The Zombie Drug

“We don't really have a strategy, except to try to keep people alive,” says Carolyn James. She is a community outreach coordinator at CODAC, the oldest, largest, and only nonprofit treatment organization for opioid use in Rhode Island. James is referring to the increased presence of Xylazine, otherwise known as the zombie drug. 

Xylazine is an animal sedative not approved for human use, but researchers have been finding it in samples sold as fentanyl, crack, and crystal methamphetamine. Xylazine on its own can lead to overdoses and other major health risks, but in most overdose cases it is found in combination with fentanyl or other illicit drugs. Despite its relatively small presence in the national drug supply as of now, researchers expect it to become a much larger problem in Rhode Island.

Xylazine is not an opioid, but its health risks are extensive. The zombie drug has been found to cause drowsiness, dry mouth, unresponsiveness, hypertension, increased heart rate,  respiratory depression, dysrhythmia, and decreased breathing. Beyond this, users often experience skin wounds and soft tissue injuries. There is also a risk of dependency which can then lead to withdrawal symptoms. The biggest concern when it comes to xylazine is risk of overdose. Xylazine has caused both fatal and nonfatal overdoses, with the CDC reporting 1,357 xylazine-positive or xylazine-related overdose deaths in 2019, mostly in the Northeast. 

Although not a topic of concern until about a year ago, Xylazine is not a new drug. It has been found in the United States for decades, albeit infrequently. Showing up for the first time in Puerto Rico in the early 2000s and then in the Northeast in 2006, its presence has grown across the country since the mid-2010s. Mostly popping up alongside fentanyl, xylazine has caused significant concern among researchers studying the drug supply. It has followed trends similar to fentanyl, with xylazine first hitting illicit drug markets in the Northwest, and then spreading to the South, and eventually the West. Brown University researcher Alexandra Collins, one of the leading scientists studying xylazine, says that it is most frequently popping up in Philadelphia, but will likely keep coming down the 95 corridor and become a bigger problem in Rhode Island. 

Collins co-runs Test RI, a two-year research study created in an effort to learn more about the drug supply in Rhode Island. The study works with community partners, Collins says, to push out information about Xylazine and help people who use drugs. They are educating drug users on the potential risks of being exposed, and ways to get help if they are experiencing skin wounds or other health problems. Test RI tests drugs brought in by drug users, to see if they are laced with xylazine or other dangerous substances. 

So far, Xyalzine has been found in 42% of the 130 samples brought in by drug users and tested by Test RI since May of 2022. Collins says this number surprised her and her team, they weren’t expecting to see the drug in so many samples. She expresses great concern about the Rhode Island drug supply following the same trends as Philadelphia. “It's definitely an emerging thing that is increasing here.” 

Collins explains that in addition to testing samples, Test RI has conducted interviews with people who use drugs. So far, the Test RI team has not spoken to anyone who prefers the effects of xylazine. Rather, drug users unknowingly take laced drugs. The biggest interview takeaway for Collins was that people really want to know what is in the drugs they are taking. “Living in such uncertainty, because the supply changes so much, is really stressful,” says Collins. 

Drug users may find xylazine impossible to identify, as the substance appears in many different forms, including white or brown powder, and mixed into pills. James says, “it's a combination of xylazine in opioids that are probably laced with fentanyl. So it's, it's really a triple whammy.” Collins says that many people know the drug is around, and hope to avoid it. But if people are using drugs often enough, it is likely they will come in contact with xylazine.  

Collins says that drug users have been really excited by the surveillance data provided by Test RI. Participants are able to donate samples, and the program gives them back their individual sample’s data. She says that people have responded very well to having that data and being able to warn their friends about dangerous substances. “It’s been really powerful as a researcher to see what happens when we give out information directly back immediately, rather than waiting till things are published.”

As Carolyn James said, there is no real solution to the xylazine problem right now. Researchers are trying to learn as much as they can about the drug, and make sure drug users and clinicians are informed. Because xylazine is a drug intended to be used on animals, it has not been studied on people and the long-term effects of xylazine exposure is not known. 

James explains that one of the major problems with xylazine is that Narcan, a medication used to treat overdoses, has not been successful in reversing the effects of a xylazine-induced overdose. Xylazine creates prolonged sedation, and so, even if someone is breathing again after an overdose, they are often still sedated for multiple hours. That said, Narcan should still be administered in overdose cases, as xylazine is often found alongside fentanyl. Collins says that people must now respond differently when they witness an overdose if the victim is still sedated. Instead of waiting for the person to wake up, people should make sure they are still breathing and then call for medical help. 

In addition to pushing out information about overdoses, when it comes to skin wounds, Test RI is working to educate victims about at-home wound care and resources where they can get additional aid. And harm reduction tools such as test strips will hopefully become more readily available with the upcoming opening of the new overdose prevention center in Providence in 2024. 

Rhode Island has been a leader in harm reduction, as the first state to allocate opioid settlement dollars to an overdose prevention center. Alexandra Collins remains hopeful that the researchers and policy makers in Rhode Island will continue to make discoveries about xylazine and the Rhode Island overdose crisis as a whole.