Community Health & Wellness

Xylazine, a tranquilizer intended for large animals, feared as new threat

Xylazine, a common veterinary sedative that is increasingly being mixed with fentanyl in some parts of the U.S., has not significantly infiltrated the drug market on the Kitsap Peninsula, based on available data and anecdotal accounts from local providers. But concerns remain that it could spread to the state in coming years.

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Federal regulators approved the drug, often called tranq, decades ago to sedate large animals like horses. But the cheap and accessible tranquilizer is a common fentanyl adulterant in some East Coast cities. Combined with an opioid, it can increase the duration and intensity of intoxication. 

Dangerously slow heart rates

The National Institute on Drug Abuse reports limited research into xylazine and its effects on humans. It remains unclear if it increases the risk of an opioid overdose, but the drug can cause heart rates to slow to dangerously low levels and produce gruesome skin ulcers. The sedative has no available antidote and cannot be reversed with naloxone, an opioid antagonist that has become a critical harm reduction tool. 

Wayne Swanson, the director of subacute recovery services at Kitsap Mental Health Services, said providers in Washington state have been talking about xylazine for about a year. It has popped up in the supply locally, but like most trends it is likely to take off in a more heavily populated area first.

“We’re aware of it, and preparing for what that might look like, but we’re seeing it in small amounts,” he said.

Xylazine first appeared as an adulterant two decades ago in Puerto Rico. It spread to all regions of the U.S. by 2020, according to the U.S. Drug Enforcement Agency. The White House declared fentanyl laced with xylazine an emerging threat last year.

Effects locally have been minimal, but the drug’s presence has caused some concern. Xylazine so far has followed a similar path to fentanyl, which was introduced in the Northeast heroin market before eventually spreading to the south and then, years later, to Washington.

Drugs often appear in Washington later

Nationally, overdose deaths are on the decline, dropping by nearly 13% between May 2023 and May 2024, according to preliminary data from the Centers for Disease Control. Washington was among the few states to buck that trend, seeing a 10% increase.

“We are two to three years behind the national average on things,” said Nathan Schlicher, an emergency room physician and past president of the Washington State Medical Association who lives in Gig Harbor. “Xylazine is not severely contaminating our supply yet, but I expect that we’ll see that in the next 12 to 24 months.”

During the second quarter of 2024, the state saw positive cases for xylazine more than double compared to the average quarter over the past three years, according to an analysis of preliminary data by the Addictions, Drug & Alcohol Institute at the University of Washington. 

Yet, the overall number of instances remains low. The data found only 45 instances positive for xylazine during that quarter. Nearly all of these cases were west of the Cascades, but none were in Kitsap or Pierce counties. 

“On the East Coast in some cities, the majority of fentanyl actually has xylazine in it,” Caleb Banta-Green, a researcher and Director of the Center for Community-Engaged Drug Education, Epidemiology and Research at the University of Washington said during a presentation this month on emerging issues in the state’s drug supply.

“On the West Coast, xylazine has hit a bit later and has not become as common,” he said. “It sort of arrived and stayed at this lower level.”

Few direct interactions locally

Although comprehensive tracking of xylazine is difficult, as it is often inconsistently reported, Kitsap officials say they have had few direct interactions. Among the 60 overdose deaths within the last year in Kitsap County, only two also involved xylazine, said Jeff Wallis with the county medical examiner’s office

Jolene Kron, clinical director of The Salish Behavioral Health Administrative Services Organization, a state-funded provider serving Kitsap, Clallam and Jefferson Counties, said outreach teams saw xylazine last year, but have found no reports this year. 

Sara Marez-Fields, executive director of Bremerton treatment provider Agapè Unlimited, said while there is increasing positivity in Washington for xylazine, they have not seen it with the population they serve. 

“I think xylazine is something we should be aware of and something we should be preparing for – how we want to manage this – (but) the cases right now are extremely low in Washington state,” Dr. Sasha Kaiser, associate medical director of the Washington Poison Control, said during a presentation this summer. “We need to be aware, it’s not crazy cases here.”