Contaminated drugs | Intravenous animal tranquilizer

Health Canada is considering more stringent regulation of the use of xylazine, an animal tranquilizer that appears in a growing number of illicit drug samples. The high-risk crop is wreaking havoc in major US cities, including hard-hit Philadelphia.

Marc Thibodeau

Press

A growing number of illegal drug samples analyzed by Health Canada in the country contain the potentially devastating animal tranquilizer, which health authorities are alerting.

Data Press Last week, the federal agency indicated that the number of xylazine-positive samples identified in its laboratories increased from 198 in 2020 to 1,350 in 2022.

This significant increase occurred while the total number of samples analyzed in the country remained relatively stable over the years.

Health Canada spokeswoman Charlaine Sleiman said in an email that more and more tests are finding xylazine among the “additives” in illegal substances like fentanyl and cocaine, and xylazine is being detected at opioid-related rates. deaths” without giving an exact figure on this subject.

The increase in the number of positive samples is particularly marked in Ontario, which increased from 9 to 1,011 in two years, about 75% of the total observed across the country.

In this regard, British Columbia, the second most important province, will have 260 in 2022, compared to 99 two years ago, while Quebec has also increased by 2 to 36, which is practically the same as Alberta.

These totals seem relatively small compared to the tens of thousands of samples tested annually, but are nonetheless being taken into account by Health Canada, which is “currently assessing the risks of xylazine to determine whether further regulatory action is necessary.” .

All the effects of injecting this tranquilizer for animals in humans are not yet well known, but the use of xylazine can cause the appearance of particularly serious wounds.

Contamination with fentanyl

The Canadian Community Epidemiology Network on Drug Dependence (CCENDU) issued a warning about xylazine over the summer, noting that it is “increasingly used as a withdrawal drug in Canada and the United States.”

The agency further noted that the percentage of fentanyl samples containing xylazine increased from 1.4% in 2020 to 6.9% in the first part of 2022.

These numbers are out of proportion to those seen south of the border, particularly in Philadelphia, where almost 90% of the doses of drugs sold on the street as fentanyl now contain xylazine.

Sarah Laurel, who runs a community organization that helps addicts in the city, notes that some unknowingly take fentanyl cut with xylazine and become addicted, forcing them to continue despite the risks.

Karen McDonald, who is in charge of Toronto’s drug control center, which offers free analysis of street-bought doses, notes that the “fentanyl” advertised by sellers is often made up of many other products.

“The level of contamination with fentanyl is extremely high. “Sometimes you even find samples without fentanyl,” he says.

Xylazine said it was present in 20% of fentanyl samples analyzed by its service in the first half of 2022, but that number has since dropped to 6%.

“It goes up, it goes down. It’s not like here in Philadelphia,” said Mr.^I However, McDonald worried about the speed with which dealers are changing the composition of the drugs being sold, sometimes with dozens of different products.

Samuel Tobias, a researcher with the British Columbia Center on Substance Abuse, notes that a few years ago, xylazine was rarely detected in fentanyl in British Columbia, but now it is found in 3.5% of tests.

“It’s still relatively rare, and when you do find it, it’s usually rare,” says Tobias.

Another analytical center in the province warns consumers on its website that recently analyzed samples contained up to 95% xylazine.

The illegal market is faster than analytics

“People buying fentanyl on the street can’t know what they’re going to find without asking for a test,” says Tobias, who is most concerned about the unannounced addition of synthetic opioids like carfentanil. , ten times more potent than fentanyl. , on street drugs.

D^D Marie-Eve Goyer, medical director of drug addiction and homelessness programs at the CIUSSS du Centre-Sud-de-Montréal, notes that it is difficult to get an accurate idea of ​​the presence of xylazine in illegal drugs in Quebec because agencies “don’t systematically look for it” with the help of tests.

As interviewed by researchers in Ontario and British Columbia Presshe notes that the illegal drug market has “really deteriorated” in recent years.

Opioid dosages today often contain many products that are unrelated to what is advertised to the recipient, leading to increased health risks.

“The market moves faster than us. It’s hard to know exactly what people are consuming,” says Dr.^D Goyer.

“People rot and die in the street”

Sarah Laurel first realized four years ago that there was a serious problem with drugs being sold in Kensington, the inner city of Philadelphia where she had lived for a long time.

“All of a sudden, we started seeing unusual lesions in people using fentanyl [un opioïde répandu]. “Sex workers developed it on their legs and feet, no one understood what was going on,” he says.

Analysis of samples sold locally found that many were “cut” with xylazine, a tranquilizer made for large animals and not approved for use in humans.

The tranquilizer’s place has continued to grow in importance since it makes up almost all of the certain doses sold on the street as fentanyl. A local think tank estimates that 90% of them contain it.

Today, many people addicted to opioids have no choice but to use them, despite knowing the risks.

For years, he has been trying to alert local authorities to the seriousness of the crisis caused by the release of the product.

“No one cares about the fate of people who use drugs. But those who died are my friends,” he says with emotional emotion, currently overseeing a community organization called Wild Sisters, which supports drug addicts in a difficult situation.

Necrotic wounds

M^I Laurel sees dozens of people pass by every day affected by xylazine, which without proper treatment can cause necrotic sores to open up, leaving her feeling like “people are rotting away in the street.”

According to some researchers, this phenomenon may occur because the tranquilizer has a vasoconstrictor effect that reduces the supply of oxygen to the body’s surroundings.

“We regularly see people with maggots in their wounds… What we do is like putting a band-aid on a gunshot wound,” says M.^I Laurel, upset that the city recently set up a mobile support service for people who need wound care.

Their management in the hospital setting is complicated by the fact that many institutions do not test for the presence of xylazine and do not consider the possibility of developing withdrawal symptoms due to dependence on the product. These are in addition to the withdrawal symptoms for opioids, which last for a shorter period of time.

“People are so afraid of finding themselves wanting that they leave without treatment,” she said.^I Laurel.

Because xylazine, like opioids, tends to slow heart rate and breathing, it presents another significant challenge for health care providers and increases the risk of overdose.

Naloxone blocks the effects of opioids, but not xylazine.

Therefore, people can remain unconscious for a long time and must receive continuous respiratory support, M.^I Laurel developed a protocol that included the use of oxygen.

Unknown effects

According to a recent study, the tranquilizer is now found in more than a third of overdose deaths in Philadelphia, usually along with fentanyl, but its role cannot be clearly defined.

Overdoses are also becoming increasingly common in states like Maryland and Connecticut, but national trends are difficult to determine because many states and counties do not systematically screen for it.

M^I Laurel notes that there is an urgent need to more actively study xylazine’s effects in humans to understand how to help those who use xylazine and often become dependent on it.

He said traffickers were potentially trying to prolong the first felt effects of fentanyl by mixing it with a tranquilizer, without necessarily reducing future side effects.

The COVID-19 pandemic has complicated the supply of fentanyl and increased interest in the tranquilizer, which is not a controlled substance in the United States.

Criminalizing its possession is not the solution, M^I Laurel.

“If we restrict access, traffickers will simply find another potentially more dangerous product to replace it. “First of all, you have to find a way to reverse its effects,” he says.