In addition to fentanyl, fatal overdose cases involving a veterinary drug that was nearly unknown in the area five years ago have quietly risen.
Data from the Cook County Medical Examiner’s Office shows 146 opioid-related deaths last year where xylazine was listed as the primary cause, marking a 16.8% increase from 2021. Current numbers are preliminary and likely to rise as there are 564 pending drug tests since last year starting on Tuesday.
Testing for xylazine is standard when a drug overdose is suspected, according to the Cook County Medical Examiner’s Office and other area coroners. Cook County recently estimated the total number of opioid-related deaths last year will exceed the total in 2021.
Xylazine accompanied 8.4 percent of all opioid-related deaths in Cook County in 2022, up two percentage points from 2021.
First discovered in 1962, xylazine is used in veterinary medicine as a sedative and pain reliever. It was connected to “speedballs” (a combination of heroin and cocaine) in Puerto Rico in the early 2000s and is now more commonly called a sedative or tranquilizer.
Users are not always aware of its presence. Some seek it out while others avoid it.
Not approved for human use, the drug is “often found mixed with deadly opioids, such as fentanyl, and has been detected in mixtures containing cocaine, heroin and a variety of other illicit drugs,” according to a statement from the Chicago Drug Enforcement Agency Division Field.
The use of xylazine can cause serious problems including necrotic skin ulcers, heart rate changes and low blood pressure, according to reports from the Food and Drug Administration and the National Institutes of Health. Wounds caused by the injection of the drug can lead to amputations.
Adding to the drug’s danger, naloxone, which is often used to reverse opioid overdoses, doesn’t respond as well to xylazine. Despite this, doctors still recommend its use.
Local groups react
While xylazine’s growing presence is reflected in the number of fatal overdoses, local harm reduction organizations say its growing presence in the area’s drug supply is evident in other ways.
Organizations like the Chicago Recovery Alliance are working with xylazine users to minimize its potentially fatal consequences. The group provides clean syringes and other supplies to people who use drugs, as well as HIV and hepatitis C testing and counseling services.
Taylor Wood, lead technician at the Chicago Recovery Alliance and head of the drug control program, has been in contact with distributors, individual users and even a bar that wanted to test bags that were confiscated or found on the floor.
Wood uses infrared spectroscopy combined with test strips to inform users of the composition of a pill or bag. Often the composition of drugs bought on the street can be a mystery.
Sometimes it’s hard to identify xylazine fast enough in the Chicago drug supply, Wood said, estimating it made up between 4 and 6 percent per bag tested. Wood said the substance increased in the drug supply in Chicago in mid-to-late 2021 and that about 20 percent of opioid samples tested locally by the organization contain xylazine.
Wood has seen the injuries that lead to amputations and said colleagues and public health professionals commonly see addiction and other injuries.
“Even drug treatment programs, they still don’t know how to deal with it,” Wood said. “Many people who suffer from it don’t have many options in terms of assistance.”
Chicago Recovery Alliance offers services in its warehouses and vans. It has drug testing facilities at its West Taylor Street warehouse on Mondays 5-7pm, Wednesdays 4-6pm and Saturdays midday-2pm. location, 4756 W. Madison St., during business hours, Wood said.
The Night Ministry, which provides housing support, social services and health care to Chicago’s homeless community and those living in poverty, is also seeing the effects of the drug. The organization’s mobile medical program includes xylazine overdose and injury care.
Stephan Koruba, a senior nurse at the Ministry of Night, says some of these clients, exhausted from years on the road, wait until the last minute for treatment due to previous negative experiences with the health system. Hesitation can lead to serious consequences including blood clots, amputations or even death.
“Let’s see all that stuff. And xylazine makes the worst outcomes happen faster and more intensely,” Koruba said. “It’s a big deal.”
The Ministry of Night gets reports every two weeks from the city based on 911 data on where overdoses are most common so harm reduction services, including education and testing, can focus on that area, he said Koruba.
“You know, if people could imagine, ‘Hey, I need to make sure I have my Narcan today before I go to work,’ it’s a different reality, and it brings it home,” Koruba said.
Sound the alarm
Xylazine is not currently listed as a controlled substance. Both the DEA and Congress can schedule a drug as a controlled substance.
Recently three Republican members of the House of Representatives wrote a letter to the DEA and Customs and Border Protection seeking an update on their response to xylazine, and suggested they would introduce legislation if the DEA did not schedule the drug, according to media reports.
Researchers have also found a strong connection between fentanyl and xylazine in fatal overdoses.
Neeraj Chhabra, an emergency medicine physician and medical toxicologist at Cook County Health, early raised the alarm about xylazine locally.
He published a report last year on fatal overdose cases in Cook County and the peak of xylazine-related deaths in 2021. More than 99 percent of those cases involved fentanyl or fentanyl analogues, the report said.
“I think the overall umbrella we need to combat this problem is through a harm reduction lens, recognizing that there are people who use drugs and who deserve treatment to prevent a fatal overdose,” Chhabra said. “This includes things like expanded access and easier access to naloxone and low-barrier access to opioid use disorder medications. These are things like buprenorphine, suboxone, methadone, as well as decreasing stigma for people who use drugs when they get into the healthcare system.
Naloxone, commonly given to reverse opioid overdoses, doesn’t work the same way with xylazine. However, Chhabra still encouraged its use in overdose cases.
“The vast majority of these deaths involving xylazine also involve fentanyl,” Chhabra said. “So naloxone should definitely still be given in those circumstances, just with the understanding that it may be less effective.”
The majority of fatal overdoses in Cook County involving xylazine involve residents of Chicago, although as of 2020 there have been more than five cases each involving residents of Cicero, Chicago Heights, and Schaumburg.
A recent ABC-7 Chicago/League of Women Voters mayoral debate had candidates answer a question about opioid addiction and fatal overdoses. Safe injection sites, where users can be supervised while using drugs, have been a solution proposed by Roderick Sawyer and Ja’Mal Green.
All candidates discussed mental health care and harm reduction. Both Brandon Johnson and Paul Vallas have mentioned a family connection to addiction.
Spread in the area
Will County coroner’s public data showed that 9 of 135 overdoses in 2022 identified xylazine as the cause of death. All of these cases also involved fentanyl. The total grew to five cases in 2021 from two in 2020.
Kane County coroner Robert Russell said his office handled 78 opioid-related deaths in 2021 and estimated the final total in 2022 would be similar. He identified one case in 2021 with a positive test for xylazine and five in 2022.
Russell said he has seen at least one case involving xylazine, which he described as “meat disintegration.”
Lake County has identified four overdose cases involving xylazine in 2021 and seven cases so far in 2022, according to a coroner’s office toxicologist. McHenry County went from one xylazine death in 2021 to two in 2022. 2022 data for both is preliminary.
The DuPage County coroner did not respond to questions about the xylazine and overdose cases.
Test identified xylazine in a Springfield sample this year, showing its reach may not be limited to the Chicago area.
Even if opioid use affects everyone racial and ethnic groups, the legal one and the health consequences fall disproportionately on communities of color. Drug arrests and fatal overdoses cluster geographically in Chicago’s West Side neighborhoods, including Garfield Park and Humboldt Park.
Last year, about 55 percent of fatal opioid overdoses in Cook County involved Black residents. The data is similar for the cases of xylazine, even though it represents 22.3% of the population, according to the last census figures.
A lower percentage of overdose deaths in Chicago involve xylazine than in Philadelphia, where use of the drug was first documented in 2006. The drug has moved across the country from the Northeast. The Philadelphia medical examiner reported that 90% of the street drugs sampled contained xylazine.
A recent DEA ratio declared xylazine it can be bought cheaply by traffickers over the internet from international suppliers and has been found in raids where the drug is sold and stored.
Laboratories have identified an increase in xylazine showing up in tests conducted by DEA Laboratories every year since 2015. It has appeared in nearly 9,000 articles tested by laboratories in 2021according to the Drug Enforcement Agency.
The local DEA lab also saw a spike in seized specimens across Illinois that tested positive for xylazine. The figure increased by 50% in fiscal 2022 with a total of 39 seizures.