy began accounting for
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  Xylazine as a part of fatal overdoses, as a part of our surveillance.
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  So we don't have really good, rich data on that.
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  In doing some research for this, I found an interesting approach that we've
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  used is a wastewater analysis. Have you ever heard of this as a public health measure?
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  No. So tell me more. Yeah, it's really interesting.
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  It's actually not uncommon. It's been used to address a variety of different
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  concerns, and not just environmental concerns, but public health trends in different conditions.
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  So what these researchers did is analyze wastewater in different parts of Kentucky
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  for the presence of Xylazine. and they found 63% of the samples that they tested had Xylazine present.
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  And so that doesn't give you very specific information. You don't know exactly
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  who, but what you know is that that means that people are consuming Xylazine
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  and then it's going into the wastewater supply.
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  It means it's here in Kentucky. So it's an interesting way of saying,
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  even though it's not reflected in the overdose data, we know that it's here.
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  Okay. So let me play devil's advocate here just for a second,
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  because if it is used for veterinary use, could it not also be reflected in
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  the wastewater because the animals are excreting it as well?
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  I'm going to be totally honest with you, Mindy. That's a brilliant question,
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  and it's not one that I considered.
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  Once you started asking it, it's like obviously a very important confound.
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  I would have to look back at the study to see how they tried to account for
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  that. It's a really interesting question.
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  But I would just say generally, because wastewater analysis is not an uncommon
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  approach to epidemiology and public health metrics, my guess is that they accounted
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  for that. Yeah, I would think so too.
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  To control for it. And I'm guessing
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  that they could look at just the human wastewater as opposed to the...
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  Like not to get carried away on a whole thing, but you know,
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  back in the day, we used to use wastewater analysis even to determine like TV viewership. Sure.
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  Right? Because like during the commercial breaks for I Love Lucy,
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  you get an analysis of how many people are watching based on how many people
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  are flushing the toilet.
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  So it's interesting to think about, but... Yeah. Okay. I'm talking about dilazine.
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  Sorry. I digress. That's right. Okay.
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  So why should we be concerned about Xylazine? Is this affecting the opioid overdose?
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  Yes. I think the bottom line is that Xylazine is complicating a pre-existing overdose crisis.
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  So you kind of have to remember that the context for the emergence of Xylazine
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  is we've already had a prescription opioid epidemic, and that was the first wave.
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  And then we had a heroin epidemic, and that was the second wave.
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  And then we're in the midst of the deadliest of the three, a fentanyl wave.
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  And now this fentanyl that's being contaminated with Xylazine,
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  the reason it really complicates things is because, so we lost 100,000 people
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  last year to fatal overdose.
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  And Naloxone is the best weapon that we have to fight against fatal overdose.
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  And Naloxone is the medication that temporarily reverses an opioid overdose,
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  but it only works on opioids.
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  So the reason this is so complicated is because if someone has used fentanyl
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  that's mixed with Xylazine and you administer Naloxone to reverse that overdose.
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  The Naloxone will still be effective at reversing the opioid overdose.
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  So it will help the person begin breathing again, but they may not regain consciousness
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  the way they normally would if they didn't have Xylazine present.
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  So it's making it harder to identify overdoses. It's making it harder to respond
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  to overdoses and possibly making overdoses just more deadly.
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  So there's a variety of reasons to be concerned, but I think to put a bow on
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  that, the most important thing for people to remember is there are no known
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  side effects to administering Naloxone.
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  You have a good Samaritan law that protects you if you administer it in good faith.
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  So if you think that someone, if you have any reason to believe that you've
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  come upon someone who is having an opioid overdose, whether you think Xylazine
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  is present or not, don't let that complicate it too much.
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  Always administer Naloxone. Always call 911 and get help. Okay. And...
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  The person might not know if there's Xylazine present or not, right?
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  That's right. And it's not like you can ask them because the person responding
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  to the overdose doesn't know. The person who's overdosed probably doesn't know.
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  And to be honest with you, the person who sold it to him may not know either
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  because it may have been further on down the line.
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  That's exactly right. That's exactly right. Okay.
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  At a broad scale, what this is, is there's this phenomenon called the Iron Law
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  of Prohibition. and the iron law of prohibition says that when we make something
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  illegal, when we prohibit it and we drive it underground, it becomes a lot more unsafe.
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  Sure. You can think of abortion as an example of that.
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  You make abortion illegal, people don't necessarily stop having abortions,
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  but they have to do it in a much more unsafe way.
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  And so the same thing happens with drug use. And you're seeing this where in
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  the illicit drug market, all these contaminants are being included,
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  fentanyl derivatives and now Xylazine.
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  And so it speaks to the need for us to really get a handle on this thing. Definitely.
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  Alex, thanks so much for taking the time to share with us about this drug that
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  I didn't know anything about.
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  And I'm sure that a lot of our listeners knew nothing about it as well.
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  Yeah. Thank you for highlighting an important and concerning trend.
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