'People will start losing limbs': 'quiet' animal is changing the RI drug landscape (2023)

Round, gray bumps dot Amy Treglia's forearms, as if someone cruelly held lit cigarettes to the 45-year-old's skin until the flesh melted. In some spots, scabs appear at the edges, evidence that not long ago the wounds were fresh and raw.

Treglia began noticing lesions sprouting, growing, and worsening on her arms, legs, and other parts this summer. She had no idea of ​​the cause.

“That's what would happen the second he fired. The other punctures would turn green. Neon green,” Treglia said recently as he examined the scars on his arms, indentations that feel a little rough to the touch.

Tara Dorsey, Project Weber/RENEW legal aid coordinator, gave him a hint:xylazine, a tranquilizer and muscle relaxant used by veterinarians, it was probably laced with a drug that Treglia thought wasfentanyl.

"I couldn't understand why it was burning," Treglia said. “She felt like gasoline coursing through her veins. It eats you from the inside out."

More about xylazine:'Big trouble:' Animal sedative found in local drug supply raises overdose risk

Xylazine is becoming popular in the Rhode Island drug supply

Xylazine is rising in the Rhode Island drug supply and is catching people like Treglia off guard with its ability to cause persistent scaly sores and knock them out for hours on end.

“I woke up with a knot in my head. I was like, 'Where was my day?'” said Treglia, who recently got a bed in a sober house and has been clean for more than six weeks, as evidenced by her light brown eyes.

Strange bumps and bruises appeared after long blackouts. Tiny punctures and ingrown hairs turned into oozing sores. Treglia went through agonizing withdrawal, with horrible stomach pains and retching until only bile remained.

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She and her dealer couldn't figure out what was going on. She bought a new batch. She tried to cook it; she tried not to cook it.

She forced herself to her feet while wearing it to keep from passing out, swearing to herself that "we won't leave."

“I never thought I would be afraid of anything,” Treglia said. "It's so scary."

Treglia decided she had had enough and checked into Butler Hospital, she said.

“I said whatever this animal is, I don't want to be a part of it,” Treglia said.

Further:Fighting to prevent overdose in pregnant women and new mothers: What's working in New England

What is xylazine and what are its side effects?

Approved by the Food and Drug Administration in the 1960s for use by veterinarians,salvationIt acts as a long-acting sedative and pain reliever for animals, particularly large mammals such as horses and cattle.

It is a long-acting central nervous system depressant that can put people into a prolonged stupor, especially when combined with other sedative medications such as opioids. It can cause low blood pressure, slow heart rate, and slow breathing and has been linked to skin lesions and infections.

Increasingly, xylazine is showing up in the drug supply across the country as a cutting agent mixed with heroin and illicit fentanyl. Known as "tranq" or "tranq dope" in some circles, xylazine hashit Philadelphia hard.There, people report darkened and dying skin from wounds caused by the sedative and amputated limbs due to untreated abscesses.

A Philadelphia nurse recently spoke with the Weber/RENEW Project team in Rhode Island about what to look for, how to treat injuries, and ways to protect the community.

“Somehow it eats away at the skin. It's horrible,” said Matt Elliott, Kennedy Plaza coordinator at the Weber/RENEW Project.

People who come across the drug, like Treglia, are left baffled by its effect. They don't know what hit them.

“It really confuses people when they take it,” Elliott said. "It's very difficult to wake them up and when they do, they can still be quite confused."

Further:The fentanyl is causing an overdose in IR. That's why they distribute Narcan in Kennedy Plaza.

Many users don't know they're exposed to xylazine, study finds

The true prevalence of the drug is not yet known, as both health professionals and researchers struggle to study its impact, due to an ever-changing drug supply. According to Traci Green, co-director of the Rhode Island Hospital's Center for Excellence in Biomedical Research in Opioids and Overdose, few emergency rooms or medical examiners currently test for this.

Rhode Island Hospital, however, includes xylazine in its drug evaluation, Green said.

One study found xylazine in biospecimens from nonfatal overdoses after advanced toxicology testing on blood and urine collected during emergency room visits with the patient's consent, according to Dr.raquel wightman, professor of emergency medicine at Brown University Alpert School of Medicine.

The trial showed that xylazine was always found to be found in illicit fentanyl, although none of the participants reported known xylazine exposure, said Wightman, who led the study in collaboration withStranger's Bay, director of the hospital's toxicology laboratory.

Additionally, a two-year drug trial study published last year bytestRI(Rhode Island Drug Toxicology and Ethnographic Surveillance Test) revealed that 44% of 90 samples of street drugs sold as fentanyl, cocaine, or methamphetamine contained xylazine.

According to the testRI researchers, of whom Wightman is the principal investigator, the findings highlight the unpredictability of drug supply and the reality that people may not know what they are taking, increasing the risk of overdose.

The state Department of Health is working with testRI to share these findings with primary care and behavioral health providers, people who use drugs, local harm reduction organizations, peer recovery support specialists, and the general public, according to spokesman Joseph Wendelken.

Still, much remains to be known.

"How much is there is the big question," Green said. “Since we don't know the safe dose, any presence is not good. Is it too little or too much that causes abscesses? We don't know the answers. … If we can better control the dose, we can keep people safe.”

How the use of xylazine spread in the United States

The national extent of xylazine-related overdose deaths is unknown, butresearch shows xylazine-related overdose deaths have spread westward in the United States over the past decade, according to the National Institute on Drug Abuse. The greatest impact was seen in the Northeast, where xylazine was involved in 19% of all drug overdose deaths in Maryland in 2021 and 10% in Connecticut in 2020.

“It's a double whammy. You can die of an overdose. You can die from the infection,” said Dorsey of the Weber/RENEW Project.

The state Department of Health is working to add xylazine to drug screening panels at the Office of the Medical Examiner, but it is not part of the testing regimen at this time, Wendelken said. Consequently, state data does not indicate whether xylazine contributes to accidental overdose deaths at a time when fatal overdoses reached a record 435 in 2021.

A downward spiral: 'It consumes everything in my mind'

Treglia developed a substance use disorder in his 20s after being prescribed painkillers after a car accident. An ex-boyfriend soon introduced her to heroin.

Treglia said that last summer he went on a fentanyl spiral. She sold the house and began living in hotel rooms, where she says she used drugs herself.

“I spent a disgusting amount of money in four months,” Treglia said.

It was during this time that he first noticed sores developing on his skin. She realized that she was wasting time due to blackouts during which her body would stiffen and twist into positions that left her cramping, sometimes with blocked circulation to her extremities.

The side effects seeped into his psyche. Chronic use of xylazine can lead to dependence and a withdrawal syndrome that can cause irritability, anxiety, and malaise.

“It gets into your mind amazing. It consumes everything in my mind," Treglia said. "You have to get more and more to feel better."

Why xylazine poses an even greater threat to the homeless

Xylazine presents particular concerns for the homeless community. Prolonged sedation leaves people vulnerable to sexual assault, other violence, and robbery, not to mention the dangers posed by the elements.

"Being heavily sedated for vulnerable people is a problem," said Michelle McKenzie, director of theNaloxone Overdose Prevention and Intervention (PONI).

Doctor Josiah “Jody” Rich told of a client who recently woke up in shock to find his pockets were empty.

“People, if they are homeless, are extremely vulnerable,” said Rich, an addiction specialist at Miriam Hospital and Brown University Alpert School of Medicine.

Advocates call for greater caution with drug use due to possible contamination

Advocates are spreading the word that people need to be more cautious when using drugs, given the uncertainty of supply.

“What I say to those who are still using it is to be very careful. Don't use it as much as usual and never use it alone," said Elliott of Project Weber/RENEW.

Rhode Island State Police Lt. Derek Melfi said xylazine is increasingly being found in drugs seized by police, always as an innovation aimed at increasing profits. He theorized that the long-acting xylazine was being used to perhaps enhance the effects of fentanyl.

“It all comes down to money,” Melfi said.

He warned that young adults who buy counterfeit pills they think are Adderall or Percocet could unknowingly ingest xylazine, with unknown and unforeseen consequences.

“You have to understand what you are taking,” Melfi said.

How can you help someone who seems to have overdosed?

Public health officials also stress the need to act quickly to restore breathing when encountering a person believed to be overdosing.

Call 911 first, then administer naloxone while performing chest compressions and ventilations. Because xylazine is a sedative that does not respond to naloxone, the overdose may not show the more immediate, emergent response seen with opioids alone.

"Rescue breaths are still needed," said Tom Joyce, director of the East Bay Recovery Center and co-chair of the Governor's Overdose Prevention and Intervention Task Force.

Proponents advise giving naloxone every two minutes if necessary, continuing to work to restore breathing with compressions and breaths.

Once breathing is restored, even though the person remains sedated, place them in therecovery position— on your side, with your hand supporting your head and your knee bent to prevent you from rolling onto your stomach — and stop giving naloxone. The position will help them breathe while they wait for rescuers to arrive.

Advocates also urge people to seek treatment for injuries and practice good hygiene using clean needles and other sterile supplies. A test strip is being developed that can alert people on the ground to the presence of xylazine in a drug sample.

There is no approved antidote for xylazine overdose in humans, but the approach often involves treating opioid use disorder, advocates said.

"Withdrawal symptoms would have to ease, and then [the health care provider] would treat the underlying opioid use disorder," Green said.

Green would like to see first responders, police and other public health officials have protocols for dealing with wound care, as well as safe places to hold heavily sedated people until they regain consciousness.

"It's in everyone's best interest," Green said.

Sid Wordell, executive director of the Rhode Island Police Chiefs Association, said he was not aware of any specific police protocol regarding xylazine.

Also, the Providence Fire Department doesn't know when responding to an overdose call if xylazine is in the mix, Capt. Thomas Stegnicki said.

“We are not treating it any differently,” he said.

'I don't want anyone to go through this'

Typically, an overdose victim will respond to naloxone, but Stegnicki said he's seen the dose increase from 0.4 milligrams to 2 mg and even 10 mg over the years. If the person does not respond, it is up to the hospital to determine what health issue is at stake.

"Usually you get some response with Narcan," Stegnicki said, referring to the brand name for naloxone.

Amy Treglia agreed to share her story as a warning to others that xylazine has found its way into drugs in Rhode Island. People are starting to talk about it on the streets, she said.

“I don't want anyone to go through this,” said Treglia, who is now on methadone. “Xylazine is crack cocaine. This is really going to do some damage. People will start losing limbs."