Jun 30, 2023 - Health

Xylazine overdose deaths surged between 2018 and 2021

Data: National Center for Health Statistics; Note: Deaths involving more than one drug are included in totals; Chart: Axios Visuals

Americans in 2021 were fatally overdosing from xylazine at a rate 35 times greater than in 2018, according to Centers for Disease Control and Prevention data released Friday.

The big picture: The spike shows how the the veterinary sedative known as "tranq" or "zombie drug" that's often mixed with fentanyl is vastly complicating the addiction crisis.

  • Xylazine, which is not an opioid and resists common overdose reversal methods, still accounts for a small number of fatalities, said Merianne Spencer, lead researcher of the CDC study, which looked at death certificate records.
  • But, Spencer told Axios, "The amount that has increased in the last couple of years really calls attention to what makes this an important public health issue."

By the numbers: The age-adjusted death rates for overdoses involving xylazine jumped from 0.03 in 2018 to 1.06 in 2021, per the study. Almost all of these death certificates also mentioned fentanyl.

  • Put another way, the number of people in the U.S. who died from a xylazine-related overdose increased from 102 Americans in 2018 to nearly 3,500 three years later.
  • While all age groups saw a spike, the death rates were highest for those ages 25 to 34 in 2020 at 1 death per 100,000 people and then the 35-to-44 age group in 2021 at 2.24.
  • Among racial and ethnic groups, xylazine-involved overdose death rates were highest among Black people, who are also facing an overall rise in overdoses nationwide.
  • But the greatest increase occurred in Hispanics, who saw the xylazine-involved overdose death rate tripling from 0.21 in 2020 to 0.64 in 2021.

Catch up fast: Xylazine triggers blackouts, suppresses heart rates and can cause skin-rotting wounds that have led to amputation when left untreated.

  • A patchwork of surveillance systems scattered across local and state governments makes it difficult to track the drug's prominence in real time, said Rahul Gupta, director of the White House's Office of National Drug Control Policy, in an April call with reporters.
  • "Many communities are not even aware of the threat in their backyard," Gupta added.

What we're watching: Delaware became the first state in the U.S. to start distributing paper strips that test for both xylazine and fentanyl this week in hopes of abating the rise in xylazine-related overdose deaths.

  • Fentanyl and xylazine test strips are generally offered separately.
  • Nearby Philadelphia is one of the hot spots for xylazine use and "we have seen a precipitous increase in a number of serious wounds and individuals requiring, unfortunately, amputation," Delaware Lt. Gov. Bethany Hall-Long told Axios.
  • Jermonica Boardley, president of SIVAD Diagnostic Medical Group, which distributes the xylazine-fentanyl test strips, said the company is currently in talks to expand the programs to other states.

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