“I’m not usually one that runs to sound the alarm on things, but this is concerning to me,” said Michael Dulitz, opioid response coordinator at Grand Forks Public Health.”
Though drug overdoses declined significantly in Grand Forks last year, public health officials are concerned that xylazine-laced fentanyl may cause a spike in 2023 overdoses.
There were 38 reported drug overdoses in 2022, according to data from Grand Forks law enforcement and the fire department. This is more than a 45% decrease from 2021, when there were 71 reported overdoses.
Additionally, fatalities declined from 11 in 2021 to eight in 2022.
“I think that’s primarily based on the accessibility of naloxone,” said Michael Dulitz, opioid response coordinator at Grand Forks Public Health.
As naloxone – known also by the brand name Narcan – becomes more accessible to the public, overdose victims can receive a dosage of the treatment before emergency personnel’s arrival.
“[Naloxone is] getting administered sooner, so it’s not necessarily requiring a trip to the hospital for people who have returned to, kind of, their normal state,” said Dulitz. “… We’re actually at the lowest number of overdoses in the emergency department at Altru since 2014 or 2015.”
However, new concerns arise as cases of fentanyl laced with xylazine appears in 48 states, according to the United States Drug Enforcement Administration.
“I’m not usually one that runs to sound the alarm on things, but this is concerning to me,” Dulitz said.
Xylazine is a depressant not approved for human use. It is used on large animals as a tranquilizer. Many issues were reported when the drug was tested on humans – including hypotension and vasodilation, according to Dulitz. When a depressant (such as xylazine) is combined with an opioid (such as fentanyl), it has a cumulative effect.
“That can increase the chances for an overdose – and potentially an overdose that is very difficult to reverse,” Dulitz said.
Dulitz said a xylazine overdose is “a lot more complex” than an opioid overdose.
Generally, someone experiencing a xylazine overdose has to go to the hospital, where they receive more supportive care than necessary for an opioid overdose. Dulitz said supportive care may include managing breathing and administering different types of medications.
“That isn’t typical at all of what we see with an opioid overdose,” Dulitz said.
Though xylazine overdoses cannot be treated with naloxone, a suspected opioid overdose should initially be treated the same, regardless of whether xylazine might be present.
In veterinary medicine, there is a reversal agent for xylazine, so Dulitz is hopeful a reversal agent for humans will soon become available. However, he suspects it’s unlikely the reversal agent would be as “simple” as naloxone.
“It would be something that would probably be limited to the hospital,” Dulitz said.
Dulitz doesn’t have concrete evidence of xylazine appearing in illicit substances circulating through the city, but he has suspicions based on reports from the local syringe service program.
Though a number of drugs have been reportedly laced with fentanyl, fentanyl has become increasingly common on its own.
“Based off of economics, it made more sense to make fentanyl the most commonly available opioid,” Dulitz said.
Those addicted to fentanyl, or other illicit drugs, have no way of knowing what they are actually taking.
“There’s no control over what somebody puts in a substance,” said Dulitz. “… They may be marketing it as just the regular fentanyl, or a regular opioid of any nature, and then they’re adding [xylazine] in on the back end. … If you’re dependent on the substance, it’s not like you have a lot of choice … when you’re having to go into an illegal market to get it.”
When someone is familiar with fentanyl and believes it to be the only drug they’re ingesting, they will be unprepared if they come into contact with xylazine.
“Once xylazine kind of gets a hold of the community, we’ll probably end up seeing an increase in [deaths] related to opioid use, which will be really difficult,” said Dulitz. “… We saw a peak in 2021 related to fentanyl pressed pills, and now we kind of got that under control in 2022. … A potential spike again certainly concerns us.”
On Monday, April 3, Grand Forks Public Health received its first box of xylazine test strips, made by the same company that manufactures fentanyl test strips.
Dulitz said they will be available at the Grand Forks and Fargo syringe service programs, and might be available in others across the state.
The strips are “kind of expensive,” at $2 per test, but Dulitz said it’s really a “small price to pay to save lives.”
“That’s my sincere hope … that we can prevent anyone from dying from this in the community,” Dulitz said.
Tags: Fentanyl Naloxone Opioid Epidemic Overdose Xylazine
