If you live or have spent enough time in a major American city since the Covid pandemic, you may have witnessed ‘dope lean’.
It has become increasingly common in recent years for drug users to curl up in a lifeless state, seemingly oblivious to what is going on around them.
Many experts point to the arrival of an animal tranquilizer that has begun flooding the U.S.’s illegal drug supply — laced with everything from fentanyl to cocaine.
Xylazine – known on the street as ‘Tranco’ – is a powerful sedative used to put large animals to sleep before veterinary procedures and surgery.
However, it is now being used by drug dealers as a cutting agent to make the drug stronger and give users a ‘high’.
But mixing these sedatives with stimulants and opioids, some of which act like stimulants and keep the body awake, can lead to a ‘dope lean,’ or someone hunched over while unconscious.
What happens when Xylazine enters the body?
Xylazine depresses the central nervous system, causing users, such as those in the Kensington neighborhood of Philadelphia, to exhibit a zombie-like appearance.
Xylazine targets adrenergic receptors in the brain, which release the neurotransmitters norepinephrine and dopamine.
The drug works to block those receptors, reducing the amount of that neurotransmitter.
Because xylazine is usually laced with fentanyl or heroin, it’s usually injected — but it can also be swallowed, smoked, or snorted.
‘When xylazine is injected, it starts to take effect within minutes,’ Dr. Kelly Johnson-Arber, a medical toxicologist at the National Capital Poison Center, told DailyMail.com.
‘The effects can last for several hours or in some cases longer.’
If xylazine is injected, it travels immediately into the bloodstream. However, if it is swallowed, it must pass through the digestive tract and be broken down, which can take over an hour.
From Los Angeles (left) to New York City (right) as the drug spread across the country, news crews captured people crouching on the ground.
Smoking pills containing xylazine are also a faster way for the drug to enter the bloodstream. It is easily absorbed in the lungs, which are covered in small blood vessels.
At first, one may experience high blood pressure, slow heart rate, abnormal breathing and feeling tired.
‘Over time, people can become very disoriented and confused, even comatose.
‘They may develop shallow breathing or stop breathing.
‘They may have urinary incontinence, their muscles may relax,’ says Dr Johnson-Arber.
However, he emphasized that these symptoms depend on the individual, the quality of the drug, what it is mixed with, and the dosage.
The Food and Drug Administration (FDA) has approved doses of 20 mg/ml and 100 mg/ml in animals, which are injected intramuscularly.
Because illegal xylazine is often mixed with other substances and in varying amounts, it is difficult to know how much someone has taken.
Dr Johnson-Arber said, ‘That’s one of the very scary things about the supply of illegal drugs in this country is you never know what you’re getting.’
In animals, it is used to calm them down and help them sleep.
According to the DEA, it usually takes about 10 to 15 minutes for animals to kick in, helping them go into a sleep-like state and numbing them to pain.
Because xylazine is a sedative, it can cause decreased movement, loss of consciousness, decreased reflexes, slowed judgment, and perceptual difficulties.
‘When combined with other opioids, including fentanyl, it depresses the central nervous system to the point where little movement can occur,’ Pat Ossem, vice president of the non-profit Partnership to End Addiction, told DailyMail.com.
These healing effects, mixed with drugs that act as stimulants, may explain why users turn to human statues instead of falling off entirely.
An unnamed 32-year-old IV drug user underwent surgery in which open wounds on his chest were patched with skin from elsewhere on the body.
Flesh-eating medicine can affect someone’s skin at a different place from the injection site. This patient frequently injected the drug into the veins of her neck and arms, but she experienced open wounds on her chest and legs
The zombie-like state can leave users completely unaware of what is happening around them, making them vulnerable to dangerous situations.
‘People who use Xylazine may black out or experience memory loss, they may be at greater risk of sexual assault or robbery,’ Ms Aussem said.
Xylazine users have also seen skin rotting from the inside out.
Doctors stress that more research is needed into why this happens. One theory is that xylazine constricts blood vessels, slowing or blocking the flow of oxygenated blood throughout the body.
‘You can have a small traumatic wound that can be significantly enlarged because the blood vessels that go through the skin don’t carry a significant amount of oxygen and are very narrow,’ says Dr Johnson-Arber.
In addition, even if someone does not have a lesion while using the drug, it can make someone more sensitive to them. If your blood vessels are constricted and you bump your knee on a table, for example, a bruise that would normally heal on its own can become a major bruise.
Although the drug still works as a sedative in animals, it is largely a mystery why the effects of xylogen are so extreme in humans compared to animals.
‘It was initially developed as a drug for potential use in humans, but largely abandoned because of the side effects of the drug,’ said Dr Johnson-Arber. ‘It has not been shown to be safe for human consumption.’
‘A human body is not exactly like a horse’s body or a cat’s body or a dog’s body.’
What is xylazine?
Xylazine is currently spreading across the country and is readily available online for as little as $6
The graph above shows the cumulative annual figure for the number of drug overdose deaths reported by month in the United States. It also shows that they continue the upward trend
Xylazine is an animal tranquilizer developed in the 1960s to aid veterinarians working to treat cows, horses, and sheep, among other animals.
It is commonly sold under brand names including Rompun and Anased.
Xylazine is not approved for human use.
It is not an opioid like heroin and fentanyl, but it has increasingly been found in the supply of those drugs to make high doses last longer. Xylazine lasts longer than these drugs, from hours to even days.
Xylazine first appeared in the illicit drug supply in Puerto Rico in the early 2000s. It was dubbed Anesthesia de Caballo (horse anesthetic).
But it wasn’t until 2018 that the trunk was initially found on the streets of US cities on the East Coast. It is often mixed with other substances such as heroin and fentanyl to prolong the effects of this drug.
Incredibly cheap counterfeits — available online for as little as $6 — have come with alarming frequency.
In 2015, xylazine was involved in less than one percent of drug overdoses in 10 U.S. cities but rose to seven percent in 2020. That year, almost 26 percent of fatal overdoses in Philadelphia alone involved xylazine
It was also found in 90 percent of the city’s heroin supply. The Kensington neighborhood of Philadelphia is known as ‘Ground Zero’ for the city’s drug crisis.
The true prevalence of xylazine is unknown, as hospitals do not test for it. But the federal Drug Enforcement Administration says that in 2022, about 23 percent of all fentanyl powders and seven percent of fentanyl pills will contain tranquilizers.
Ann Milgram, head of the federal DEA, said earlier this year: ‘Xylazine is making fentanyl the deadliest drug threat in our country.’
A March safety alert from the Drug Enforcement Agency said xylazine and fentanyl mixtures have been detected in 48 of the 50 states.
How is xylazine overdose treated?
There is no FDA-approved treatment specifically for xylazine withdrawal.
Philip Moore, chief medical officer of non-profit treatment provider Gaudenzia, told the Philadelphia Inquirer that weaning people off xylazine is a complicated process.
‘We’ll start treatment for opioid withdrawal, and they should get better – but we’ll see chills, sweating, restlessness, anxiety, agitation,’ he said.
‘These are very, very unpleasant symptoms. That’s what triggers us to realize that we’re dealing with more complex withdrawals, with more xylazine in the mix.’
The FDA issued a warning about xylazine in November after the drug began showing up in a growing number of toxicology reports following fatal overdoses.
‘The risk of overdose is increased when combined with other substances such as fentanyl,’ said Ms Ausem.
A record nearly 107,000 Americans died of overdoses from August 2021 to August 2022, 66 percent of them involving synthetic opioids like fentanyl.
Estimates of the number of deaths caused by xylazine are not available because these data are not routinely collected by the Centers for Disease Control and Prevention (CDC).
Because xylazine is a sedative mixed with opioids like fentanyl, it counteracts standard opioid treatment methods like naloxone, also known as Narcan. However, Narcan can sedate fentanyl or other opioids in the system.
“One hundred percent I would give Narcan to a patient who has decreased breathing and altered mentation because it’s an illegal drug,” Dr. Johnson-Arber said. ‘You don’t know what the person used.’
‘Even if you highly suspect that the person overdosed on xylazine, we can’t prove that there aren’t other opioids there.’
Wound care is also a priority. Ms Ausem recommends keeping the area clean, moist and covered. This can be done with soap and water, or even a potion like Vaseline can be spread on a clean t-shirt with tweezers.