Narcan-resistant drug reaches York County: 'Nobody was prepared for this'

Meredith Willse
York Dispatch

There’s a new drug on the streets of York County that can be tremendously lethal because users can't detect it using test strips and its effects aren't reversed by Narcan.

Coroner Pam Gay said her office recently confirmed the presence of xylazine, an animal tranquilizer commonly referred to as tranq, in a handful of overdose deaths. She declined further comment because the investigations are ongoing.

"Nobody was prepared for this," said Angel McLaughlin, a local certified drug counselor.

McLaughlin, who's been in recovery for the last 12 years, said she's grateful she stopped using drugs before the rise of fentanyl. Now, with the addition of tranq, the threat of overdose is even more acute in the communities she serves.

Angel McLaughlin in West York on Saturday, Feb. 4, 2023.

Audrey Gladfelter, administrator of the York/Adams Drug and Alcohol Commission, said tranq often masquerades as an opioid overdose but the drug itself is not an opioid. Instead, it depresses the central nervous system, resulting in slowed breathing, a lower heart rate and a drop in blood pressure.

Since tranq is a sedative, unlike fentanyl and heroin, naloxone can't reverse its effects. Administering Narcan will reverse the impact of opioids that tranq is often mixed with, Gladfelter said, but a tranq overdose victim will remain unconscious even when dosed with Narcan several times.

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Gladfelter said it's important for responders to call 911 and immediately begin rescue breathing when a tranq overdose is suspected.

It's not yet clear how widespread tranq usage is in York County, but local officials say its presence in autopsies indicates that drug users and responders need to be aware that it's circulating.

A baggie found under the College Ave bridge in York on Dec. 28, 2022.

Xylazine is a relatively new drug.

According to the U.S. Food and Drug Administration, it was first synthesized in 1962 for use in humans. However, its harmful side effects meant that the FDA only approved it for veterinary use — typically for cattle and other large mammals.

Xylazine was first noted as an adulterant — a substance added to enhance other illicit drugs — in Puerto Rico in the early 2000s, according to the U.S. Department of Justice. Since then, it's gradually spread across the United States, seeming to accelerate in usage in the last few years.

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The Philadelphia Medical Examiner's Office began testing for xylazine in 2006. By 2021, the drug was found in 90% of all illicit drug tests conducted there, according to the city's Department of Public Health.

Most of the attention locally is still on fentanyl.

'Scary': Casey Bowling, an unsheltered man living in York City, said that's what he's most concerned about. Bowling said he recently unknowingly smoked fentanyl-laced marijuana.

"It sounds scary," Bowling said of tranq. "They need to stop. They've got enough out here that we have to track and save lives for."

Casey Bowling and his opioid overdose reversal kit in York on Tuesday, Jan. 31, 2023.

As dangerous and prevalent as fentanyl is, test strips are readily available to law enforcement, social workers and drug users in order to prevent overdoses.

Those test strips won't detect the presence of tranq, McLaughlin said, nor is it obvious based on a visual inspection of the drugs. A report from the Pew Charitable Trust noted that field test strips are still being developed.

McLaughlin said long-term drug users have learned harm-reduction techniques over time that help safeguard them from overdose — whether it's from fentanyl or tranq.

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But younger drug users are particularly vulnerable.

“These kids are being taken out because they don’t know,” she said. 

Several local officials who work with drug users, including Gladfelter and McLaughlin, said they've heard of tranq being mixed with heroin, creating a substance commonly described as "tranq dope."

Casey Bowling and his opioid overdose reversal kit in York on Tuesday, Jan. 31, 2023.

Skin lesions: While tranq can only be detected via a blood test, it does produce some telltale wounds: skin lesions that turn black and shed skin.

Gladfelter said she hasn't witnessed such wounds firsthand but described the photos she's seen as "pretty intense." The wounds can happen regardless of how the drug is taken — smoking, snorting or injection.

If anyone has these wounds or comes across anyone with these wounds, Gladfelter said, it's important keep the area clean and dry. Medical treatment is also vital because the wounds typically don't heal on their own and, in a worst-case scenario, could result in amputation.

Withdrawal from tranq comes with its own symptoms: elevated heart rate, excessive sweating, anxiety and agitation — similar to any sedative withdrawal.

Precautions: McLaughlin said it's important for drug users not to use alone and to be alert to any unexpected side effects from the drug. Test strips remain an important tool for harm reduction, she added, because fentanyl is still a significant driver of overdoses even if the strips won't detect tranq.

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While many people are afraid to call for help, McLaughlin said they should not be. Police are more interested in shutting down distribution networks — not arresting those who overdose from personal use.

If someone is overdosing, she added, the state's Good Samaritan Law will protect bystanders who report the incident. 

“Your friend might be pissed that you called 911, but they’re alive to be pissed,” McLaughlin said. “They’re not going to be mad at you if they’re dead.”

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Another element of harm reduction, McLaughlin said, is a healthy dose of skepticism when it comes to drug dealers. Even if they know what they're selling — which is not always the case — they may not be forthcoming about any adulterants like tranq.

“It may be mixed into the supply way high up and no one ever knows,” she said. 

For those looking for naloxone, contact the York/Adams Drug and Alcohol Commission at 717-771-9222, the Emergency Detox Regional Support Center at 866-769-6822 or the Lancaster Harm Reduction Group at 717-468-6846.

— Reach Meredith Willse at mwillse@yorkdispatch.com or on Twitter at @MeredithWillse and Daniella Heminghaus at Hemingaus@yorkdispatch.com or @dheminghaus9.