Two Potent Drugs Make Their Way Into The Illicit Drug Supply

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Two dangerous and very potent illicit drugs are increasingly seeping into the illicit drug supply, putting people at risk of a fatal overdose.

One is a class of synthetic opioids, called nitazenes, which can be up to 10 times more potent than fentanyl, experts say. Fentanyl is already 50 times more potent than heroin.

On Thursday, the Tennessee Department of Health released data showing a four-fold increase in fatal overdoses related to nitazenes over the past two years.

No nitazene-related deaths were documented in Tennessee in 2019, according to the report. In 2020, however, 10 such deaths were reported. In 2021, the number has increased to 42.

“Nitazenes are an emerging group of highly potent psychoactive substances” that are often excluded from drug testing, the report authors wrote.

While naloxone, or Narcan, is highly effective in reversing opioid overdoses, Tennessee health officials are concerned that nitazenes are so potent they may require multiple doses of the rescue medication.

High potency opioids have been found in illicit drugs in the Midwest and Northeast since 2019, but have since spread to other states.

“We were holding our breath, waiting when we were going to see it,” said Erin Tracy, a chemistry researcher at the Center for Injury Prevention Research at the University of North Carolina at Chapel Hill.

She and her colleagues recently began detecting nitazenes in illicit drug samples collected across the state.

Additionally, Tracy and others also find traces of xylazine, a non-opioid animal tranquilizer, in fentanyl samples.

“It’s own disaster awaits,” she said.

Xylazine is used to fall asleep horses, dogs and other animals before veterinary surgery. Typical toxicology tests also do not look for xylazine.

Increasingly, however, the animal sedative has been found mixed with illicit injection drugs. It is often called “tranq” or “tranq dope”. People who use it tend to slip into a state of unconsciousness for hours.

“This deep sedation leaves people in really dangerous places,” making them vulnerable to sexual assault and robbery, said Dr. Laura Kehoe, medical director of the Massachusetts General Hospital Substance Use Disorder Bridge Clinic.

The sedative effects of xylazine are so powerful that a person can suffocate, for example, if lying face down on a pillow, said Dr. Joseph D’Orazio, associate professor of clinical emergency medicine at the Lewis Katz School of Medicine at Temple University in Philadelphia.

The drug has also been linked to reports of skin abscesses, much like cases seen in other injection drug users. In some cases, the injuries are so severe that amputations are required.

“We’ve definitely seen an increase in the number of chronic wounds in people who inject drugs,” D’Orazio said, adding there’s no evidence that xylazine itself leads to those open wounds. .

But he and other experts suspect that several factors could be at play with the use of xylazine. The drug can decrease blood flow, reducing the body’s ability to heal. It could also increase the likelihood of users engaging in skin-picking behavior that can lead to open wounds.

“It really is a poison drug supply,” Kehoe said.

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