Melanie Cole (Host): Tranq has been in the news a lot. What is it? We're going to get the facts on It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole and joining me today is Courtney Mattley. She's a Pharmacist Manager of Pharmacy Services at Henry Mayo Newhall Hospital. Courtney, I'm always glad to have you as a guest on the show.

Tell us what is Tranq or xylazine? Is this legal? What is it?

Courtney Mattley, PharmD: Hi, Melanie. Thanks so much for having me, especially about this topic that's, it's really on the news lately. So xylazine is the generic name or the chemical name of this compound, but, it's more frequently called Tranq, which is the street name. It's also called Tranq Dope. Some have actually called it the zombie drug because of its effects.

it is a non-opiate, so it's not a narcotic, but it is a very powerful sedative. It was actually approved in the 1970s for animal use, for veterinary use only. it was not approved specifically in humans because of its profound sedative effects and how much it affects our central nervous system.

So it's not safe to use in humans and it can have serious life threatening side effects that we'll talk about today. Some of those effects are similar to those that we see with opioid overdoses and opioid use, which makes it very hard to distinguish when there's an exposure to xylazine versus an opiate.

And what we're seeing now is that it's actually being mixed. So, when someone is usually exposed to Tranq, they aren't intentionally taking that. It's just part of something that was, given to them possibly on the street, mixed with something like fentanyl or heroin. And then it just potentiates the effects from those opiates making it even more dangerous.

Host: Something new. And I hadn't heard of this before doing this podcast, so I hope listeners feel the same and we're getting this great information. So what effect does it have? Tell us about those side effects.

Courtney Mattley, PharmD: The acute side effects, so when someone's actually has it in their system, the most profound is the sedation. And that sedation can lead to a really long period where someone just doesn't move. It's immobilization, which is why it's considered the zombie drug, on the streets, where people just can't move for hours and that can lead to other complications like muscle breakdown and things like that called rhabdomyolysis, which is also life threatening.

It can potentiate the effects of opiates. In most of these cases, it's mixed, which can lead to a higher risk of respiratory depression, which is the life threatening risk of opiate overdose. But something different specifically about this medication is that it affects the heart. And it can also lower blood pressure, called hypotension, and cause a very low heart rate as well.

Now that's just the acute effects. Long term, if somebody is doing this excessively, it has a very strange, that we don't really know why, but it can cause skin wounds, not just where someone may be injecting it, and it can actually cause these skin wounds if someone's taking this drug not even from injecting, which means it's having some sort of systemic effects on the skin, and it can lead to something as severe as needing an amputation even.

Host: Wow, how scary. And how is it used, Courtney? Is it injected all the time or is there an oral or snorted? What is it?

Courtney Mattley, PharmD: It can pretty much be taken any way that a fentanyl or heroin injection or inhalation or any route that, can be done. People get very creative, so it has a lot of different routes that it can be given. Anything that you can think of with fentanyl or heroin, this can be mixed with it.

Host: So, how prevalent is it? Is it easy to get? Is it easy to, obviously, overdose on, but are you seeing it a lot?

Courtney Mattley, PharmD: So most people don't even know that it's mixed with whatever they possibly are taking. The DEA did release a statement saying that they have seized fentanyl mixed with xylazine in 48 out of 50 states. So it's definitely widespread. They released a specific stat in 2022 saying that of all the fentanyl powder that was seized, xylazine was found in 23 percent of it, and of all the fentanyl pills that were seized, xylazine was found in about 7 percent of it, and that was a year ago, so, the numbers are probably even higher today.

Host: Now, it is approved for use in animals, right? So that's kind of where it started and now got integrated into the drug system here.

Courtney Mattley, PharmD: Correct. Yeah, what we don't know yet is whether, getting it on the streets is coming from people diverting it from the veterinary use, which it's legal to use for animals, but is it coming from that market, the veterinary market, or is it being made off market possibly in other countries and coming over to America as similar as fentanyl.

We're not really sure yet, but it's definitely scary that it's in a lot of our fentanyl and heroin on the streets and people don't even know it.

Host: What do you want us to know? What do you want us to do? Obviously, we don't want to be using those drugs and those illegal substances, but there are people that do and have addiction issues. What do you want them to know about the possibility that this zombie drug is mixed in with whatever drug they use?

Courtney Mattley, PharmD: Yeah, I think the scariest thing about this is that, the life saving reversal that I think everybody's heard of at this point called Narcan, that reversal agent that's used for opiate overdose and something that we use in the hospitals for opiate overdose when patients come in. Because of that, Narcan does not reverse xylazine, so we could potentially be trying to treat an opiate overdose with narcan and the patient will not respond because, Narcan does not reverse the xylazine drug. So that's very, very scary. At that point, we're just doing supportive care, possibly, intubating a patient and putting them on life support just to get them through the overdose.

But the Narcan won't help. So, because it is mixed with fentanyl and heroin, it's very important that people know that Narcan should still be administered, because if someone is overdosing, we still want to reverse the opiate. But it just may not have the success rate that we've seen with just reversing opiates by themselves.

Host: Well, thank you for bringing up Narcan because that's so important for people to discuss with their pharmacists or their providers to keep on hand. Really, really important. Give us your best summary about xylazine and what you want us to take forward from this.

Courtney Mattley, PharmD: Yeah, I think this is a new term we're going to be hearing more of. It's very scary that things are just being mixed with stuff on the streets. And, we don't have a way to reverse this medication right now, which is very scary. So ultimately, don't accept anything that you don't know what it is.

And hopefully, people are aware that this is something that's on the streets at this point and it just puts the risk of overdose even higher, which is really alarming considering the state that we're in already.

Host: You give us such great information, Courtney. Thank you so much for joining us today and telling us about this. It's pretty scary, but we have to be aware. We have to know these things. So thank you again for educating us today. The Substance Abuse and Mental Health Services Administration has a confidential 24-7 referral and information service for individuals and families facing mental or substance use disorders. The number is 1-800-662-HELP. That's 1-800-662-4357. You can also go to the free health information library at library.henrymayo.com for a lot of great information that you know that you can trust because we're all learning from the experts at Henry Mayo Newhall Hospital together.

That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. Please always remember to subscribe, rate, and review this podcast and all the other Henry Mayo Newhall Hospital podcasts. I'm Melanie Cole. Thanks so much for joining us today.