Quick Take:
As social services and medical providers struggle to deal with fentanyl overdoses, xylazine’s movement from east to west in the U.S. has spawned a new crisis in the making. “Xylazine creates all these other crazy issues like lesions and breaking down of the skin and tissue,” said EMS medical director Dr. David Ghilarducci. “It cuts off the blood supply in your skin, so the skin just dies like gangrene.”
Mix fentanyl and xylazine, an animal tranquilizer, and you get tranq. If a user overdoses on tranq, specifically on the xylazine in tranq, Narcan can’t stop it.
Though xylazine contributes to a small percentage of overdoses, some fear its rise in Santa Cruz County may soon exacerbate the fentanyl crisis.
Joey Crottogini, health center manager for HPHP, which offers low-cost healthcare through three grant-funded health centers in Santa Cruz County, said his team has been preparing for xylazine for some time.
“Staff attended training. We became more aware of the types of wounds associated with Xylazine,” he said. “Narcan only treats opioid-related overdose. Narcan goes into the brain and takes over the receptors for opioids. It doesn’t work on Xylazine, which is a hardcore sedative.”
On July 5, 2023, Santa Cruz County announced its first confirmed xylazine-related death, a 35-year-old woman who died the previous month. A toxicology report stated she tested positive for fentanyl and xylazine.
Part 1: With fentanyl deaths doubling, Coral Street is a “hot spot”
Part 2: Fentanyl response: Redoubling efforts as the crisis doubles
Part 3: Xylazine: An emerging deadly threat
The coroner’s spokesperson confirmed two additional people, who died in Santa Cruz County in the past year, tested positive for xylazine.
Sheriff Hart acknowledged xylazine has appeared in toxicology reports. But, despite xylazine’s reputation and the ugly spectacle of “zombie” users he’s seen on social media, fentanyl is still the sheriff’s primary concern.
“Xylazine is an emerging drug,” he said. “We’re not seeing it at the level of fentanyl in the county yet, and I hope we don’t.”
Xylazine, however, has been a well-known threat to harm reduction coalitions and medical providers since at least the pandemic era, when the tranq epidemic in Kensington, Philadelphia, went viral on YouTube. Locally, addiction experts are preparing for a possible surge in xylazine’s proliferation here.
SafeRx hosts an online Xylazine Library with up-to-date information on the narcotic. The library is sourced from the Central Coast Overdose Prevention, a tri-county coalition of concerned residents, healthcare providers, and nonprofits. The coalition’s regional director and licensed pharmacy technician, Rita Hewitt, created the library.
Hewitt tracks drug trends emerging from the East Coast to help better educate and prepare the community with education and connection to addiction help.
“The illegal drug manufacturers are really smart. We’re trying to stay ahead of them and be responsive with xylazine test strips.”
Beyond the increased risk of overdose, xylazine has a particularly gruesome effect on the body — chronic open wounds and sores. Sometimes, tissue death leads to amputation.
“Xylazine creates all these other crazy issues like lesions and breaking down of the skin and tissue,” said EMS medical director Dr. David Ghilarducci. “It cuts off the blood supply in your skin, so the skin just dies like gangrene.”
Methamphetamine users tend to be manic and agitated when they overdose, said Dr. Ghilarducci, whereas opioid overdoses lie quietly. That’s the insidious part about opioids or xylazine. Tucked away in a corner, nobody notices they’re dying.
“Narcan relies on someone being there and awake and able to apply to somebody suffering from an overdose. By the time EMS is called, it could be 30 minutes, it could be two hours into an overdose, and at that point, it’s probably too late.”
Xylazine slows breathing, decreases blood pressure, and decreases heart rate. Add fentanyl, and those effects increase, as does the risk of an overdose. Brain death due to lack of oxygen, occurs within seven minutes.
Most of the users I spoke to over the past few weeks, natives of Santa Cruz, were aware of tranq but were unconcerned. Perhaps it was out of sight, out of mind for them.
One Thursday afternoon in June, I met Chris York, 26, on Coral Street. He had been sleeping outside for two days. Previously, York and his partner had shelter — a campervan on Ocean Street — until the police hauled their living quarters away without warning, he says, presumably for illegal parking.
York hunkered down in a makeshift shelter made of thin plastic sheeting–his home, for now. He and his partner don’t know anyone in California. It was only two months ago that they drove their campervan from Maine.
“Meth is dangerous now,” he warns. Methamphetamine is York’s preferred substance. “Fentanyl is in the meth. It has xylazine in it, all different cuts. It’s scary. People take the wrong hit and drop. People don’t know what’s in it. I take my chances.”
In search of signs of xylazine in the Santa Cruz community, I spoke to a worker at the Armory, where Santa Cruz’s Safe Parking Program and the Salvation Army’s emergency shelter are located.
The worker has a lot of knowledge about street drug users (he preferred to stay anonymous, fearful he’d lose his job for talking to a journalist). Fentanyl, he says, works better when smoked. Tranq comes from an injection.
“That’s the future. We know tranq is here when we see more needles around town.”
James Dobbins is a journalist based in the Bay Area. His work has been published in The New York Times, Texas Observer, Texas Monthly and alt-weeklies.
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