Narcan-Resistant ‘Tranq’ Linked To 1 in 5 of Milwaukee’s Overdose Deaths

Overdose deaths involving a powerful animal tranquilizer mixed with fentanyl are soaring in Milwaukee County.

Last year, 138 of the 616 overdose deaths in Milwaukee County were linked to a combination of Xylazine, also known as “tranq,” mixed with fentanyl. So far this year, six of the confirmed 16 overdose deaths in the county were from that combination, according to the most recent data from the Milwaukee County Medical Examiner’s Office.

Although that’s a small sample size, public health experts are worried deaths involving the combination will continue to rise because Xylazine doesn’t respond to naloxone — an opioid reversal medication commonly referred to as Narcan. Xylazine is not an opioid.

Deaths attributed to the drug combination were rare just a few years ago.

In 2020, there were four overdose deaths attributed to the Xylazine and fentanyl mixture in the county. That number is estimated to rise to 239 this year, according to county data.

“I fear it is here to stay, at least for a while,” said Dr. Maryann Mason, an associate professor of emergency medicine at the Feinberg School of Medicine at Northwestern University.

Gregory Miller, the mobile integrated healthcare manager for the Milwaukee Fire Department, said his team is working to educate people about the deadly combination. They meet with people who have overdosed to offer them harm reduction tools and discuss treatment options.

“It’s just been on the rise,” Miller said about the xylazine and fentanyl overdoses. “We just try to educate people that it’s in the supply, it’s in what they’re using.”

Other communities across the state and nation have also been seeing the drug, which is not approved for human use, pop up in more synthetic opioids. The U.S. Drug Enforcement Administration found that overdose deaths involving Xylazine increased by 516 percent in the Midwest from 2020 to 2021.

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

The White House’s Office of National Drug Control Policy also called Xylazine an “emerging threat to the United States.” 

Side effects include open wounds

Mason said the drug is often used at veterinary practices to sedate large animals like cows or horses. The drug, which is usually used in a powder form, first emerged in drug markets in the U.S. in the mid-2010s, starting on the East Coast, according to a report from the Harm Reduction Journal.

“Now it’s made its way into the larger drug supply in the U.S.,” Mason said. “It has spread and it is definitely in the Midwest now.”

The drug is almost always mixed in with fentanyl, a synthetic opioid that’s 50 to 100 times stronger than morphine. Mason said fentanyl is powerful, but “short acting.”

“So in order to stave off withdrawal and coming down from the high too soon for people, they will mix Xylazine in it to extend the high of fentanyl,” she said.

The drug constricts a person’s blood flow, which can lead to open wounds. That can then lead to other issues like amputation or sepsis.

Mason said even though Narcan does not counteract Xylazine, people should still use Narcan when they witness someone who has overdosed because it’s often mixed with fentanyl.

“Because Xylazine is usually used with an opioid, you may revive somebody, but they will float back out after a little bit because the Xylazine is still active in their system,” Mason said. “So it can take much longer to recover from an overdose that involves Xylazine and it can lead to the need for multiple hours of observation and keeping people in hospital longer.”

Testing strips could help lead to fewer overdoses

Vivent Health is a Milwaukee-based health clinic that distributes Narcan and fentanyl test strips with the help of the state’s Narcan Direct program. Kristen Grimes, the director of prevention services for Vivent, said Xylazine test strips can help lead to fewer overdoses because people will then know what they’re using.

“They (drug users) want to know if Xylazine is there because if it is there, they can take strategies to reduce their risk of overdose,” Grimes said.

Wisconsin lawmakers passed a bill to exempt Xylazine test strips from being labeled as drug paraphernalia, similar to a move they made to legalize fentanyl test strips.

That bill is still awaiting a signature from Gov. Tony Evers. A spokesperson for Evers said he plans to sign it.

If you or someone you know is struggling with addiction, call the Wisconsin Addiction Recovery Helpline at 211 or text your ZIP code to 898211. You can also learn more about treatment options or how to respond to an overdose at: dhs.wisconsin.gov/opioids.

Listen to the WPR report

Overdose deaths from Xylazine on the rise was originally published by Wisconsin Public Radio.