Whatcom County just reported its first xylazine death. What you should know about the drug

Whatcom County reported its first overdose death related to the tranquilizer xylazine on Friday, April 5. The drug has become increasingly prevalent in recent years and is often combined with fentanyl. This is particularly dangerous since the opioid overdose reversal drug naloxone (Narcan) doesn’t reverse the effects of xylazine. Here’s what you need to know about the drug.

What is xylazine?

Xylazine, sometimes referred to as “tranq,” is an animal tranquilizer, commonly used on pets, cattle and horses. While it’s intended for use in animals, its use has become increasingly prevalent in humans, especially mixed with other drugs. Its primary effects are slowing down a person’s heart rate and breathing, while reducing blood pressure and brain activity.

“For several decades it’s been showing up in a few places in the country in the heroin supply, and more recently in the fentanyl supply,” Whatcom County co-Health Officer Greg Thompson said.

A study of 10 U.S. cities found that xylazine was in less than 1% of fentanyl samples in 2015, but by 2020, that number had risen to 7%. By 2022, 23% of the fentanyl powder seized by the Drug Enforcement Agency and 7% of fentanyl pills contained xylazine.

How common is it in Washington?

A Center for Disease Control study of reports from 31 states found xylazine in 14.8% of overdose deaths in the Northeast between January 2021 and June 2022. On the West Coast it was present in 0.7% of overdose deaths.

However, that number is likely rising. A DEA analysis showed that xylazine presence in overdose deaths increased in the western U.S. by 750% between 2020 and 2021.

Thompson said the health department hadn’t confirmed any cases of the drug being used in Whatcom County before the recent overdose, though they suspected it was already present.

“It’s been showing up a little bit in Washington state for some time now,” Thompson said. “There are a few places in the state where they have been seeing it. We’ve suspected it may be present in Whatcom County for a while just due to anecdotal reports, although we haven’t had any positive detections in Whatcom.”

The county has been testing all suspected overdose deaths for xylazine since the summer of 2022.

What does this mean for Whatcom County?

Because Narcan doesn’t reverse its effects, there are fears that xylazine will worsen the fentanyl crisis. The White House declared the drug an emerging threat in April of 2023. Thompson said that he considers xylazine to be another factor to combat in the opioid crisis, not a new crisis in its own right.

“Heroin to fentanyl completely changed the game [for] addiction and overdose deaths,” Thompson said. “Xylazine is another bad factor but it’s not the kind of game-changer that the shift from heroin to fentanyl was.”

According to Thompson, the fact that Narcan doesn’t reverse the effects of xylazine doesn’t render the overdose reversal drug useless when xylazine is present.

“Xylazine overdoses are almost always occurring in the context of fentanyl also being present,” Thompson said. “So it can reverse the fentanyl or any other opioid component, which in many cases, will be enough to revive someone.”

Instead, the biggest threat from xylazine is that it worsens the effects of fentanyl when the two are used together, according to Thompson.

“The biggest danger with it is that you’ve got two drugs that are potentiating each other… It does increase the risk of overdose from fentanyl when xylazine is also present,” Thompson said.

Xylazine overdose prevention

Thompson said that the presence of xylazine in Whatcom County doesn’t change the steps people should take to prevent overdoses.

“Of course, avoiding drug use avoids the risk of overdose death. But if people are using drugs, there are a few things they can do,” Thompson said. “One is to never use alone. So if people are using, make sure that someone’s available who could respond if there is an emergency. We always say that, again, if people are using, to use slowly. ... And to always have naloxone, or Narcan, present and someone who knows how to use it.”

If someone you know does overdose, the rise of xylazine makes it especially important to call 911 since it’s not a guarantee that Narcan will reverse the overdose, according to the CDC.

“Call 911, administer naloxone as quickly as possible, give rescue breathing as if you can do it safely, and if not, then hands-only CPR,” Thompson said.

Thompson added that a common mistake is to assume that someone is safe once they wake up from an overdose.

“Even if EMS shows up and this person happens to wake up, and they don’t go to services, we do recommend staying with them… The effects of the naloxone, or Narcan, may wear off faster than the drugs,” Thompson said. “So sometimes people will wake up and then they’ll have a secondary overdose.”

This story was originally published April 5, 2024 at 5:20 PM.