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Tranq-related overdose deaths are rising in Pennsylvania and other East Coast states, a new CDC study found

Nearly all xylazine-related overdose deaths between 2018 and 2021 also involved fentanyl.

Jen Shinefeld, a volunteer, cleans the wounds on the hands of a man named C.J. at Savage Sisters, an outreach organization based in Kensington, in January. Xylazine, an animal tranquilizer, has contaminated much of the city's fentanyl supply and can cause wounds that are quick to open and slow to heal, risking infection. A recent Centers for Disease Control Study found that xylazine-related overdose deaths are most pronounced on the East Coast.
Jen Shinefeld, a volunteer, cleans the wounds on the hands of a man named C.J. at Savage Sisters, an outreach organization based in Kensington, in January. Xylazine, an animal tranquilizer, has contaminated much of the city's fentanyl supply and can cause wounds that are quick to open and slow to heal, risking infection. A recent Centers for Disease Control Study found that xylazine-related overdose deaths are most pronounced on the East Coast.Read moreHeather Khalifa / Staff Photographer

Pennsylvania and surrounding states have seen the nation’s highest rate of overdose deaths involving the animal tranquilizer xylazine, known on the street as “tranq,” a new study from the Centers for Disease Control and Prevention has found.

Rates of death involving xylazine remain relatively low in the broader picture of overdose deaths nationwide, making up about 3% of all drug overdose deaths in 2021. But federal researchers say they have increased dramatically since 2018.

The rapid rise of xylazine-related deaths — from 102 Americans in 2018 to 3,468 in 2021 — means health officials should be paying attention to the drug’s increasing prevalence, said Merianne Spencer, a statistician for the National Center for Health Statistics and the lead author of the study.

The problem is most pronounced on the East Coast. The rate of xylazine-related overdose deaths in 2021 was 4.05 deaths per 100,000 residents in the region that includes Delaware, Washington, Maryland, Pennsylvania, Virginia, and West Virginia.

That was nearly double the rate in the next deadliest region of states, according to the federal health department’s tracking. The second-highest rate of deaths were seen in the region that includes Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont.

Rates on the West Coast were so low that they were not reported in the study.

» READ MORE: A powerful sedative in Philly’s drug supply is causing severe wounds and agonizing withdrawals. It’s quickly becoming unavoidable.

‘This is not a drug that is acting alone’

Although xylazine-involved deaths increased across all age and racial groups in 2020 and 2021, the CDC report found that Black people had the highest rates of overdose death. Hispanic or Latino people saw the highest increase in death rates, which tripled between 2020 and 2021.

Overdoses in general have seen a demographic shift — nationally and locally — in recent years. Overdose deaths among Black Philadelphians rose by 70% between 2018 and 2021, and deaths among white residents have declined slightly by 9%.

Xylazine has exploded in Philadelphia’s dope supply in the last few years. (“Dope” is a catchall term the city health department uses to denote drugs marketed as heroin or fentanyl, both addictive and dangerous opioids.) By 2022, xylazine was turning up in 90% of the dope samples tested by the city health department.

Nearly all xylazine-related overdose deaths between 2018 and 2021 also involved fentanyl, the CDC study found.

“This is not a drug that is acting alone,” Spencer said.

Health officials in Philadelphia believe xylazine, which is not approved for human use, was initially added to fentanyl to produce a longer-lasting high. Fentanyl, a deadly synthetic opioid that replaced most of the heroin in the city’s drug supply in the mid-2010s, is more powerful than heroin, but its effects wear off more quickly.

Xylazine isn’t an opioid, but can have a similar sedative effect. Many people who use xylazine suffer from serious wounds that heal slowly, putting them at risk for infections and even amputations. Like opioids, it can slow the breathing, but it will not respond to naloxone, the drug used to reverse opioid overdoses. That can make it harder to bring a person out of a fentanyl-xylazine overdose.

The drug also causes serious withdrawal symptoms — severe chills, sweating, anxiety, and agitation among them — that Philadelphia-area doctors have scrambled to learn to treat in recent years.

Philadelphia health officials said that the city saw more than 100 overdoses involving xylazine in 2018. By 2021, 434 residents had died of xylazine-related overdoses.

“Since Philadelphia was one of the first cities in the United States to start looking for xylazine and noting it on death certificates, many of the earliest diagnosed cases were found here,” the health department said in a statement.

The department noted that some communities still are not testing for xylazine in autopsies, so the full spread in the United States might not yet be known.

The city is working to distribute xylazine testing strips, advising clinicians on treating xylazine overdoses and withdrawal from the drug, and expanding its capacity to provide wound care.

Gov. Josh Shapiro’s adding xylazine to the state’s controlled substances list has supported local initiatives, the department said.

On the state level, the Department of Drug and Alcohol Programs is funding two drop-in centers where people who use drugs can get access to treatment and resources to reduce the harm of drug use, said Stephany Dugan, a press secretary for the department. The state also expects to make free xylazine testing strips available in the coming months, she said.

“The Shapiro administration remains committed to continuing to take a multidisciplinary approach to addressing this crisis,” Dugan said.