The city of Philadelphia has been struggling for several years with a new substance with devastating effects: xylazine. Nicknamed the “zombie drug,” it plunges people who consume it into a prolonged state of unconsciousness, in addition to creating strong dependence and irreversible physical damage. The duty went there to document the social impact of this drug, which is starting to make its way into the country. Last of five texts.
“Get ready, because it’s impossible to stop,” warns Dr. Monika VanSant, who works in addiction and wound care in Philadelphia, where xylazine is wreaking havoc. “Make sure you have the resources in place,” adds his colleague Nakomo Finnel. And if it doesn’t hit like it hit here, at least you’ll be prepared for everything else. »
Xylazine, a powerful horse tranquilizer commonly known as tranq “, or “zombie drug,” is present in 90% of drug samples tested by public health authorities in Philadelphia, causing overdoses to skyrocket and forcing field workers to treat wounds that often lead to death. amputation.
In Montreal, we are still a long way from such prevalence. But xylazine is indeed present. “Yes, xylazine circulates in Montreal, we’ll tell each other,” confirms the DD Carole Morissette, medical consultant in STBBI prevention and reduction of drug-related harm at the Regional Public Health Directorate (DRSP) of the metropolis. “But in reality, the prevalence of its presence is stable or even decreasing. »
In March 2023, the DRSP of Montreal launched a “call for vigilance” to its partners in the health network to inform them of “significant exposure to xylazine among people who use drugs in Montreal” which increases the risk of overdose.
With her team, the doctor analyzed urine samples collected in the fall of 2022 from 300 drug users. This was the first time xylazine appeared on their radar. Among the samples tested, 5% contained it, concomitantly with fentanyl or a derivative. “But when we looked at the people in whom we had detected fentanyl, there were 29% of these samples which also contained xylazine,” specifies the DD Morissette.
She repeated the exercise in the fall of 2023. This time, 4% of urine samples contained xylazine, and 19% of samples from fentanyl users. “We have a small reduction. We cannot say that it is statistically significant, but in any case, there is no increase, then we could speak of a slight decrease,” she says. The DD Morissette agrees, however, that the study has limitations that must be taken into account — which is why it is important, she reminds, to have other sources of data.
In all cases, none of the participants reported having used xylazine, which indicates consumption without their knowledge. “There is no such thing as someone who says they are thinking of consuming xylazine. We didn’t see that. »
Very present in Ontario
In Canada, xylazine was first detected in 2001 by Health Canada’s Drug Analysis Service. “But it only began to emerge in 2019,” writes the federal ministry in a summary document on the emergence of xylazine in Canada published in 2023.
Since then, its prevalence has increased exponentially. In 2018, the analytical services noted five samples containing xylazine. This number increased to 205 the following year. In 2022, we were talking about 1,350 occurrences. The majority of samples containing xylazine came from Ontario (63%), followed by British Columbia (21%) and Alberta (13%). A little more than 2% came from Quebec.
“We cannot compare the situation in Ontario with that in Montreal,” assures the DD Morissette. And [la situation au] Canada certainly does not compare with what is happening in Philadelphia. »
No reports at the moment
The Montreal DRSP nevertheless takes the situation very seriously and is constantly monitoring developments. In her call for vigilance, she requested the collaboration of clinicians and organizations in the health network by calling on them to keep an eye open and to “report as soon as possible any suspected case of overdose” resembling a combination fentanyl and xylazine. “We have not had, until now, any reports showing an increase in this type of picture,” explains the DD Morissette.
Teams working in the field are also paying attention to the appearance of necrotic wounds typical of xylazine, which can be seen in Philadelphia. Again, there have been no reports to this effect. “We don’t currently have one. [de plaies causées par la xylazine], and I would add: we don’t want it. »
“Our entire network is well informed as concerns arise about new substances. Then if we had observed any increase in xylazine, we would certainly have paid particular attention to communicating this information. »
More and more toxic mixtures
What worries her above all, she repeats, is not so much the presence of xylazine, but of all the “new substances” in “complex mixtures” which have invaded the illegal drug market. , “extremely dynamic” since the arrival of fentanyl in the summer of 2020. “It’s not just xylazine that worries us, it’s really this set of drugs, complex mixtures,” says the doctor.
“It’s really a challenge, because we’re seeing not just fentanyl arrive, but several increasingly powerful fentanyl analogues. We are also seeing the arrival of nitazenes, which concern us as much, if not more, because these complex mixtures carry enormous risks of death and overdose. »
She remembers a meeting with her counterparts from Toronto and Vancouver held not so long ago, just before the pandemic. “You could say that at that time, Montreal was quiet compared to other cities. And everyone told us: “Get ready, because when fentanyl arrives, the situation changes completely. We’re seeing an increase in overdoses, an increase in deaths.” And indeed, this is what we witnessed. »
Fortunately, she said, Public Health had prepared for it — through the distribution of naloxone, in particular — which prevented the number of deaths from increasing at the same rate as the number of non-fatal overdoses. “Where it is a challenge is to ensure that we deploy the right interventions at the right time so that the response has the necessary intensity to ensure the protection of the population. That’s really a challenge. But the current level of intensity appears to at least prevent deaths. At least. »
This report was financed thanks to the Transat-International Journalism Fund.The duty.