If you’ve lived or spent considerable time in a major American city since the Covid pandemic, you may have witnessed the ‘dope lean’.
The sight of drug users hunched over in a lifeless state, seemingly unaware of what’s happening around them has become increasingly common in recent years.
Many experts point to the influx of an animal tranquillizer that has started to flood the US illicit drug supply – being laced with everything from fentanyl to cocaine.
Xylazine – known on the street as ‘tranq’ – is a potent sedative used to put large animals to sleep before veterinary procedures and surgeries.
However, it’s now being used by drug dealers as a cutting agent to make drugs more potent and extend users’ ‘high’.
But mixing this sedative with stimulants and opioids, some of which act like stimulants and keep the body awake, could lead to ‘dope lean,’ or someone hunched over and standing up while still unconscious.
What happens when Xylazine enters the body?
Xylazine depresses the central nervous system, causing users, such as these in the Kensington neighborhood of Philadelphia, to exhibit a zombie-like appearance
Xylazine binds to and blocks adrenergic receptors in the brain, which release the stress hormones norepinephrine and dopamine, effectively slowing brain activity.
The result is a reduction in pain and stress.
Because xylazine is usually fixed with fentanyl or heroin, it is commonly injected – but can also be swallowed, smoked, or snorted.
‘When xylazine is injected, it’s going to start having effects within minutes,’ Dr Kelly Johnson-Arbor, a medical toxicologist with the National Capital Poison Center, told DailyMail.com.
‘The effects can last for hours, or longer in some cases.’
If xylazine is injected, it immediately travels to the bloodstream and the euphoria is near-instant.
However, if it’s swallowed, it has to travel through the digestive tract and be broken down, which can take over an hour.
Smoking drugs laced with xylazine is also a fast way for the sedative to enter the bloodstream. It is easily absorbed in the lungs, which are covered in tiny blood vessels.
At first, someone might notice high blood pressure, slow heart rate, abnormal breathing, and feeling tired.
Because often mixed with fentanyl and other illicit drugs that make users feel euphoric, it has the added effect of prolonging or intensifying the high or euphoric effect of those drugs.
‘But as time goes on, especially at larger doses, people might become very disoriented and confused, and even comatose.
‘They might develop shallow breathing, or their breathing might stop.
The drug has spread across the country, from Los Angeles (left) to New York City (right), with news crews capturing people hunched over and on the ground, strung out on the drug
‘They might have urinary incontinence, they might have muscle relaxation,’ Dr Johnson-Arbor said.
This is because while xylazine has an effect on the brain, it also shuts down the body, causing a plunge in blood pressure, a slower heart rate, and depression of the lungs.
However, she stressed that these symptoms depend on the person, the quality of the drug, what it’s 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 into the muscle.
Because illicit xylazine is often mixed with other substances and in varying amounts, it’s difficult to know how much someone has taken.
‘That’s one of the very frightening things about the illicit drug supply in this country is you just never know what you’re getting,’ Dr Johnson-Arbor said.
In animals, this is used to calm them down and help them sleep.
According to the DEA, it usually takes about 10 to 15 minutes to kick in for animals, helping them drift off into a sleep-like state and numbing them to pain.
Because xylazine is a sedative, it could lead to decreased movement, lost consciousness, decreased reflexes, slower judgment, and perceptual difficulties.
‘When combined with other opioids, including fentanyl, it depresses the central nervous system to a point where there can be little movement,’ Pat Aussem, a vice president with the nonprofit Partnership to End Addiction, told DailyMail.com.
These sedative effects, along with being mixed with drugs that act as stimulants, could explain why users turn into human statues rather than falling over completely.
The zombie-like state can leave users completely unaware of what’s going on around them, making them vulnerable to dangerous situations.
‘Individuals using Xylazine may black out or experience a loss of memory, placing them at a greater risk of sexual assault or robbery,’ Ms Aussem said.
Xylazine has also been shown to rot users’ skin from the inside.
Doctors stress that more research is needed as to why this happens. One theory is that xylazine constricts blood vessels, slowing down or blocking oxygenated blood flow throughout the body.
‘You could have minor traumatic wounds that can enlarge significantly because the blood vessels that go to the skin are not carrying a significant amount of oxygen and are very narrow,’ Dr Johnson-Arbor said.
An unnamed 32-year-old IV drug user had to undergo surgery in which the gaping wounds on his chest were patched up with skin from elsewhere on the body
The flesh-eating drug can affect someone’s skin in places separate from the injection site. This patient often injected the drug into his neck and arm veins, but he experienced open lesions on his chest and leg
Additionally, even if there are no wounds at the time someone uses the drug, it could make someone more susceptible to them. If your blood vessels are constricted and you bump your knee on a table, for example, the bruise that would normally heal on its own could grow to a larger wound.
While the drug still works as a sedative in animals, it’s largely a mystery as to why the effects of xylazine are so extreme in humans compared to animals.
‘It was initially developed as a drug for potential use in humans, but those effects were abandoned because of basically the drug’s side effects,’ Dr Johnson-Arbor said. ‘It was found to not safe for use in humans.’
‘Human bodies are not exactly the same as horse bodies or cat bodies or dog bodies.’
What is xylazine?
Xylazine is currently sweeping across the country and is readily available online for as little as $6
The above graph shows the cumulative annual figure for the number of drug overdose deaths reported in the US by month. It also shows that they are continuing to trend upwards
Xylazine is an animal tranquilizer developed in the 1960s to help vets 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 consumption.
It’s not an opioid like heroin and fentanyl, but it has been increasingly found in the supply of those drugs to make the high last longer. Xylazine has a longer duration than these drugs, lasting hours to even days.
Xylazine first emerged in illicit drug supply during the early 2000s in Puerto Rico. It was dubbed Anestesia de Caballo (Horse Anesthetic).
But it was not until around 2018 that tranq was found on the streets of US cities primarily on the East Coast. It has often been mixed with other substances, such as heroin and fentanyl, to prolong those drugs’ effects.
The incredibly cheap adulterant – available online for as little as $6 – has cropped up with alarming frequency.
In 2015, xylazine was involved in less than one percent of drug overdoses in 10 US cities but increased to seven percent in 2020. That year, xylazine was involved in nearly 26 percent of fatal overdoses in Philadelphia alone.
It’s also been 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.
Xylazine’s true prevalence is unknown, as hospitals don’t test for it. But the federal Drug Enforcement Administration has said that in 2022, approximately 23 percent of all fentanyl powder and seven percent of fentanyl pills contained the tranquilizer.
Anne Milgram, head of the federal DEA, said earlier this year: ‘Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier.’
A March safety alert from the Drug Enforcement Agency stated that xylazine and fentanyl mixtures have been detected in 48 out of 50 states.
How is xylazine overdose treated?
There are no FDA-approved treatments specifically for xylazine withdrawal.
Philip Moore, chief medical officer for the nonprofit treatment provider Gaudenzia, told The Philadelphia Inquirer that weaning people off xylazine is a complicated procedure.
‘We’ll start treating for opioid withdrawal, and they should be getting better — but we’ll see chills, sweating, restlessness, anxiety, agitation,’ he said.
‘They’re very, very unpleasant symptoms. That’s what triggers us that we’re dealing with a more complicated withdrawal, that there’s more xylazine in the mix.’
The FDA issued a warning about xylazine in November after the drug began to show up in a growing number of toxicology reports after fatal overdoses.
‘The risk of overdose is amplified when combined with other substances like fentanyl,’ Ms Aussem said.
A record nearly 107,000 Americans died from overdoses from August 2021 to August 2022, with 66 percent of them involving a synthetic opioid such as fentanyl.
Estimates on how many fatalities are down to xylazine are not available because this data is not routinely collected by the Centers for Disease Control and Prevention (CDC).
Because xylazine is a sedative mixed with opioids, such as fentanyl, it resists standard opioid treatment methods like naloxone, also known as Narcan. However, Narcan could mitigate fentanyl or other opioids in the system.
‘One hundred percent I would give Narcan to a patient who comes in with decreased respiratory status and altered mentation because this is an illicit drug,’ Dr Johnson-Arbor said. ‘You don’t know exactly what the person used.’
‘Even if you highly suspect that the individual overdosed on xylazine, we can’t prove that there’s no other opioid there.’
Wound care is also a priority. Ms Aussem recommends keeping the area clean, moist, and covered. This can be done with soap and water, or even medications like Vaseline spread on a clean t-shirt in a pinch.