Hamilton County Coroner Dr. Lakshmi Sammarco reports if you're using street drugs like opioids and fentanyl, there's a good chance it also has xylazine, an animal drug that slows breathing and heart rate.
The veterinary tranquilizer is increasingly showing up in overdoses and deaths across the country, leading law enforcement agencies to issue warnings. Sammarco estimates it's in two-thirds to three-quarters of street drugs locally.
It does not respond to Narcan or naloxone, the fast-acting opioid overdose reversal drug.
"Xylazine is a sedative. It is not meant for human consumption," Sammarco says. "This is not FDA approved for human consumption. It's meant for horses."
Referred to as "tranq," "tranq dope," or "zombie drug," xylazine is generally mixed with other street drugs like opioids and fentanyl as a cheap way to make a supply stretch further. People often aren't likely to know the drug is in what they're taking, she says.
"You're not going to be able to tell what effect is being caused by fentanyl versus this drug, especially when it's mixed."
In addition to slowing heart rate and breathing, it can cause hyperglycemia, blood pressure to spike and fall, sores, and the skin to breakdown.
Sammarco says the drug started showing up in Greater Cincinnati in 2019.
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She reports in 2022, the office found 3,209 items that contained fentanyl and 1,958 that contained xylazine. "And year-to-date for this year, we've had 492 fentanyl related items and 64 xylazine — so 61% of the fentanyl items analyzed contain xylazine, both solid or residues."
The Hamilton County Coroner's Office reports 433 confirmed fatal overdoses in 2022, 67% (288) of which were attributed to fentanyl.
"Fifty death certificates contain xylazine as a contributory cause, but that's based on a presumptive test. That's not necessarily the only cases where xylazine was seen because it was a presumptive test and not a confirmatory test," she explains.
Additional testing and newer machines are needed to provide more confirmatory tests and a fuller picture.
So far in 2023, there are 29 confirmed fatal overdoses, 18 attributable to fentanyl, and five death certificates including xylazine as a contributory cause.
"The message is that we're seeing so much of it mixed with fentanyl, both in the seizure cases as well as in the overdose cases, that we really think that people need to be aware," says Sammarco.
She points out this situation is similar to when fentanyl started showing up — hospitals, doctors and emergency responders aren't familiar with the effects because xylazine is a veterinary drug and not something they're looking for or trained to respond to.
"We don't have anything to counteract it that EMS carries right now."
