Rising Overdose Deaths From Drugs Cut With Xylazine In Milwaukee

Milwaukee County Medical Examiner, 933 W. Highland Ave. Photo by Dave Reid.

A new and potent pharmaceutical combination is complicating the already dangerous and deadly opioid epidemic in Milwaukee County.

In the Milwaukee area and across the country, a powerful veterinary sedative and tranquilizer called Xylazine has increasingly been showing up mixed with the already dangerous opioid Fentanyl.

The drug adds another layer of suffering and danger for people suffering from addiction to opioids like Fentanyl. It has been found to cause “horrendous skin wounds,” as Dr. Ben Weston, chief health policy advisor for Milwaukee County, put it. The drug, which, like opioids, also causes depressed breathing, cannot be reversed by life-saving emergency medications like Narcan.

“Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” said DEA Administrator Anne Milgram.

In 2020, Xylazine was present in approximately 1% of overdose deaths in the county, and by 2022, 10.4%. During an emergency press conference sounding the alarm about a rash of overdose deaths, Sara Schreiber, technical forensic director of the toxicology lab at the Milwaukee County Medical Examiner, said the latest data shows its presence in approximately 35% of fatal overdoses thus far in 2023.

If other areas of the country are any indication, the Xylazine-Fentanyl cocktail will continue to proliferate across the illicit drug supply in Milwaukee. In 2021, 90% of street drug samples in Philadelphia contained Xylazine, according to the Philadelphia Department of Public Health.

Fentanyl hit Milwaukee sometime in the middle of the last decade. In 2015, Fentanyl accounted for only 8% of all overdose deaths in the City of Milwaukee. Five years later, it would be found in approximately 73% of overdose deaths in the city. The arrival of Fentanyl also marked the beginning of year-over-year increases in overdose deaths. Between 2016 and 2020, the number of overdose deaths increased 60% in Milwaukee County, according to data from the Milwaukee County Medical Examiner.

Ryan Gorman remembers when Fentanyl hit Milwaukee. Gorman is a former intravenous drug user, “opioids primarily”, who has been in recovery since 2010 and currently works as a substance abuse counselor and clinic manager for Community Medical Services.

“Friends started to overdose a lot,” he said. “Went to a lot of funerals.”

These were friends that Gorman had used with or met through recovery.

“In those early years of my recovery, usually when people would relapse, start using again, they would almost inevitably find their way back to recovery one way or another.” he said. “But what I started seeing in, yeah, 2015, 2016, where people were leaving, relapsing, and then never coming back.”

Gorman said the first time he heard about Xylazine was likely at an Overdose Fatality Review Board meeting. “It was just a novel substance that was showing up in medical examiner reports,” he explained. “And everybody in these overdose fatality reviews were concerned, but I don’t think anybody really knew what it was or if they did, they didn’t seem overly concerned at the time.”

Then Gorman began to hear from other people in recovery and clients coming through Community Medical Services, that they were experiencing “weird symptoms” while using. “And these are people with, with a long history of substance use. So for them to report, you know, different symptoms, strange symptoms kind of stands out,” he said.

One of these symptoms was an “immediate loss of consciousness after using.” Blacking out like that is not a traditional overdose symptom, Gorman explained. Later on he would learn that this is a  symptom that is attributable to Xylazine. And now, within the last three to six months, he said he has been hearing of these sorts of experiences more and more.

The mixture of Xylozine and Fentanyl is often called “tranq” or “tranq dope.” Both the Philadelphia health department and the DEA referenced the drug that way. But Gorman said, as far as he can tell, despite it having a nickname, “tranq dope” is not something active drug users are seeking out.

“That’s almost universally not the case,” he said. “What people are doing, typically, is the same thing that people were doing early on when fentanyl was hitting the streets; they think they’re getting one thing, and they’re actually getting something different.”