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March 1, 2024

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Clark County health officials watch out for xylazine; ‘tranq’ not prevalent in county so far

Sedative does not respond to Narcan

By , Columbian staff reporter

Although a drug called xylazine — commonly referred to as “Tranq” — is a growing threat in some communities, health officials say only a small amount has been found in Clark County’s drug supply.

Officials are preparing for the possibility that amount will increase.

Xylazine is a sedative used by veterinarians as horse tranquilizer. It’s not approved for human use by the Food and Drug Administration because of its dangerous, even deadly, side effects.

The drug has been linked to an increasing amount of overdose deaths throughout the country, especially in large cities including Philadelphia and New York City.

There’s only been one xylazine overdose death in Clark County recorded by the Medical Examiner’s Office, which began testing for the drug last year. However, data collected by Columbia River Mental Health Services, an organization that treats people with substance use disorders, shows around 4 percent of fentanyl in the county contains xylazine.

How to help

What to do during an overdose involving xylazine:

Signs of an overdose include small, pinpoint pupils, loss of consciousness, shallow breathing, choking sounds, limpness and pale, blue or cold skin, according to the Centers for Disease Control and Prevention.

If someone is showing the signs of a possible opioid overdose involving opioids and xylazine, the Substance Abuse and Mental Health Services Administration recommends taking these steps:

1. Call 911 and stay on the phone until first responds arrive.

Washington has a good Samaritan law to protect people trying to save someone from an overdose.

2. Give naloxone — a drug that can reverse the effects of an overdose.

Naloxone will not cause harm if opioids are not involved in an overdose, but be aware that the effects of an overdose may continue after naloxone is given if xylazine is involved.

3. Give rescue breaths and chest compressions.

Rescue breaths are important for overdoses possibly involving xylazine because the sedative slows down breathing. To give adults rescue breaths, make sure the airway is clear, place one hand on the chin, tilt the head back and pinch the nose closed. Seal your mouth over the person’s mouth and give two slow breaths, watching the person’s chest rise. Follow up with one breath every five seconds. For chest compressions on adults, place the person on their back, press hard and fast on the center of the chest and keep your arms extended.

4. Monitor the person.

If the first dose of naloxone hasn’t taken effect after two to three minutes, another dose may be necessary.

The Washington State Department of Health has a detailed guide with visuals on its website.

After becoming aware of xylazine’s presence in other communities, Dr. Kevin Fischer, chief medical officer at Columbia River Mental Health Services, added the drug to the list of substances his organization tests for in February of 2022.

“We almost saw it present in drug screen specimens immediately,” he said. “It’s been consistently there in the drug supply at a low rate.”

Xylazine can cause slowed breathing, low heart rate and low blood pressure — effects that are exacerbated by the drug’s frequent combination with opioids, according to the National Institute on Drug Abuse.

The drug is sometimes added to illicit fentanyl during production because it prolongs the effects of fentanyl.

The side effect xylazine is likely most known for is rotting human tissue — earning it another nickname: “Zombie drug.” A presentation by Columbia River Mental Health Services shows images of people with wounds from xylazine who have red splotches or blackened legs and forearms that resemble severe burns.

“Most people are getting this into their drugs without their knowledge or desire. People are pretty scared of this effect,” Fischer said.

It’s unlikely that xylazine is playing a significant role in soft tissue infection hospitalizations in Clark County, according to Fischer.

The level of xylazine within the county is lower than other communities, such as Philadelphia — where 26 percent of all overdose deaths involved xylazine. That’s because drug markets tend to be regional, so the prevalence of certain drugs in different communities varies, Fischer said.

Still, officials in Clark County are concerned about xylazine’s presence in the community and whether it will increase.

“It’s certainly something we’re prepared — or trying to prepare for — as much as possible,” said Clark County’s deputy health officer, Dr. Steven Krager.

Clark County Public Health works with a group of local providers to stay updated on xylazine’s presence in the local drug supply. The county also put out an educational flyer in April of last year warning about the effects of xylazine.

Since xylazine is not an opioid, it doesn’t respond to naloxone — a drug that reverses the effects of an overdose. Krager said people should still use naloxone for an overdose even if they suspect xylazine might be involved because the sedative is often combined with fentanyl, which does respond to naloxone.

If xylazine is mixed with an opioid, it may take more naloxone, also called by its brand name, Narcan, to bring them back, Fischer said.

“We’ve heard cases in the community about people needing six, seven, eight doses of Narcan to reverse an overdose,” Fischer said. “I suspect those are overdoses complicated by xylazine.”

It’s common for overdoses to require multiple doses of naloxone, even when xylazine is not involved, according to the Mayo Clinic.

Rescue breaths are also important if someone suspects an overdose may involve xylazine because the drug causes breathing to slow down, according to the Centers for Disease Control and Prevention.

Xylazine testing strips, which people can use to test their drugs to see if the sedative is present, have recently become available but are not yet widely distributed, according to the National Governors Association.

Some governments, such as the city of Philadelphia and the state of New York, are giving away xylazine test strips for free. The sedative has no distinctive taste, smell or look when mixed with opioids, making tests the only way to identify the xylazine, according to New York’s Office of Addiction Services and Supports.

However, the test strips are not approved by the Food and Drug Administration and they do not appear to be widely available in Clark County, where the amount of xylazine is low compared with communities on the East Coast.

Clark County Public Health has requested xylazine test strips through its partnership with the Washington State Department of Health, but it hasn’t secured them yet and does not know when it will receive them.

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Krager said it’s hard to predict whether the amount of xylazine in Clark County will increase.

“It is certainly a concern,” he said. “It’s something we’re going to continue to be vigilant and watching out for, and if we see increases, we will be alerting the public along with our provider community.”

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This story was made possible by Community Funded Journalism, a project from The Columbian and the Local Media Foundation. Top donors include the Ed and Dollie Lynch Fund, Patricia, David and Jacob Nierenberg, Connie and Lee Kearney, Steve and Jan Oliva, The Cowlitz Tribal Foundation and the Mason E. Nolan Charitable Fund. The Columbian controls all content. For more information, visit columbian.com/cfj.