Posted at 5:00 am
Marc Thibodeau The press
A growing proportion of illicit drug samples analyzed by Health Canada in the country contain an animal tranquilizer with potentially devastating effects, which has health officials on the alert.
Data provided to La Presse by the federal organization last week shows that the number of xylazine-positive samples detected in its laboratories has increased from 198 in 2020 to 1,350 in 2022.
This significant increase occurred while the total number of samples analyzed in the country remained relatively stable over the years.
A Health Canada spokeswoman, Charlaine Sleiman, said in an email that tests are increasingly showing the presence of xylazine among “additives” in illicit substances such as fentanyl and cocaine, and that xylazine “has been detected in a proportion of opioid-related drugs Deaths” without giving an exact number on the subject.
The increase in the number of positive samples is particularly evident in Ontario, which went from 9 to 1011 in two years and accounted for almost 75% of the total observed nationwide.
British Columbia, the second most important province in this respect, recorded 260 in 2022, compared to 99 two years earlier, while at the same time Quebec rose from 2 to 36, a number practically identical to that of Alberta.
These totals appear relatively small compared to the tens of thousands of samples tested each year, but are considered worrisome by Health Canada, which says it is “currently evaluating the risks of xylazine to determine if more regulatory measures are required”.
All the effects of injecting this animal tranquilizer in humans are not yet well known, but the use of xylazine, in particular, can lead to the appearance of severe wounds.
fentanyl contamination
The Canadian Community Epidemiology Network on Drug Addiction (CCENDU) issued an alert on xylazine this summer, noting that it is “increasingly being used to reduce drugs in Canada and the United States.”
The organization then pointed out that the percentage of fentanyl samples containing xylazine increased from 1.4% in 2020 to 6.9% in the first half of 2022.
These numbers bear no relation to those south of the border, particularly in Philadelphia, where it is estimated that almost 90% of the drug doses sold on the street as fentanyl currently contain some xylazine.
Sarah Laurel, who runs a community organization that helps drug addicts in the city, notes that some have unknowingly taken fentanyl-cut with xylazine and become addicted, forcing them to keep going despite the risks involved.
PHOTO DARRYL DYCK, THE CANADIAN PRESS ARCHIVE
Xylazine is increasingly being used to reduce fentanyl doses in the United States and Canada, authorities on both sides of the border are warning.
Karen McDonald, who oversees a Toronto drug control center that offers free analysis of cans bought on the street, notes that the “fentanyl” advertised by vendors often contains many other products.
“Fentanyl contamination is extremely high. Sometimes you even see samples that now have no fentanyl at all,” she says.
Xylazine was present in 20% of fentanyl samples analyzed by her service in the first half of 2022, but that number has since fallen to 6%, she says.
“It goes up and down. The situation in Philadelphia isn’t the same at all,” stresses Ms. McDonald, who is nonetheless concerned about the speed with which drug dealers are changing the composition of the drugs they sell, sometimes including a dozen different products.
The range of medicines is constantly changing. You can spend days trying to understand the effects of a particular product and find the next day that it is no longer detectable in the analyzed doses.
Karen McDonald, director of a drug control center in Toronto
Samuel Tobias, a researcher at the British Columbia Center on Substance Abuse, notes that a few years ago xylazine was very rarely detected in fentanyl in British Columbia, but is now found in 3.5% of sample analyses.
“It’s still relatively rare and there are usually few when you find it,” says Tobias.
However, another analysis center in the province warns consumers on its website, writing that recently analyzed samples contained up to 95% xylazine.
The black market faster than analysis
“People who buy fentanyl on the street can’t know what they’re going to find without asking for a test,” says Tobias, who worries most about the undeclared addition of synthetic opioids like carfentanyl, which has been done dozens of times stronger than fentanyl, in street drugs.
dr Marie-Ève Goyer, medical director of addiction and homelessness programs at CIUSSS du Centre-Sud-de-Montréal, notes that it is difficult to have an accurate idea of the presence of xylazine in illicit drugs in Quebec. , since the institutions “do not systematically look for it” with tests.
Like the Ontario and British Columbia researchers interviewed by La Presse, she notes that the illicit drug market has “really gotten worse” in recent years.
Opioid doses today often contain multiple products unrelated to what is being explained to the purchaser, resulting in increased health risks.
“The market moves faster than we do. It’s hard to know exactly what’s in what people are consuming,” says Dr. goyer
“People are rotting in the streets”
Sarah Laurel first realized four years ago that something was seriously wrong with the drugs being sold in Kensington, downtown Philadelphia, where she lived for a long time.
“We suddenly saw unusual sores in people using fentanyl [un opioïde répandu]. Sex workers developed it on their legs and feet without anyone really understanding what was going on,” she says.
PHOTO PROVIDED BY SARAH LAUREL
Sarah Laurel, founder of Savage Sisters, an organization that helps drug addicts in Philadelphia
Analysis performed on locally sold samples found many of them had been “cut” with xylazine, a tranquilizer developed for large animals and not approved for human use.
The locus of the tranquilizer has continued to grow in importance since then, to the point where almost all specific doses sold as fentanyl on the street are manufactured. A local analysis center estimates that 90% of them contain it.
People addicted to opioids today have no choice but to use them, although many are aware of the risks involved.
On the street you take what they give you. Drug users are at the mercy of the criminal market.
Sarah Laurel, founder of Savage Sisters
She has been trying for years to alert local authorities to the seriousness of the crisis caused by the product’s release.
“No one cares what happens to drug users. But it’s my friends who are dying,” said the activist, who now runs a community organization, Savage Sisters, that helps drug addicts in need.
Necrotic Wounds
Ms Laurel sees dozens of people affected by xylazine every day, which without proper treatment can result in gaping necrotic sores that, she says, give the impression that “people are rotting in the streets”.
According to some researchers, the phenomenon could occur because the sedative has a vasoconstrictor effect that reduces the oxygen supply to the extremities of the body.
PHOTO SUZANNE STEIN, SPECIAL COLLABORATION
Injected drug user with massive xylazine wound in Philadelphia
“We regularly see people with maggots in their wounds… What we’re doing is like putting a bandage on a gunshot wound,” notes Ms. Laurel, who is upset that the city recently set up a mobile emergency service for people who who need to cleanse their wounds.
Their treatment in a hospital is complicated by the fact that many institutions do not test for the presence of xylazine and do not consider the likelihood that they may develop withdrawal symptoms from their dependency on the product. These occur in addition to the withdrawal symptoms for opioids, which last less.
“People are so afraid of food cravings that they leave it untreated,” Ms. Laurel says.
Xylazine also poses another significant concern for healthcare workers because, like opioids, it tends to produce slow heart rate and breathing, increasing the risk of overdose.
Naloxone blocks the effects of opioids, but it does not affect xylazine.
People can therefore remain unconscious for long periods of time and need sustained respiratory support, notes Ms. Laurel, who developed a protocol involving the use of oxygen.
unknown effects
According to a recent study, the tranquilizer is now found in more than a third of overdose deaths in Philadelphia, mostly in conjunction with fentanyl, although its role cannot be precisely defined.
It’s also becoming more common in overdose cases in states like Maryland and Connecticut, but its progression across the country remains difficult to determine because many states and counties don’t test for it systematically.
Ms. Laurel notes that there is an urgent need to more actively study the effects of xylazine in humans in order to understand how to help the people who use it and often depend on it.
The traffickers, she says, may initially have been trying to prolong the felt effects of fentanyl by mixing it with the sedative, without necessarily ignoring the side effects that would follow.
The COVID-19 pandemic has complicated the supply of fentanyl and increased their interest in the tranquilizer, which is not a controlled substance in the United States.
Criminalizing her possessions is not the answer, Ms Laurel argues.
“If we restrict access, traffickers will simply find another potentially more dangerous product to replace. Above all, you have to find a way to reverse the effect,” she says.
Learn more
44% share of opioid overdose deaths in 2021 in Philadelphia, where xylazine was also detected
Source: PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH