Xylazine, a new threat for illegal drug addicts

2022-06-17 05:13:47 By : Mr. Fred Chen

Baltimore — A young woman in a pink sweatshirt with blond hair tied back clutched a plastic bag containing 20 new syringes and a box of naloxone, the antidote to opioid overdoses.Jason Bienert, a nurse at a syringe exchange program in Cecil County, noticed her bandaged hand and offered to take a look.She refused and hurried out to a waiting car."That was the first time I met her," Bienert said."I just gave her a little love and didn't push her."Bienert hoped that in time the young woman would trust him and accept the medical care.[ To read this story in Spanish, please click here ]He knows he'll need her because, thanks to a new government-backed testing program, he already knows what's causing her injuries.Since October, he and nurses at seven other Maryland syringe exchange programs have sent swabs collected from street drug users to the National Institute of Standards and Technology in Gaithersburg.The results revealed a new scourge in the great drug epidemic: xylazine, an animal tranquilizer.In all recently tested batches, xylazine has appeared as part of the drug mix.It eats the meat from the legs, arms and, above all, the hands of people.“Knowing what we're up against is everything,” says Bienert.Jason Bienert, a nurse, looks into the trunk of his car at the Voices of Hope center.(Vincent Alban/Baltimore Sun)He added supplies for cleaning and wrapping wounds to the packages of syringes and naloxone distributed at Voices of Hope, the Elkton clinic where he works, as well as keeping them in the trunk of his car, which serves as a kind of mobile clinic. .Federal officials believe that public health providers are getting unique and detailed information from the program, which is operating only in Maryland as a pilot.The process – called Rapid Analysis of Drug, or RAD – was initially used only by law enforcement to determine in near real time all ingredients of illicit drugs.Heroin, long the drug of choice for many users, has now been replaced by the powerful painkiller fentanyl and even more dangerous fentanyl analogues.The latter are powerful synthetic opioids produced in the laboratory, and their use has increased overdoses.Meanwhile, traffickers often use combination agents to extend or weaken their product.Sometimes it's caffeine or acetaminophen, but often it's now xylazine.The pilot testing program is focused on helping to reduce damage.Their goal is to keep people alive until they receive treatment.April Tabor photographed on May 22, 2022 in New Castle, Delaware.(Vincent Alban/Baltimore Sun)The most powerful drugs claimed more than 100,000 lives in the United States last year.In Maryland, there were 2,129 intoxication overdoses in the first nine months of 2021, according to the most recent data available from the state health department.Fentanyl contributed to almost 84% of them.Deaths fell in 2019 after a year-long increase, but resumed an upward trend after the start of the coronavirus pandemic the following year.In Cecil, a particularly hard-hit rural county on the Maryland-Delaware border, deaths increased ninefold between 2008 and 2020.Bienert asks people looking for clean syringes at Cecil to return dirty syringes and drug wrappers, usually paper bags the size of a little finger.The wrappers are cleaned and mailed to the federal lab, where chemists use a system called DART–MS, or direct real-time mass spectrometry analysis.It's the same technology used to detect explosive residue at airport security checkpoints.For now, Bienert knows what she's up against when she sees homemade stamps on the wrappers.She writes their names on a blackboard at the clinic entrance: Quick Game 8, Hooked, Peace Pike, Prada.Next to each one, she notes what the tests showed, that the mixtures contain xylazine.Word has spread in Cecil that this is what is causing the progressively raw, black and bloody wounds on people's hands.The hands are a popular place to inject drugs because veins are easier to detect there than in other areas of the body.Bienert asks users to clean needle tips after filling a syringe but before injecting it to reduce the amount of xylazine that touches the skin.He also recommends washing injection sites with soap and water and using new bandages on wounds.Jason Bienert, a nurse at the Voices of Hope center.(Vincent Alban/Baltimore Sun)Many addicts aren't put off by injuries, since xylazine can amplify the effects of fentanyl, "giving them legs," says Bienert.But it also decreases their respiratory rate, endangering not only limbs, but also life.And the overdose antidote, naloxone, doesn't work with xylazine.April Tabor did not initially know what she had added to the drugs she was taking, but she said that addiction – and some embarrassment – ​​prevented him from receiving treatment for the injuries on her hands.This 41-year-old woman followed a common path years ago, taking prescription opiates for pain after a car crash and becoming addicted.When she couldn't keep paying for the pills, a boyfriend introduced her to the street drugs fentanyl and methamphetamine, though she takes responsibility for her use.She was living in a motel when she met Bienert.She drives between 500 and 1,000 miles a month offering help in motels, abandoned houses and alleys.He could see the damage on Tabor's hands.Still not knowing her cause, he convinced her to stop injecting drugs into her right hand, since she is right-handed.That hand of hers eventually healed, though her skin seems to have melted in a fire.She continued to inject drugs into the wounds on her left hand and then into her muscle once she could no longer find the veins.When she sought treatment for her addiction and her injury, doctors had to amputate her left arm below the elbow.Nine months later, Tabor is still recovering from her addiction and her amputation.She is learning how to use an electronic prosthetic hand and reconnect with her three children, including a five-year-old boy who didn't know her mother before she took drugs.Tabor is interested in resuming her career in customer service and training as a peer counselor like those at Voices of Hope, who provided her with clean needles and eventually helped her get treatment.April Tabor photographed on May 22, 2022 in New Castle, Delaware.(Vincent Alban/Baltimore Sun)"It seems pretty straightforward," Tabor said."But no matter how long or short you've been doing it, it always seems like an impossible journey until you get it."Ed Sisco, a chemist who heads the testing project at NIST, wants to give Tabor and Bienert all the information in the hope that he can help.The lab supplies the high-powered equipment to the State free of charge, and the Maryland Department of Health pays the bill for shipping the envelopes.Officials say conventional drug labs can't provide the same information.The NIST lab only accepts smears from drug containers;the bags that traffickers wrap in drugs and needles are considered dangerous and pose transportation problems.Sisco said the lab rarely finds heroin anymore, identifying instead increasingly potent forms of fentanyl such as fluorofentanyl, methamphetamine, cocaine and other synthetic stimulants known as bath salts.The lab has so far tested about 600 samples from Maryland dispensaries.It only takes a minute or two, although the response time depends on the delivery of the incoming mail.Anonymous results are dumped into a spreadsheet by location for all participating programs to view.“We can get the information to them quickly,” Sisco said."We can start to provide information about new or more powerful compounds, so that resources can be moved or it can be alerted that there is a new substance on the street."Federal and state officials are studying how to further reduce response time and expand use of the program inside and outside of Maryland, or even get portable lab equipment into the field.That would augment other programs, such as those that distribute simple test strips that identify fentanyl and an alert system in Baltimore City that sends text messages to vendors and users about a suspected defective batch.That information comes from emergency services that don't know precisely what is causing the overdoses they treat.“There are different combination agents and that is something that no one looks at,” Sisco said.“It turns out that information is almost as valuable as the drug information we were looking at.”The state plans to do an analysis to understand how useful the information is to providers and users, said Robin Rickard, executive director of the Maryland Opioid Operational Command Center.But he already believes that knowing what's in the drugs at any given time can have an impact.Officials can, for example, make sure resources are going to the right places, such as ensuring that naloxone is widely distributed in areas with deadly fentanyl.Also, he said, some users may calibrate their dose if they know they have stronger drugs, or at least prepare for the results.With xylazine, she and Bienert advise users who don't stop taking xylazine-containing drugs to use it less, avoid open wounds and seek care for wounds.“It became clear that we needed a way to understand the unpredictable drug market, instead of getting information after someone died,” Rickard said.“If we knew what was out there, we could help people before they overdose.”The program is part of a comprehensive strategy that includes education, treatment and recovery resources, as well as law enforcement.Rickard said the overdose data is still being analyzed, but he expects it to show a slight drop in deaths statewide by the end of 2021.“We need everything in the toolbox,” he said.