The Charleston County Coroner’s Office (CCCO) began finding an unusual drug in autopsies of 2020 overdose victims: a commonly used veterinary sedative called xylazine.
The drug was present in six county-wide deaths that year. In 2022, that number had increased to 38 — a 500% jump over two years.
Since January, there have been 18 xylazine-related deaths, but the number may grow as results of pending investigations arrive. The county, said Forensic Analyst and Deputy Coroner Dr. Suzanne Abel, is on track in 2023 to reach 2022’s number of overdose deaths — and perhaps exceed it.
- Related, 10/5: Charleston coroner says overdose deaths jump 15% in county
‘Zombie drug’
Xylazine, which goes by the street name “tranq,” is also known as the “zombie drug.” A quick search through Google will yield countless graphic photographs of one particularly chilling side effect — rotting, wounded skin.
Xylazine can act as a central nervous system depressant, according to the U.S. Drug Enforcement Administration (DEA). It mimics the effects of many opioids.
“It’s an adulterant,” Abel said, and “it increases the duration of the high” when mixed with a stimulant like cocaine or an opioid like fentanyl. But Marc Burrows, president of the South Carolina Harm Reduction Coalition (SCHRC), said it hasn’t really seen anyone using xylazine for these reasons — or intentionally at all.
“Xylazine doesn’t seem desirable,” he said. “It’s a way for cartels to be able to traffic lesser amounts of fentanyl. It can kind of trick the user a little bit to make it seem like it’s a stronger opioid.” Cartels do this because xylazine is cheap and easier to get than fentanyl, Burrows told the Charleston City Paper. Abel added it’s not a controlled substance — even though the DEA is working to make it one.
Burrows warned against this prohibitive strategy, however, citing it as contributing to the ongoing drug epidemic: “This is what happens when you squeeze down and put pressure on the drug supply.”
He spoke of how the DEA pressured doctors to stop prescribing painkillers at the height of the opioid crisis, with “no contingency plan.” This move, Burrows added, forced countless opioid-dependent patients to find their medication elsewhere, often on the street due to cost and access — a much riskier endeavor. For example, Burrows said, fentanyl is not harmful when prescribed with safety precautions for severe pain by an experienced medical provider, but “unregulated fentanyl is what kills people.”
Testing drug compounds
So what’s next? “Anytime there’s something like this, the hardest part is getting places to test for it,” Burrows said.
Charleston County is ahead of the curve, according to Abel, because it “was one of the first counties in the Southeast to document the presence of xylazine in toxicological analysis.” Still, xylazine deaths are “criminally underreported,” especially in counties that may not be as well-funded as Charleston, she added.
Test strips are another way of identifying xylazine-positive drug compounds, Burrows said, but only about “four groups across the state have been [distributing them] slowly in the last couple months.”
“Xylazine overdoses present a challenge primarily due to the scarcity of toxicology data related to overdose survivors,” said Charleston County Police Department spokesperson Anthony Gibson. “Furthermore, as xylazine is not classified as an opioid and is unresponsive to Narcan, we typically lack specific information on xylazine-related overdoses that do not result in fatalities.”
Chanda Funcell, director of an addiction treatment facility named Charleston Center, said the organization is finally getting the support necessary to distribute test strips alongside Narcan (generic name, naloxone) — a medication administered to someone showing symptoms of an opioid overdose — to patients.
Even though Narcan doesn’t reduce the effects of xylazine, it should always be administered in the event of a suspected overdose, Funcell said, because the substance ingested often also contains an opioid. In August, the Charleston County Emergency Medical Services began a “Leave Behind” program, which equips family members and friends of overdose victims with Narcan and trains them how to use it.
Overdose prevention and harm reduction
Burrows said he wants to see the conversation move beyond xylazine testing — and toward the question of “Now, what do we do?”
One strategy is looking at the root of the issue. Drug use is predicated by social determinants of health, Abel said, which include education access, support system, family life and medical care, including mental health.
Harm reduction messaging — including drug user health education, Burrows said — is also extremely important. It might look like xylazine-specific safety tips and overdose prevention, Burrows told the City Paper. For instance, because xylazine often results in heightened drowsiness, an individual should try to avoid using before getting behind the wheel and ensure proper blood circulation.
Another essential harm reduction mechanism is accessible medical care for users who might develop soft tissue wounds, Burrows said. He also recommended drug-checking, which is when users will “take a sample of the drug supply” and send “to a laboratory to … to see what’s actually in [it]. It’s really empowering for the user and the community” to make informed decisions.
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