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Xylazine, isotonitazine new to drug trends, experts say

A box of Narcan sits in the Savage Sisters' community outreach storefront in the Kensington neighborhood of Philadelphia in May. Generically known as naloxone, the medication used revive people who have stopped breathing, doesn’t reverse the effects of xylazine. Philadelphia officials stress that naloxone should still be administered in all cases of suspected overdose, since xylazine is almost always found in combination with fentanyl. Associated Press File Photo

The types of drugs in circulation on the street can ebb and flow, but medical professionals, including Dr. C. Thomas Brophy of the Ellen O’Brien Gaiser Center, are noticing certain new substances rise in popularity.

The medical director of the Butler-based recovery center said people struggling with addiction tend to seek euphoria by what ever means necessary.

“They don’t care so much whether it arrives via morphine, Demerol, Dilaudid, heroin, fentanyl, or the newest synthetic, isotonitazine,” Brophy said. “Many times, regardless of which form of opioid is involved, it is simply referred to as 'dope.’”

Xylazine, or “tranq,” is one such new drug, which Brophy said has been traced back to Puerto Rico, made its way up the East Coast and into Philadelphia before coming to Western Pennsylvania more than a year ago.

Dr. C. Thomas Brophy is medical director at the Ellen O’Brien Gaiser Center in Butler. Butler Eagle photo

Brophy said xylazine is not used on humans. It’s mixed with ketamine to act as a sedative for large animals and is administered through an injection.

“(People) are not seeking the xylazine, it is simply an additive to whatever dope/fentanyl they are buying,” he said. “Additives are not an uncommon thing.”

Other drugs, such as tramadol and crushed methadone pills, have also been mixed with substances.

“The additives that get used depend very much on what is cheap and easily attainable,” Brophy said. “Different additives are added for different reasons. Addicts sometimes say they do like the xylazine additive because it ‘gives the dope legs,’ meaning it makes the overall dope-effect last a little longer than it normally would.”

According to Chief Butler County Detective Tim Fennell, its common to see drugs mixed together, allowing dealers to sell lesser amounts for a more powerful high.

He reported 22 of the 65 deaths caused by overdoses in 2022 were connected to xylazine. The drug’s prominence remained constant and steady in 2023, playing a factor in 14 of 42 fatal overdoses, Fennell said.

Xylazine can be especially dangerous, he said, as Narcan does not reverse the drug’s effects.

Brophy addressed the possibility of an overdose.

“Another concern is suppressed breathing, as it is a sedative, but it is not an opioid, therefore it does not respond to Narcan, the reversal agent that our EMS brothers and sisters rely on to save people's lives,” he said.

The effects of xylazine use can give the skin a “zombie” type of appearance, according to Brophy. He explained once the drug is injected into the skin, a crater forms.

It is possible to be accidentally exposed to xylazine through contact, making it dangerous for more than just the person injecting the drug.

A mixture of marijuana and opioids is also becoming popular under the name “African Kush,” according to Brophy.

“Kush has always been a term that applies to marijuana products, but this form is wreaking so much havoc because the opioids are making people chemically dependent and turning them into dope addicts,” he said.


Another opioid gaining traction is isotonitazine, Brophy said, which is stronger than fentanyl.

“I am not sure if this is being done because it is cheaper, or perhaps easier to avoid detection at the border … but it must offer some benefit if they are moving away from their golden-egg-laying-goose fentanyl labs in pursuit of something else,” Brophy said.

The Drug Enforcement Administration Washington Division warned of isotonitazine in June 2022, reporting that the new drug was emerging in the D.C. metropolitan area that is “as dangerous and deadly as fentanyl.”

“We want to get this info out and warn people,” said Jarod Forget, special agent in charge of the DEA Washington Division in a news release. “If we can educate and inform our communities about the dangers of taking counterfeit prescription pills or other drugs, we stem the proliferation of these deadly opioids, stop all of these senseless deaths, and help keep our neighbors and loved ones safe.”

According to the DEA, the drug’s high potency comes with an increased risk of overdose.

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