We’re talking about fentanyl and xylazine all wrong

Xylazine, sometimes called tranq, is an animal tranquilizer that has infiltrated the fentanyl supply in the United States. Earlier this year, the Biden-Harris administration designated fentanyl laced with xylazine as an emerging threat to the nation. This designation — which has never been used before — will allow for new research and resources to reduce the impact of xylazine, in addition to a concentrated effort to improve treatment strategies.

But the attention has also generated a great deal of media coverage — both for the way that fentanyl laced with xylazine has complicated treatment for patients with opioid use disorder and for how the drug is associated with serious skin wounds.

While this attention is sometimes helpful to amplify the risk of xylazine, I can’t help but feel — as an emergency room doctor — that we’re going about this the wrong way. Much of the language and images we use to discuss fentanyl and xylazine can further stigmatize the individuals who suffer from addiction.

It’s easy to sensationalize and dehumanize people with opioid use disorder as “zombies,” or to show images or videos of people under the influence of opioids. Similarly, it is common for reporting to focus on individual drug users and their wounds, including those who have suffered amputations.

Words are powerful, and so are photos. While some might argue that sharing images of the consequences of opioid use may deter others from using drugs, the well-intentioned thought is misguided. Doing so can alienate an already vulnerable population suffering from one of the deadliest chronic illnesses to plague our country. I also worry that it deters individuals from seeking medical attention for fear of judgment or poor treatment.

Drug use is not a problem that can be reduced to one individual alone.

Since 2019, heroin has been gradually supplemented and displaced by fentanyl, which is 50 times more potent, less expensive, and more deadly. Doses of fentanyl on the street are highly variable. This increases the risk of overdose, often with deadly consequences. In 2021, 71,238 of the 80,816 deaths from opioid overdose were from synthetic opioids, primarily fentanyl.

People with drug addiction are unable to control their cravings and tend to use whatever is available, including fentanyl mixed with xylazine. Less harmful options don’t exist, especially in Philadelphia, where the drug supply is 90% adulterated with xylazine. According to the U.S. Drug Enforcement Administration, xylazine was initially diverted from veterinary supplies and is now also imported from China.

Interrupting the supply of xylazine is one solution, but disrupting demand by using xylazine test strips can be effective, too. Although we know patients are being exposed to fentanyl-xylazine combinations in Philadelphia, the clinical overdose patterns are indistinguishable, and testing is not widely available.

The experiences of people who use opioids are particularly helpful in informing how we speak about and address the threat of fentanyl and xylazine. In a recent study published in the Journal of Addiction Medicine, I worked with my study team to analyze Reddit posts in drug-related communities for discussions about xylazine and then surveyed Redditors for additional insights. Due to its anonymity, Reddit and other social media sites can be useful tools to gather information on sensitive topics.

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From our surveys, we found that 75% of people exposed to xylazine do not seek it out. Many described that xylazine worsens their fentanyl withdrawal symptoms and makes treatment with highly effective medications (such as buprenorphine) more challenging. Participants also reported skin wounds that occurred whether they injected the drug or used it through the nose.

The people most impacted by xylazine are rarely those whose voices we hear. Rather than stigmatizing individuals who use drugs, it’s more important to offer care in nontraditional settings, such as overdose prevention sites, that can help direct patients toward prevention and treatment strategies.

There are some ways to mitigate the dangers of fentanyl laced with xylazine, including the use of xylazine test strips and being familiar with drug-checking websites and harm reduction organizations such as Savage Sisters, which provide education, wound care, and wound care supplies. These organizations are also aware of what is in the local drug supply.

Narcan is highly effective in reversing overdoses and should continue to be widely offered and distributed. Despite all the attention on xylazine, fentanyl is still the driver of fatal overdoses. Highly effective treatments such as buprenorphine and methadone are available, but only about 11% of people with opioid use disorder receive these medications.

Rather than stigmatizing people living with addiction, the most important thing we can do is encourage and support people on their journey to recovery.

Jeanmarie Perrone is a professor of emergency medicine and director at the Center for Addiction Medicine and Policy at the Perelman School of Medicine at the University of Pennsylvania.