David Lee Wells smirked as he snapped a selfie with iced coffee in hand—a morning favorite for many of us. But for Wells, holding a coffee hadn’t been routine in years, until he was recently fitted for new titanium fingers after the flesh on his hand literally rotted away. This wasn’t an accident. Wells, at only 31 years old, is one of tens of thousands disfigured by xylazine. The Wall Street Journal from June 11, 2023, introduces, “Xylazine, also named ‘Tranq,’ is an animal tranquilizer that has been covertly mixed into America’s increasingly toxic and illicit drug supply.” As the CDC explains, nearly 108,000 Americans died from drug poisonings between August 2021 and August 2022—with 66% of those deaths involving synthetic opioids like fentanyl. But fentanyl isn’t the only substance to blame. Back in March 2022, the Drug Enforcement Administration found a disturbing statistic: nearly one quarter of fentanyl samples that were confiscated in 48 states contained Tranq—prompting the DEA to issue a national xylazine alert. While on Tranq, users like Wells experience a life-threatening high—one that dramatically depresses their breathing and nervous system, leading to a 300% increase in fatalities each year. Both on and off Tranq, users enter a sluggish state and risk losing their limbs—leading news headlines to flag xylazine as “the zombie drug.” So today, we must discuss problems, causes, and solutions to America’s Tranq epidemic because as Sarah Laurel, founder of Savage Sisters, a harm-reduction group in Philadelphia, and former user herself, points out, “The only way that you can get rid of a zombie is by killing their brain. Why would you say that about a human? It’s already hard enough getting people to care about us.”

Brooke Peder, a 38-year-old tattoo artist in Philadelphia, lost her right leg from an infection that drilled its way from her skin to the very marrow of her bone, forcing doctors to amputate. Brooke’s dismemberment is emblematic of one of two consequences of Tranq’s abuse: amputation or death. First, amputation. The CDC, last accessed September 12, 2023, introduces Tranq’s primary physical effect: a rare flesh-eating bacterial infection that destroys tissue under the skin, corroding and rupturing skin in places other than the initial injection site, like the shins, fingers, and forearms. The only treatment: surgical removal of infected tissue. Medical News Today from May 24, 2023, furthers that even with treatment, deadly bacteria may have already seeded the blood, and as many as one in three people may die from the infection. Tranq is a fast, efficient killer. If we do not address the treatment needs of users, their bodies are at risk.

Second, Tranq was designed to be nearly undetectable, killing users without a trace. Opioid drugs have antidotes like Narcan, which first responders can quickly administer in an emergency overdose. But as the Chicago Tribune from April 24, 2023 clarifies, Tranq is a nonopioid agent, so Narcan has no effect. Even if a patient gets to the hospital before they die, no treatment for Tranq exists. The Philadelphia Department of Public Health from December 2022 furthers that ER doctors screen for drugs with urine testing, but xylazine is not present in urine samples even amongst routine users. Dr. Paolo Coppola, the board-certified cofounder of Victory Recovery Partners explains on August 28, 2023, “When users come to the ER, you fully expect them to wake up when you push the opioid antidote, Narcan, but all of a sudden, they’re not waking up.” Tranq in the body is lethal, and doctors have no idea it’s even there.

Tracey McCann, a 39 year old homeless woman living in Philadelphia, became addicted to fentanyl that was unknowingly dirtied by xylazine. Her forearms rotted off, and she now trims her dying skin tissue with toenail clippers. McCann’s story highlights our two causes: racialized addiction and the drug supply chain. First, racialized addiction. Addiction in America remains concentrated in low-income communities of color due to poverty, segregation, hospital deserts, and more. Tranq has only exacerbated these issues and shattered users’ shots at recovery. The Boston Globe from March 2, 2023 conveys, “Urban Black communities are now ground zero for overdose deaths. Black deaths have increased at 44% from 2020.” Instead of seeing addiction as the racialized disease it really is, health systems interpret it as a moral failure. For example, methadone is an anti-addiction medication that satisfies opioid cravings, but cannot be administered in many homeless shelters or group homes due to its classification as a narcotic 1 drug. Black and Hispanic communities were never given a fair shot at recovery, so users are now reaching for more potent drugs like Tranq.

Second, accessibility to Tranq within the drug supply chain has exponentially increased. According to the San Diego Union-Tribune from September 9, 2023, “The growing use of xylazine may be driven in part by its low cost and lower risk of law enforcement scrutiny. Tranq creates a much stronger, longer-lasting high than heroin. And, it’s cheaper. In the Philadelphia neighborhood of Kensington, a bag of heroin ran about $10; Tranq only $5. When drug dealers found Tranq could halve their production costs, they didn’t hesitate to dirty their supply. Pennsylvania is at the center of America’s xylazine crisis, but as Anne Milgram, head of the DEA, emphasizes on March 21, 2023, the links in this drug supply chain keep entrapping users from city to city, making Tranq the “the deadliest drug that we have ever seen.”

David Lee Wells never sought out xylazine. One day, it showed up in his supply. And soon, he couldn’t go without it. Not even when his hand began burning—finger by finger, until he lost all five. Addiction centers turned Wells away because his injuries were too complicated—leaving him to literally rot. We must incorporate two solutions: addiction management and harm reduction. First, administering methadone daily requires discipline, compliance, and long-term access. Luckily, in May 2023, the FDA approved an extended release injection of buprenorphine that satisfies addiction cravings for one month. After being injected by a healthcare provider, the drug is released slowly over time, helping users avoid relapse. While we work to increase access to this life-saving medication, I have created a list of signs people should be aware of to screen addiction in their loved ones. Please utilize it; we need to look out for each other.

Second, we can help protect users. The American Journal of Emergency Medicine from October 2023 explains that immunoassay fentanyl strips have recently emerged to test illicit drug samples directly. An individual whose drug sample unexpectedly tests positive for Tranq may elect to discard the sample, use less, or warn others. Education is key to harm reduction efforts, which need to start locally before expanding. That’s why I’ve partnered with University of Illinois’s Public Health Alliance to host a “Demystifying Overdose” workshop, which you can replicate at your campus to equip your peers with resources like this to avoid falling victim to the Tranq epidemic. As for a national harm reduction effort, I drafted a letter to be sent to U.S. ER Departments nationwide with support from concerned citizens about how patients at risk of Opioid Use Disorder are being screened for xylazine. Please use this QR code to add your name to the growing list advocating for free xylazine test strip distribution by U.S. hospitals. As of right now, this letter has 250 signatures. Even just one more could help make the difference between an overdose and avoiding Tranq entirely.

As an aspiring physician, the communities that are actively facing the Tranq epidemic are the same communities I’m committing my life to serving. But I also want to emphasize that actively participating in uplifting those affected doesn’t require a medical degree. Today, we discussed problems, causes, and solutions to address the xylazine crisis. David Lee Wells couldn’t have imagined losing limbs to a drug he didn’t even know existed, but through addiction management and harm reduction, we can prevent the same fate for users like him.