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Drugs cut with xylazine create new overdose risks

Monitor staff
Published: 11/25/2021 11:00:28 AM
Modified: 11/25/2021 11:00:12 AM

While new national data shows an increase in overdoses over the last year, partly due to fentanyl-laced drugs, New Hampshire harm reduction advocates say that substances cut with hard-to-detect tranquilizer xylazine present new dangers for drug users.

Last week the Centers for Disease Control released data estimating that 100,000 Americans had died of drug overdoses between May 2020 and April 2021, an almost 30% rise in deaths from the previous year. Experts attribute the increase to the isolation of the pandemic and a more dangerous drug supply.

Locally, advocates have seen worrying new trends in the last two to three months that suggest overdoses are becoming more common.

The state tracks overdose deaths, but those numbers lag by about a month, which harm reduction advocates say is too late for drug users to become aware of increased danger. There have been 201 confirmed overdose deaths in 2021 as of Sept. 16, according to the New Hampshire Drug Monitoring Initiative.

Concord Coalition to End Homelessness Executive Director Ellen Groh said that anecdotally, her organization has seen a recent increase in overdoses among homeless clients. The Coalition trains its Resource Center staff on using naloxone, known as Narcan, which can reverse opioid overdoses.

Self-reported data collected at syringe exchange sites in Concord, Manchester and Strafford County run by the New Hampshire Harm Reduction Coalition shows participants reversed 701 overdoses between the beginning of July and end of September. During that time, 1,693 Narcan kits were distributed.

The Concord needle exchange site opened this summer in a lot owned by Next Level Auto. The NH Harm Reduction Coalition has a contract with the Department of Health and Human Services to run the sites, where drug users can learn how to prevent overdoses and exchange used needles for clean ones to prevent the spread of diseases.

Syringe exchange sites are one of the tools of a harm reduction approach, which aims to educate drug users on safety and keep participants alive even before they are ready to be treated for addiction.

People who use services at the syringe exchanges run by NH Harm Reduction have been reporting more overdoses to staff. “We’re hearing a substantial uptick in overdoses experienced and reversed by participants,” Executive Director Lauren McGinley said.

Xylazine, a large animal tranquilizer not safe for human use, is partly to blame. The veterinary sedative has not been studied extensively in humans, but a 2014 literature review in Forensic Science International suggests that it may increase deaths when mixed into drugs.

University of New Hampshire Assistant Nursing Professor Kerry Nolte said that the combination of two sedatives fentanyl and xylazine is leading to overdoses. Nolte, who is also a family nurse practitioner, has seen more synthetic fillers with similar negative effects showing up this year.

“The biggest concern is, with fentanyl or whatever version of synthetic opiates, the potency is always variable,” she said. “If someone takes this amount of drug today or tomorrow one could result in a drug overdose and one could not.”

Some of the symptoms she has heard include tremors and confusion, as well as episodes that participants describe as “seizures” but that don’t fit the medical definition.

Unlike fentanyl, which can be tested for with strips available at syringe sites, xylazine can’t be identified outside of a lab. Narcan is also ineffective in halting an overdose from xylazine. “This is a time that rescue breathing might be the thing that keeps people alive,” McGinley said.

There are preventative steps which NH Harm Reduction advises people to take, including never using alone, testing a shot first and going slowly. A hotline called Never Use Alone provides an extra layer of protection for people who use alone and want to reduce the risk of overdose.

New Hampshire, unlike states like Massachusetts, lacks a drug-checking program where people can have drugs analyzed. That kind of routine testing, as part of a robust public health infrastructure, allows for more useful, up-to-date information on the status of the current drug supply.

“That’s critical to staying on top of these mini spurts of increases, of overdoses or unanticipated negative effects of certain substances,” McGinley said.

Her organization is seeking out funding and support to start a drug-checking program in New Hampshire.

“We think it’s one of the more critical elements of identifying the major harms that could exist for the people who use substances,” McGinley said. If such a program existed, participants could bring in a sample of a drug as small as a grain of rice to a harm reduction site to find out what’s really in those drugs.

The website DrugsData.org offers a look into the results of drugs tested around the world, including in neighboring states, showing the kind of real-time information drug-checking could provide.

Nolte said from her perspective as someone working to protect the safety and health of people using drugs, prioritizing enforcement can have deadly consequences for people in the throes of addiction.

“One thing we always see is when big drug busts happen in the state, unfortunately that doesn’t end the supply of drugs or end people’s dependence on them,” Nolte said. Instead, a different supplier takes over, shifting the supply to a new, unpredictable source of drugs.

“We fund the enforcement, but we don’t really fund the harm reduction support services to come behind and say ‘hey, we know supply in this area is changing. Here’s naloxone. We care about your health and safety,” she said.


Cassidy Jensen bio photo

Cassidy Jensen has been a reporter at the Monitor, covering the city of Concord and criminal justice, since July 2021. Previously, she was a fellow at the Toni Stabile Center for Investigative Journalism at Columbia University, where she earned a master's degree. Her work has been published in Documented, THE CITY, Washington City Paper and Street Sense Media. When she's not at City Council meetings, you can find her hiking in the White Mountains.



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