WV throws support behind national effort to rein in Xylazine

West Virginia has formally thrown its support behind a national attempt to rein in one of the many ugly turns taken in the ongoing opioid epidemic.

In the Mountain State, the number of opioid overdoses deaths where the horse tranquillizer turned synthetic opioid-cutting agent, xylazine, also was present has risen each year since it first showed up on state overdose toxicology reports in 2018, according to the West Virginia Office of Drug Control Policy’s director, Dr. Matthew Christiansen.

The primary danger of the veterinary sedative, which is not approved for human use, lies in its effect of restricting or depressing the user’s breathing, which can compound a similar effect of fentanyl use and, thereby, increase risk of overdose.

Additionally, while opioid-blocker naloxone can reverse the effect of an opioid overdose, an overdose involving a high concentration of xylazine might not respond readily, or at all, to the lifesaving drug.

“Xylazine is the new up-and-comer that everyone needs to be aware of and concerned with,” Charleston Police Chief Tyke Hunt said at the April 17 meeting of the Charleston City Council’s Public Safety Committee.

“With Narcan, we give the chance for somebody to live another day, another chance for rehab to work,” he said. “That’s our whole job, is to save life and give you another chance. Xylazine is taking that away from folks.”

In recent days, West Virginia Attorney General Patrick Morrisey joined a 39-state effort urging legislators to classify xylazine as a Level III controlled substance nationally, via Sens. Shelley Moore Capito, R-W.Va., and Joe Manchin, D-W.Va.’s, co-sponsored “Combating Illicit Xylazine Act.”

Such a move would see manufacturers’ supplies more tightly reported and monitored.

“We are already dealing with fentanyl, and now we have this drug to aggravate an already dire situation,” Morrisey said in a news release. “Our lawmakers need to step up and curb this problem before it becomes another death sentence for millions of Americans.”

According to the letter, xylazine is readily available for purchase online without documentation of need or proper use.

Cutting agents might be used by drug dealers for any number of reasons, whether reducing costs, stretching supply, reducing potency to encourage greater use and/or keep customers alive longer, or increasing overall potency to emulate a “better” product.

In West Virginia in 2019, just six overdose deaths statewide involved xylazine, but that number ballooned to 59 in 2020, 90 in 2021 and 95 in 2022, even as total overdose deaths across all drugs in West Virginia declined by 3.6% from March 2021 to March 2022, according to the U.S. Centers for Disease Control and Prevention.

So far in 2023, the number of West Virginia overdose deaths where xylazine was present has plateaued at 18, according to Christiansen, who said that information is incomplete and that he expects the number to increase.

“This is really an outgrowth of our existing drug problem, a consequence of what we’re already dealing with,” Christiansen said, noting his belief that fentanyl was the primary attraction and cause of most deaths where xylazine was involved. “Drug dealers are innovative, and they put a lot of different things into their drugs. Drugs are unpredictable, deadly, and you never know what you’re getting.”

According to Office of Drug Control Policy data, Kanawha County was second only to Berkeley County’s 54 xylazine-involved overdoses during that same time period, with 29 since 2019.

“We see the highest prevalence in Berkeley and Jefferson, where the drug supply there is more closely tied to the East Coast,” Christiansen said. “To some of the metropolitan areas, like D.C. and Philadelphia. So, we’re seeing a bigger and more significant impact there, relative to other parts of the state, but we are seeing it sporadically across the state.”

According to a 2022 study conducted by Philadelphia’s public health department, traces of xylazine were found in more than 90% of opioid samples taken in 2021.

According to the federal Drug Enforcement Administration, the number of overdose fatalities involving xylazine increased by 103% in the Northeast from 2020-2021; 1,127% in the South; 516% in the Midwest and 750% in the West.

In late March, Gov. Jim Justice signed a bill that designated xylazine a schedule-IV controlled substance in West Virginia, alongside abused prescription drugs, such as Xanax and Valium.

At the national level, the DEA recently released a public safety warning regarding the cutting agent, while the Biden administration deemed it an official “emerging threat.”

“Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” DEA administrator Anne Milgram said. “[The] DEA has seized xylazine and fentanyl mixtures in 48 of 50 states. The DEA Laboratory System is reporting that, in 2022, approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.”

According to the CDC, 107,735 Americans died from overdoses between August 2021 and August 2022, with 66% of those deaths involving synthetic opioids, like fentanyl.

Beyond its strain on breathing, xylazine use also leads to grotesque side effects, such as necrosis, or rotting of tissue, and severe wounds that, in some cases, necessitate amputation, according to the DEA.

“I’ve personally seen it in patients’ wounds that are very difficult to care for,” Christiansen said. “It creates deep ulcerations that can take many months to heal.”

Christiansen said he believes that, even if xylazine were scheduled nationally, it likely would be only a matter of time before a new substance comes to prevalence to replace it.

“Xylazine is just the newest one on the block,” he said. “I suspect drug dealers are very smart and relentless, and as its scheduled, they’re going to find something else to cut into their drugs. It’s a whack-a-mole game.”

Christiansen said there are small-scale pilot programs underway to determine the utility of providing xylazine testing strips to users. As of April, the Cabell-Huntington Health Department was exploring purchase of test strips for distribution.

Despite the presence of xylazine in the area, in the event of an overdose, Christiansen said calling 911, providing naloxone and administering rescue breathing and CPR techniques are the best options.

He also reminded users that addiction is “not a life sentence” and they can seek help by calling 1-844-HELP4WV.