Close-up of wounds on the hands of Bill, a tranq user in Philadelphia. (Photo by Gilad Thaler/VICE News)
Health officials in California have detected "tranq," a dangerous new combination drug, in several fatal overdoses, prompting concerns about its spread in unhoused communities already grappling with an overdose crisis.Last week, San Francisco’s chief medical examiner’s office said tranq—usually a combination of fentanyl or heroin and xylazine—was detected in four overdose deaths in December and January. Xylazine was also detected in one fatal overdose in Los Angeles in 2021, the department of public health told the Los Angeles Times.
Tranq is most prevalent in the northeastern part of the U.S. in cities like Philadelphia. While San Francisco’s alert said tranq doesn’t appear to be widely available yet, its spread could be disastrous in a city already rife with overdose deaths; tranq has been associated with grisly wounds and amputations as well as more severe overdoses. In all four cases, the medical examiner’s office also found fentanyl, the primary driver of fatal overdoses in San Francisco and the U.S. Overdose deaths in the city have slowed in the last couple years, from 640 deaths in 2021 to 620 in 2022. The alert said the medical examiner’s office is using state funding to test for xylazine in overdose deaths in 2023. Is your community being hit with tranq? We’d love to hear from you. Contact firstname.lastname@example.org.San Francisco's medical examiner’s office said it hasn’t seen tranq-related wounds in the city yet. In Philadelphia, ground zero for tranq use in the U.S., drug users are dealing with skin ulcers even in places where they’re not injecting—some have had their fingers and toes amputated. Kensington, a neighborhood that’s described as an open-air drug market with a large concentration of drug users, has been hit particularly hard by tranq and is comparable to the Tenderloin, one of the neighborhoods in San Francisco with the highest overdose rate.
Philadelphia has hired a wound care specialist to address the issue, while harm reduction groups like Savage Sisters have been providing people with on-the-street wound care. In November, VICE News used exclusive data to report that tranq had spread to at least 39 states. In October, the DEA reported that there was a 112 percent increase in its findings of xylazine in the west between 2020 and 2021—the biggest increase, 193 percent, was in the South. Jen Shinefeld, a field epidemiologist with Philadelphia’s Department of Public Health, told VICE News the initial warnings signs that tranq was in the drug supply included people blacking out immediately after injecting drugs and waking up feeling dopesick (e.g. in withdrawal); overdoses where people remained sedated even after being given naloxone; wounds that took longer to heal or healed looking like burns. Much of Shinefeld’s work is focused in Kensington. Several tranq users who previously spoke to VICE News said they’ve had issues getting adequate medical care because there’s no detox protocol for people withdrawing from tranq and many rehab facilities cannot accept people with open wounds. Most rehabs and hospitals don’t test for xylazine because it is not a controlled substance, meaning that some health care providers and patients don’t know they’re using it.
Bill, a tranq user who had a finger amputated, previously told VICE News he didn’t like going to the hospital because he’s not treated with respect and because he doesn’t want to go into withdrawal while waiting for treatment. Dr. Daniel Teixeira da Silva, medical director of Philadelphia’s health department, said tranq wounds are unique because “they cause the tissue to die,” likely from blood vessel constriction. He said wounds need to be kept covered and moist while Shinefeld said not to use bleach, alcohol, or hydrogen peroxide to clean tranq wounds—water and soap is better. The city is working on creating best practices for providing wound care to people outside of formal settings. “Completing long term care plans when you do have a place to live or a place to stay is really difficult,” Teixeira da Silva said, adding what San Francisco is seeing is likely the “tip of the iceberg,” Xylazine can be purchased online for cheap because it’s not illegal. In January, a group of House Republicans wrote a letter to the DEA and Customs and Border Protection calling for xylazine to be scheduled. However, addictions experts have raised concerns that banning tranq could leave a vacuum open for even more potent drugs. While some news reports have said naloxone is not effective on tranq overdoses, that’s not entirely accurate. Naloxone is not effective on xylazine, because xylazine is not an opioid, however it should just be used on people who’ve overdosed because tranq most often contains opioids too. Shinefeld said the overdose response to tranq needs to include rescue breathing and monitoring oxygen levels or even using oxygen tanks, though those are less accessible. The reports about tranq in San Francisco come as the city’s handling of the overdose crisis has been increasingly politicized, with Mayor London Breed recently indicating support for opening safe injection sites—a move that is being staunchly opposed by some recovery advocates. Breed and city police are also doubling down on targeting drug dealing in the Tenderloin. Shinefeld said safe injection sites can direct people to medical care and test what’s in their drugs. Savage Sisters founder Sarah Laurel previously told VICE News that teaching people how to shoot up drugs as hygienically as possible is a key part of minimizing the risk of tranq wounds. Want the best of VICE News straight to your inbox? Sign up here.