Xylazine, or “tranq,” that makes fentanyl even more lethal is hitting the streets of Chicago, and Narcan won’t save those who use it

GARFIELD PARK Fentanyl’s death surge in Chicago has begun to slow, but the rise of another drug, xylazine, has officials worried that opioid deaths could skyrocket again.

Chicago had the most fentanyl-related deaths in 2022, with the drug largely responsible for a spate of fatal opioid overdoses in recent years linked to 1,307 deaths in the city last year, up from 1,289 in 2021, according to doctors Cook County Lawyers Office.

Fentanyl-related deaths have skyrocketed during the pandemic, leading to a record 2022 number, but that rise is starting to slow, though deaths remain high, officials said. There have been at least 391 fentanyl-related overdoses in Chicago so far this year, up from 669 in the same period of 2022.

Blacks and Latinos in Chicago were disproportionately affected by the fatal overdoses.

Sarah Richardson, of the behavioral health team at the Chicago Department of Public Health, said the steady numbers are an encouraging sign. Growing public awareness of opioid overdoses and understanding of addiction are helping, as is the more widespread distribution and use of Narcan, which can reduce fatal overdoses, Richardson said.

Harm reduction is recognizing that everyone’s life matters and we will do everything we can to keep you alive and safe, Richardson said.

Local officials and groups have worked to reduce opioid overdoses by trying new approaches: Chicago public libraries distribute Narcan, people leaving the Cook County Jail are given harm reduction kits, the health department fentanyl test strips, and the CTA has a Narcan vending machine coming at its 95th Red Line station.

But the emergence of xylazine, also known as a sedative, has Richardson and other officials worried.

Xylazine, a sedative commonly used in horses, is being used more often to cut fentanyl, with the Biden administration calling it an emerging threat last month.

And xylazine is immune to the effects of Narcan, which can make it more difficult to resuscitate people who overdose.

Xylazine is creating the deadliest drug threat our country has ever faced, fentanyl, even more lethal, said Anne Melissa Milgram, administrator of the Drug Enforcement Administration, in an agency public safety alert.

In the Midwest, the number of xylazine-related overdose deaths rose from 57 in 2020 to 351 in 2021, a jump of 516%, according to the DEA.

There have been 39 xylazine-related deaths so far in 2023 in Chicago, and there were 167 such deaths in all of 2022, according to data from the Cook County Medical Examiners Office.

Fentanyl has gained popularity in recent years because it is cheaper to produce and offers better profit margins than heroin, even though it presents more dangers for the people who use it. A trace of fentanyl the size of a pencil tip is enough to be fatal, DEA spokesman Luis Agostini said, and the addition of xylazine makes the product even more potent at a more affordable price.

There is no respect for human life from retailers and distributors, but we understand they are business minded when it comes to making a profit, Agostini said. This really crosses all the demographic and socioeconomic factors because fentanyl is in every type of drug out there.

Richardson and Lee Rusch, director of the West Side Opioid Task Force, said the West Side is the largest center of drug-related deaths in Chicago. Richardson said years of economic divestment and systemic racism with no social safety net have made the opioid epidemic hitting these neighborhoods hardest.

Rusch said the task force has taught more than 6,000 people to administer Narcan safely and has seen people using it to keep themselves alive and to keep each other alive.

Rusch said Narcan is still worth using to try to reverse an opioid overdose, even if the person who overdosed was using a drug mixed with xylazine.

And Rusch and others think that building more programs focused on harm reduction, normalizing Narcan use, and scaling up social services like housing and job assistance could stem the surge in fentanyl and xylazine use and dead.

We see people training their friends to reverse overdoses to save a life, Rusch said. But we’re doing more than just training to save a life. Let’s see what comes next.

State Representative Shawn Ford said further testing at harm reduction sites for the drugs’ potency or the presence of xylazine could save lives.

It’s too risky to keep going down the road to tell people they should just say no,” Ford said. We need to put people in a safe place when they use, they can prevent a fatal overdose. We really need to do everything we can to step up harm reduction.

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