New drug ‘tranq’ could make SF’s fentanyl crisis even worse

As San Francisco struggles to deal with its fentanyl overdose crisis, officials are on high alert that another drug known colloquially as “tranq” — an animal tranquilizer commonly used on large livestock — could seep into the street supply and cause more death and disability.

The pharmaceutical drug xylazine has already appeared in East Coast cities, further destroying those communities. The drug can increase the risk of overdose, worsen withdrawal, and increase the risk of wounds leading to amputation for those who inject it.

While it has not yet reached the scale seen in San Francisco or California, the Office of the Chief Medical Examiner told The Chronicle on Tuesday that it is developing a method for universal xylazine testing that it will begin using early this year for all fatal overdoses. of drugs. The office also plans to retrospectively test all 2022 suspected overdose cases to see if the drug was present in any of the deceased.

“It’s certainly on our radar,” a spokesperson for the Medical Examiner said in an email. “We have been in communication with our colleagues at the San Francisco Department of Public Health, as well as colleagues at other forensic laboratories in California.”

San Francisco sees an average of one to two overdose deaths per day, mostly from fentanyl, the highly addictive super-powerful opioid. The introduction of xylazine into the city’s drug supply could be a catastrophic new phase in the city’s opioid epidemic, which has already overwhelmed public health officials and divided city leaders over how to handle it.

Those on the ground say they are monitoring any reports of xylazine being mixed into the drug supply, and several drug users interviewed Tuesday in the Tenderloin — a neighborhood with the highest concentration of drug use, sales and overdoses — said they are aware of the dangers and are becoming increasingly concerned about it.

Cosmo, 65, who lives in the neighborhood and declined to give his full name, said he plans to be more careful about what he injects because his drug of choice — “fentanyl-laced” cocaine — is that with which xylazine is usually mixed in the East. The coast.

“If it’s back East, you can bet it’s here already,” he said. “I’ll have to be very careful about what I buy.”

In East Coast drug hotspots like Philadelphia, the veterinary sedative is being mixed with fentanyl and has made the effects of the highly potent opioid even more terrifying. The sedative, which is also an analgesic and muscle relaxant, can cause devastating skin lesions that, if left untreated, can lead to amputation. Because xylazine is not an opioid, the anti-overdose drug Narcan does not work for it.

This means that if someone overdosed on both fentanyl and xylazine, Narcan would reverse the effects of fentanyl but not xylazine.

Getting into recovery may also be more difficult if xylazine enters the supply. A report by the Drug Enforcement Administration states that “users may develop a physical dependence on xylazine itself, with some users reporting withdrawal symptoms from xylazine as similar to, or more severe than, heroin or methadone; symptoms include sharp chest pains and convulsions.”

With reports circulating about xylazine infiltrating the East Coast drug supply, San Francisco officials are in the tricky position of not overstating — or understating — the potential danger. Since it hasn’t appeared in any visible way, officials are still in the early stages of planning for it and are mostly focusing on increased surveillance and education.

At the same time, however, the East Coast drug crisis tends to be a harbinger of what’s to come on the West Coast. For example, fentanyl appeared on the East Coast a few years before it took over the drug supply in San Francisco.

Now, the opioid has been found in the majority of all overdose deaths in San Francisco.

“Because we’re in the late stages of the fentanyl epidemic … people are becoming tolerant and (drug dealers) will combine it with other drugs,” said Daniel Ciccarone, a professor of family-community medicine at UCSF. He said this is particularly alarming because “we still don’t understand the overdose crisis we’re in.”

The San Francisco Aids Foundation, a harm reduction nonprofit, said the drug enforcement program tested a sample of street drugs this fall that had a “trace amount” of xylazine in it. While it was just one sample among hundreds tested over the past six months, the discovery prompted the foundation to increase its education and monitoring, knowing that the drug supply could change at any moment.

Xylazine “is something we’re very conscious of and paying attention to,” said Ro Guliano, senior director of substance abuse health services at the San Francisco AIDS Foundation. “Like what happened when we had that big change in fentanyl, that would inform how we do health education for people who use drugs, including overdose prevention.”

Currently the San Francisco AIDS Foundation has two machines that people can use to test their drugs before taking them. These machines, which cost about $70,000 each, give people a clear picture of what’s in the street drugs they take and also provide officials with a snapshot of trends overtime. One of the machines is in a mobile van, while another will be operating at their SoMa site in February.

The Department of Public Health said in a statement that it is “closely monitoring the situation” and is also continuing to work with organizations across the city and “preparing in case it becomes more rampant.” Officials are also working on developing care options, including treatment that is specific to xylazine.

However, as the city prepares for the potential new phase of the opioid epidemic, the deficiencies in the current system have become even more apparent. San Francisco does not have enough treatment options, and the city’s law enforcement agencies and criminal justice system have struggled to address drug dealers who operate openly.

Mayor London Breed is also said to have backed away from opening a safe consumption site in the city. Such a site would provide a place for people who use drugs around medical professionals who would help reverse overdoses and save lives.

Guiliano, of the San Francisco AIDS Foundation, said the danger of xylazine adds to the need to open one of these sites.

“The bigger issue is how is the city providing health care for these large numbers of people who are also experiencing homelessness?” she said. “You can’t talk about one without the other.”

The DEA report said the presence of the drug in fatal overdoses may be more widespread than reported because many laboratories do not include it in their toxicology tests.

The San Francisco medical examiner’s decision to retroactively test overdose cases from 2022 will help officials better understand how prevalent the drug currently is in the city, if at all. But increased real-time testing of the current supply would help field workers respond more quickly to any shift, Guliano said.

In the Tenderloin, Andy Berger, 31, said Tuesday he feared he may have injected xylazine — which he said is sometimes called the “zombie drug.” While it’s unclear whether he accidentally took the drug, he said he has developed widespread abscesses along his legs, arms and hands over the past few months that are unlike anything he’s had before.

He said he has been to three different hospitals or clinics since September to treat his wounds, “and they always tell me it’s cellulitis or something like that. They say they haven’t heard of the zombie drug.”

Berger sat in a red tent near the corner of Leavenworth and Ellis streets, and rolled up his left leg to reveal a cluster of deep red, angry abscesses. He held a syringe ready for his next shot in one hand, but it was difficult to grasp due to the open and swollen wounds on his fingers.

“I’ve been using for a long time and I’ve never had anything like this,” he said, referring to his scars. “I know other people who have this… I don’t know what to do. It’s pretty scary, man.”

Trisha Thadani and Kevin Fagan are San Francisco Chronicle staff writers. Email: [email protected], [email protected] Twitter: @TrishaThadani, @KevinFagan