In the past several years, xylazine, or “tranq” as it’s widely known, has spread across the United States like wildfire, and the powerful non-opioid sedative has already found its way into Butler County’s illicit drug supply.

Preemptive action and education could curb the impact to public health if the drug becomes widespread here like it has in cities such as Philadelphia, experts say, and in most cases, people in active addiction may not know their drugs have been laced with the substance.

Xylazine was first reported in Butler County in 2019. Since then, it has become one of the most common drugs in the county, and it accounts for more than 37% of fatal overdoses this year, according to the Pennsylvania Department of Health.

A non-opioid, xylazine is known to “give dope legs,” meaning that it is added to opioids such as heroin and fentanyl to extend their sedative effects, said Dr. Thomas Brophy, medical director of the Ellen O’Brien Gaiser Center in Butler. Conversely, it seems to “balance out” the effects of cocaine and methamphetamine by lowering one’s heart rate, said Bill Lynch, a clinical pharmacist from New Jersey.

Lynch spoke to local authorities, community leaders and specialists about xylazine’s threats, and how the county can address them during an addiction recovery conference Aug. 8.

In an April news release, Gov. Josh Shapiro’s administration noted that Pennsylvania overdose deaths involving xylazine rose by 600% across 30 counties in the span of five years.

“In 2019, it was in Philly and Berks County ... by 2020 it made its way out to (Western Pennsylvania),” said Mike Krafick, Recovery Hub director of the Armstrong-Indiana-Clarion Drug & Alcohol Commission. “By 2021, the map is not quite full, but so many more counties were impacted and nobody was talking about it.”

“If the trend continues, we’re two to three years behind what’s going on in Philly,” Krafick said.

The response from recovery specialists and organizations around Butler has been swift: Xylazine testing strips have been ordered, information sessions have taken place and an urgent conversation has begun.

Brophy said he first heard about xylazine entering the drug supply about 10 to 12 months ago. Since then, the Gaiser center has held four lectures for officials and the public about the drug.

“A lot of people who are dying now are dying because of xylazine,” said Bobby Best, certified recovery specialist at the Gaiser center. Outside of work, Best provides support to residents of a recovery house on Third Avenue as they navigate addiction treatment. In a conversation with some of them, xylazine was mentioned as a deadly, ubiquitous drug, overshadowing even the use of heroin.

“It’s getting crazier and crazier,” said recovery house manager Cody English. “Heroin was bad enough, and then it was fentanyl.”

Brophy said that what is now referred to as heroin bears little resemblance to the substance, which, more often than not, is actually fentanyl mixed with other drugs.

“As the years went on, they started putting, we’ll say, maybe some benzos in it, tranquilizers in it, fentanyl,” said resident and recovery advocate Robert Kennard. “And it got to the point now recently that it’s not even heroin. It’s just something some cartel or some guy threw ... together with it to stretch it.

“And when someone would (overdose) and someone would administer Narcan, it doesn’t work because it’s not an opiate that was killing them. It’s either a benzo or a tranquilizer or something else — so even Narcan wasn’t saving lives.”

Xylazine is a potent tranquilizer widely used by veterinarians to relieve pain and sedate animals. It’s also used by cartels who manufacture and distribute fentanyl, heroin, cocaine and methamphetamine, Lynch said.

The onset of symptoms is rapid and lasts hours. Little more than 16 milligrams of the substance can be fatal, Lynch said.

According to the District of Columbia Department of Forensic Sciences, fentanyl is the most common substance used in combination with xylazine.

A nonfatal dose — whether snorted, injected or taken in combination with another substance — can cause blurred vision, disorientation, ulceration and coma, and can slow one’s breathing rate to dangerously low levels, Lynch said. Xylazine also has been used to incapacitate victims of sexual assault, he said.

Xylazine has been dubbed a “zombie drug” because of the blistering sores and wounds that slowly grow larger on different parts of the body when it is injected.

In late March, Congress proposed bipartisan legislation that would regulate xylazine and require manufacturers to send reports on production and distribution to the U.S. Drug Enforcement Agency. The bill is an attempt to control the spread of xylazine and limit its proliferation into the black market.

The authenticity and purity of xylazine can no longer be guaranteed after Akorn pharmaceuticals filed for bankruptcy and ceased all U.S. operations in April. AnaSed, a brand of injectable xylazine, was one of the products recalled by Akorn.

Also in April, xylazine was declared a controlled substance in Pennsylvania after Gov. Josh Shapiro and Secretary of Health Debra Bogen submitted a notice of intent to temporarily add xylazine to the list of Schedule III drugs under Pennsylvania’s Controlled Substance, Drug, Device, and Cosmetic Act. The executive order is temporary and xylazine remains an uncontrolled substance on the federal level.

Not many people know about the effects of xylazine, or that they are using it at all.

“A lot of people are unaware of the xylazine,” Lynch said. “They don’t know it’s in the supply.”

Narcan, the brand name of naloxone, has saved countless lives in cases of opioid overdoses, but is ineffective in addressing xylazine overdoses.

Lack of knowledge about the drug and its effects have contributed to the misconception that naloxone-resistant addiction exists. It doesn’t, Lynch said. Instead, people nationwide are being hospitalized from the recently discovered condition known as xylazine withdrawal.

The condition remains poorly defined, and often goes undetected, Lynch said. It can last anywhere from weeks to months, contributing to psychiatric symptoms and even heart attacks.

It remains critical that Narcan still is administered in the case of a suspected overdose, he said.

“If somebody overdoses, still give them Narcan,” Krafick said. “Narcan will address the fentanyl and enable them to start breathing. Xylazine is a sedative, and (the person) is not going to be alert the way they would be if they were given Narcan and only took an opioid,” he said. “Still give Narcan and call 911.”

Rather than being faced with a public health crisis years after xylazine has found its way into the supply, Krafick expressed the need to be proactive in the wake of an escalating situation.

“I think what would be extremely beneficial would be statewide drug testing and analyzing of the drug supply, and sharing that information to let people know what’s happening, what drugs are in our community, and educating the public as much as possible to have better information about what they’re using,” Krafick said.

Sharing drug testing information with law enforcement agencies and community-based organizations would give them a realistic picture of what drug use looks like to better address the influx of adulterants in the drug supply, he said.

Now that xylazine is on Butler County’s streets, certified recovery specialist Mary Allen said professionals in the field are trained to treat all overdoses as potentially involving xylazine.

“We don’t know when they (overdose) if it’s fentanyl or if it’s xylazine,” Allen said. “So you have to treat it like it’s xylazine. What that means is also using Narcan, because we don’t know. Then do rescue breathing until the ambulance team gets there. So we have to breathe for them, and that’s just watching the chest, making sure it goes up until the (paramedics) get there and get them to the hospital.”

She noted that there is no harm in administering Narcan to somebody who does not have opioids in their system.

Trilogy Wellness, the Butler clinic where Allen works, recently requested xylazine testing strips from the government.

As clinics wait to receive xylazine testing strips, Allen said educating the public on harm reduction strategies is critical.

Harm reduction is not enabling drug use, Allen said. Instead it keeps people alive, gives them a chance to access treatment and eases the burden and costs associated with overflowing emergency room and ambulance visits.

“Everybody who comes through now, I talk to them about xylazine,” Allen said. “I want them to know what’s out there, and that it’s in everything.”

“Dealers want their drug to be the best and want people to come back and buy from them; that’s why they’re putting it in their stuff,” she said. “Not to kill them. But they’re not chemists. They don’t know how much will kill a person.”