Today’s drug and overdose epidemic is at a peak, with over 100,000 people dying of overdose in 2021 alone. Today, those statistics are more-often being linked to the presence of other illicit substances in heroin and fentanyl – namely benzodiazepines or benzos in Canada and the midwestern United States and a veterinary tranquilizer known as xylazine on the east coast in the United States.
While these additives aren’t the sole culprits of the overdose epidemic, data increasingly shows they contribute significantly.
In fact, of the 71,238 overdose deaths caused by synthetic opioids including fentanyl and its analogues, an estimated 31% of fentanyl overdoses involved xylazine in 2019. These synthetic drug ‘cocktails’ are also far from new. In one 2012 study, 1 in 5 fentanyl related overdoses involved xylazine. But, with some assessments showing that it’s more likely for street heroin and fentanyl to contain xylazine than to not, the problem is growing, and danger of exposure is increasing for many.
Benzo dope is a mix of benzodiazepines, which are a tranquilizer that effect the body-regulating GABA system of the brain, and an opioid – namely heroin or fentanyl. While not yet extremely common in the United States, benzo dope represents more than half of all fentanyl samples brought into Toronto’s free drug testing sites. In addition, most samples contained other drugs, with caffeine, Flualprazolam (a benzodiazepine), Bromazolam (a benzodiazepine), etizolam (a benzodiazepine analogue), and xylazine (a sedative used on horses) being the most common.
While benzodiazepines are often issued as a prescription drug, they interact with opioids in new and unexpected ways. Largely, they greatly increase the risk of overdose and cause a separate type of overdose than opioids. For example, while an opioid overdose normally lasts 10-20 minutes, benzodiazepine overdoses can last for hours. Plus, traditional opioid overdose reversal drugs like Naloxone have no effect on benzodiazepine overdose. Instead, many people go into overdose, the Naloxone does nothing, and the individual starts to go into opioid withdrawal while still suffering from the benzodiazepine overdose. A blood test can take days to process, meaning emergency rooms won’t always know what they’re treating until it’s too late.
Benzodiazepines are also more sedative, that means heavy users are more likely to be sedated into presenting a danger to themselves. For example, a person heavily sedated on benzos can walk into traffic, off of stairs without walking down them, or pass out on the street. This puts them at higher risk of personal harm as well as at increased risk of violence and sexual violence. This makes benzo dope significantly more harmful than “pure” heroin and fentanyl, despite the fact that pure heroin and fentanyl now make up less than 10% of the available supply of drugs. In fact, in British Colombia, benzo dope was responsible for 30% of all overdose deaths.
Tranq or tranq dope is increasingly common on the east coast in the United States. This ‘opioid cocktail’ blends heroin or fentanyl or one of their analogues with sedatives including xylazine. Often, these mixes include heavy doses of caffeine to offset some of the tranquilizing effects – with some seizures being as much as 30% caffeine by weight.
Xylazine contaminated heroin was first reported in the United States in 2002. Since then, it’s come to represent as much as 65% of the available fentanyl supply, depending on region, and is estimated to account for 30-50% of all synthetic-opioid related overdoses. Heroin and fentanyl adulterated with xylazine are stronger, more sedative, and more addictive. But, unlike benzo dope, xylazine contaminated opioids are less safe for human consumption and can cause severe glycemic reactions including hypoglycemia – as xylazine interferes with insulin’s ability to regulate glucose and the body’s ability to absorb glucose. This is assumed to be behind significant health problems seen by users of tranq dope, with finger and toe amputations, severe skin ulceration, and reduced oxygen in the fingers, toes, and skin.
In addition, while heroin and fentanyl overdose normally lasts under an hour, xylazine overdose symptoms can last 8-72 hours. Unfortunately, with no known xylazine agonist or antidote, xylazine overdoses are almost always fatal, although the drug yohimbine can reverse the effects of xylazine if taken shortly after the dose. Most importantly, because fatal doses range between 40 and 2,400mg depending on the person, the purity, and the individual, it’s difficult to get a safe dose – especially when you don’t know what is in the dose you took.
While benzo dope and tranq dope are nothing new, they’ve been in Puerto Rico since the 1990s, they are representative of a dangerous new trend in street drugs. Tighter controls on fentanyl and fentanyl analogues, more difficulty sourcing fentanyl from China, and significantly tighter controls on prescription opioids are forcing drug makers to experiment, to add new chemicals, and to change the chemical profile of the drug they’re working with to make it “legal”. The result is that most drugs on the street are not pure fentanyl or heroin. Instead, they’re a cocktail of synthetic tranquilizers and opioids, which have not been trialed, tested, or controlled in any way. The results can be extremely addictive, extremely dangerous, and can cause side effects in unpredictable ways – such as tranq dope resulting in amputations.
Today, drug safety experts are increasingly calling for safe drug using areas and drug testing areas, where people can have illicit drugs tested. At the least, this allows medical professionals to be able to respond quickly and with the right medication in case of an overdose.
If you or a loved one is using, it’s important to source drugs carefully, to try to stay away from tranquilizer contaminated opioids, and to get treatment if and where possible. With fewer pure drugs on the market, using is becoming more and more dangerous. At the same time, simply quitting and going “cold turkey” isn’t enough to combat behavioral problems, cravings, and the underlying problems behind the addiction. People who just quit on their own very often relapse and are at more danger of overdose because they’ve lost tolerance. Seeking out drug addiction treatment, complete with behavioral therapy and counseling, as well as any treatment for underlying mental health problems, is an important part of the process of getting clean and staying that way.
Asana Recovery provides a full continuum of highly effective drug rehab and alcohol rehab programs. If you have questions for yourself, or your loved one, contact us today to speak in complete confidence with one of our experienced and caring addiction treatment team.