California prepares for xylazine influx in illegal drug supply

State of play: CDPH has issued a letter to medical personnel outlining the risks and signs of exposure as well as patient care recommendations, including how to manage symptoms of withdrawals and treat xylazine-associated wounds.

• "Xylazine is a new and emerging issue in California," CDPH said in a recent news release. "However, the drug supply is unpredictable, and state officials are concerned that xylazine may eventually become more common in California."
• Use of xylazine can cause drowsiness, amnesia and serious skin wounds in humans — and in some circumstances slow breathing, heart rate and blood pressure to dangerously low levels, according to CDPH.

Details: Known as "tranq" or "zombie drug," xylazine is often mixed with illicit fentanyl without the knowledge of those who use these drugs.

• Taking xylazine with other central nervous system depressants, like alcohol or benzodiazepines such as Xanax, can also boost the risk of life-threatening overdose, the National Institute of Health notes.
• A September study from the drug testing lab Millenium Health found that use of multiple substances is significantly higher among those who test positive for both fentanyl and xylazine compared to just fentanyl.
• In San Francisco last year, all 15 cases of xylazine detected in accidental overdoses ​​also contained fentanyl, per a July analysis from the city's medical examiner.

Yes, but: It's been largely difficult to track the drug's spread in real time.

The big picture: The East Coast has the highest rates of xylazine detection at the moment, but the U.S. Drug Enforcement Administration said in an intelligence report last year that it appears to be moving westward from the Northeast — similar to fentanyl's path.

• Health advocates and researchers have called on the government to prioritize a stronger surveillance system.

What to watch: California Gov. Gavin Newsom announced last week a proposal for new legislation that would increase criminal penalties for illicit uses of xylazine.

• CDPH has also developed flyers and fact sheets to share with local agencies and community-based organizations to bolster awareness of the drug's threat.