An opioid addict for years, Martin, 45, has already seen the deadly and addictive fentanyl replace heroin in New York. He now also wants to avoid falling into the trap of “tranq”, a cocktail of substances that can cause horrible wounds on the skin and complicate overdoses.
“It’s not a good experience, it makes holes in your body, in your skin,” breathes Martin, his voice sometimes trembling, during a visit to St. Ann’s Corner of Harm Reduction, an association of aid and needle exchange open since 1990 in the borough of the Bronx.
He himself keeps traces of wounds on his legs or arms. A sign that he was able to inject himself without his knowledge of xylazine, also called “tranq”, and whose wounds, which can eat away at the skin and turn black, appear elsewhere than in the injection zone.
“It eats the flesh, like a crocodile,” loose Martin, who does not wish to give his name.
Sedative for animals
Xylazine, an animal sedative, is not approved for human use by the US Drug Administration (FDA), but it has entered the volatile, designer-dominated US illegal drug market. Until being designated an “emerging threat” by the White House last April.
Easily accessible on the Internet, it is very often coupled with fentanyl, the synthetic opioid 50 times more powerful than heroin, which has caused the number of fatal overdoses to skyrocket in the country, to nearly 110,000 in 2022. , a record.
According to data from the Centers for Disease Control and Prevention (CDC), the estimated number of fatal overdoses in which xylazine is involved rose from 260 in 2018 to 3,480 in 2021 in the United States. If Philadelphia is the epicenter of the “tranq”, New York is not spared: 19% of opioid overdoses, or 419 deaths, also involved xylazine in 2021, according to the city.
“Fentanyl is a short-acting opioid that people need to use more often” to avoid cravings, Courtney McKnight, assistant professor of clinical epidemiology at the School of Global Public Health, told AFP. New York University.
“The hypothesis is that the xylazine was added to extend the life of the fentanyl. But the side effects are very important, ”she adds, citing “very strong” symptoms of anxiety in the event of a withdrawal.
“KO”
Martin tries to avoid this cocktail, because “it knocks you out” for hours.
“It’s hard, but what do you want to do when you’re addicted? “, he lets go.
The wounds caregivers at St. Ann’s Corner of Harm Reduction see more and more often as they take their vans out into the streets of the Bronx to bring medical supplies, clean needles, fentanyl tests, food, or just some advice and words of comfort to people in extreme difficulty.
“Often people say they appear as little bruises or black marks, and then it’s like the tissue is dying in the affected area,” says Jazmyna Fanini, a nurse at St. Ann’s. For her, there are still many unknowns around these necroses.
In a photo she took herself in the field, a patient’s skin shows numerous, sometimes deep, wounds. “Wounds can get worse, to the bone […] Sometimes people need an amputation or a skin graft,” she adds.
Isolation
The United States is already overwhelmed by the opioid crisis.
In St. Ann’s, an image catches the visitor’s eye: a paper tree is pasted on a wall and each leaf represents a loved one lost to an overdose.
In New York City, driven by fentanyl and the pandemic, which has increased risk due to the isolation of drug users, the number of fatal overdoses has increased to 2,668 in 2021, 80% more than in 2019, with higher rates in the Bronx and for African American and Hispanic populations.
The city and the associations are going all out on naloxone, a nasal spray that serves as an antidote in the event of a fentanyl overdose. But by slowing breathing and heart rate, xylazine further complicates the situation.
Authorized for animals, the product does not have the status of “controlled substance” at the federal level, as are hard drugs, which complicates the task of the investigators, according to the special prosecutor in charge of narcotics in New York, Bridget Brennan .
“We can keep an eye on it. But even if we found a large amount of it, we couldn’t sue someone for it” and therefore “not go back to the source”, she explains.
“To poison”
At St Ann’s, it is believed that the appearance of new mixtures stems from policies criminalizing drug addicts.
“We will continue to find all these types of substances until we address the real problem, which is not having safe merchandise,” explains team leader Steven Hernandez.
“In this situation, people are really poisoned,” he says indignantly.
The center participates in a New York City program that allows users to test their drugs for risk. The initiative should also enable the city’s health services to monitor changes in the illegal market in real time.
“It’s still possible to avoid xylazine, it hasn’t proliferated on the market,” says Leonardo Dominguez Gomez, a field investigator for the New York Department of Health. “How the city decides to deliver messages and conduct public health campaigns will impact the situation,” he adds.