Fentanyl, Xylazine, Nitazene Raising the Risk for Teens

The DEA issued a national alert for the deadly drug Xylazine, an animal tranquilizer, that has entered the illegal drug supply. Sometimes referred to as tranq, the drug is paired with fentanyl in clandestine labs that mainly produce fake pills. Fentanyl is the drug that has been pushing the overdose death rate skyward to 109,000 in 2022. While Narcan has saved thousands of lives reversing the effects of fentanyl, there is no such life-saving drug to reverse Xylaxine. How does the impact of Xylazine in street drugs pose a risk for teens and why should parents be concerned? In this blog post, we’ll explore how the illegal drug supply chain is changing. putting youth at more risk and creating a perfect storm. We will also identify resources to educate on these new drug trends.

never heard of Xylazine or ‘tranq’?

The epicenter of the brewing storm seeded by the drug Xylazine, an animal tranquilizer is Philadelphia. The DEA issued their national alert on this drug in March 2023.

Xylazine, known as “Tranq”, is a powerful sedative and is a growing concern in our communities. This drug belongs to a class of medications called alpha-2 adrenergic agonists. Typically, it is used in veterinary medicine to sedate large animals. However, Xylazine has found its way into the hands of humans, leading to serious consequences.

It is almost as if the illicit drug trade has its own “FDA”. To meet requirements dealers must deliver a mixture of deadly substances to all consumers. Adding Xylazine does extend the high of fentanyl. It comes at a very high cost to the person suffering from addiction. Once the afflicted person experiences xylazine inadvertently there seems to be no turning back.

TV news stories abound that show people walking in an almost comatose condition. The shuffling figures seem to wander aimlessly. Beyond that effect, are horrific skin lesions caused by xylazine. The wounds continually expand as the flesh is eaten away. Some areas have medical vans that roam to meet the afflicted to administer wound care.  It is an endless, seemingly hopeless battle to heal the ulcerated skin due to lack of sanitary living conditions.

trend is here but unknown by most

Unlike Fentanyl, Xylazine has no reversal drug. The two drugs when paired, send the risks up substantially for a fatality. Very few parents will be aware of the name of this drug and its deadly far-reaching tentacles. Even schools won’t be aware initially. The deadly combo can show up in any illicit drug or a seemingly legit pill – complete with logo imprint. Of great concern is how deadly drugs are beginning to show up in vaping devices. The window for awareness and prevention to avoid tragedy is almost past.

‘Perfect Storm’ 

Fentanyl’s infiltration of vaping devices is detailed in a report by AddictionResource.net . This  developing trend is easily fostered by the overwhelming belief by teens that vaping is safe. There will be little or no hesitation to take a puff from a friend’s vape – just to try it once.

Pair this trend with the decades-long track record for the misuse of prescription pills by teens. (As you are reading this, if your prescription medications are in the ‘medicine cabinet’ the opening of that door can be an invitation.) 14% of high school seniors admit to using prescriptions not meant for them. In some cases, teen Rx pill misuse was sparked by a pain medication prescribed for a sports injury. Addiction can occur in as little as three weeks in that circumstance. When the prescription runs out, a teen may seek out the same pill on the street – or is it the same pill?

Enter Nitazenes Forever Changing the risk

You will be hearing about drugs called nitazenes entering the illicit drug trade. The drug is a synthetic design that mimics opioids and is more potent than fentanyl. The trafficking is recognized as originating in China. The Office of National Drug Control Policy issued a statement on the government’s determination to aggressively pursue the network of illicit drug manufacturing. The potency of nitazenes is stunning at 10x the potency of fentanyl. It is expected that new iterations of nitazenes will emerge as frequent as every 18 months.  The synthetic structure is associated with a host of drugs:

  • carfentanil
  • protonitazene*
  • isotonitazene*

*Belong to a novel class of synthetic opioids called benzimidazoles

Narcan Not Effective on Nitazenes

Narcan or naloxone has saved countless lives as a reversal drug for fentanyl.  This is not the case for nitazenes and evolving synthetic opioids. Pharmaceutical research is now challenged to keep pace and develop a lifesaving reversal drug. It is not reasonable to conclude that research will ever be able to keep pace. It is hard to imagine how the emergence of designer opioids will impact the “drug poisoning” death rate.  The term “drug poisoning” is exchanged because the term “overdose” implies a choice. The illicit drug supply appears to now be similar to a campaign. A campaign whose purpose seems to be a determination to create an ever-deadly “ingredient monopoly” over the drug trade. Those afflicted with addiction cannot avoid the “fatal intruders” now in the street drug supply

The drugs have similarities in the signs of a life-threatening reaction:

  1. Slow or Difficult Breathing: Fentanyl depresses the respiratory system, leading to breathing difficulties or decreased breathing rate.
  2. Sedation: Fentanyl’s potent effects can induce a state of extreme drowsiness or sedation.
  3. Disorientation and Dizziness: Fentanyl’s impact on the central nervous system can lead to confusion, disorientation, and dizziness.
  4. Slow Pulse and Low Blood Pressure: Fentanyl’s effects on the cardiovascular system can manifest as a slowed pulse rate and reduced blood pressure. Monitor your pulse and be aware of any unexpected drops in blood pressure to help identify potential fentanyl-related issues.
  5. Loss of Consciousness: Severe fentanyl exposure may result in loss of consciousness or even coma. If someone loses consciousness after vaping or displays unresponsiveness, take immediate action.

Vaping As a drug “delivery system”

Vaping has changed everything when it comes to drug use among teenagers. The accessibility and discreet nature of vape devices have made it possible for any drug to be consumed in this way. Now vapes or e-cigarettes are even designed to look like school supplies, making detection impossible. Add to that, the fact that marijuana has no odor when vaped and you can see why it is an uphill battle for schools to contain the use of vapes. Schools are left to contact emergency services when teens lose consciousness in school because of something they vaped.

It is not reasonable to expect that vapes will remain uncontaminated with drugs like fentanyl. xylazine and nitazeneIncidents have already occurred in high schools that point in this direction.

Adding to the dilemma is Snap Chat, a social media platform that feels drug dealers need their own identity emoji. When you child sees someone on Snap Chat, paired with the image of an electrical plug, they know that person sells or uses drugs. Delivery can easily be arranged to your front door. There’s a whole emoji language when it comes to drugs according to a NY Post article.

A change in street drugs will always trickle down the chain to taint gateway drugs now. Behaviors like vaping marijuana are riskier than they were just a few years ago. Underage use of vaping devices or e-cigarettes is illegal, but you would never know it by the high school principal’s desk drawer that’s filled with confiscated vapes. Some of these devices are sold in smoke shops and on the internet. Others are sold on the street. Legally, smoke shops can sell e-cigarettes or vape devices that contain nicotine, so long as they do not sell to minors.

When a high school student in York, PA needed two doses of Narcan to be revived, it was from vaping fentanyl. Schools are not required to have Narcan ready to administer, so this young man was very lucky indeed. Clearly vaping has progressed from bubble gum flavors with as much nicotine as a pack of cigarettes to a drug delivery system ready to deliver any combination of drugs.

Where we are now

Fake pills containing fentanyl make up 60% of the illegal street drug supply. In Philadelphia, the explosion of Xylazine since 2021 has resulted in Xylazine’s presence detected in 90% of the street drugs seized!

It is this illegal trade, now infused with fentanyl, that has effectively doubled (up 94%) the drug poisoning death rate for youth aged 14-18.  Again, “drug poisoning” is the term,  since youth were not seeking any “dose” of fentanyl. It is certain that nitazenes and the drugs to follow, will impact our youth as it infiltrates and becomes embedded in the illicit drug supply.

In addition, movies and public opinion have taken gateway drugs in stride and often with a sense of ‘Cheech and Chong’ humor. Teens experimenting with marijuana or alcohol are less likely to decline the pill offered at a campfire or say no to a friend offering to share their vape in school.

If illegal drugs are advancing at a prolific pace, from being unheard of to being in 90% of street drugs seized, then prevention should be keeping pace. If precedence remains true government action will only kick in at the extreme crisis level.

While the window for providing prevention knowledge of drug trends, and the caution that vaping is emerging as a drug delivery system is NOW – you should not expect intervention on a national scale any time soon.

Historically, the government focus on any trending drug calls for a prevention program for that particular substance. For example, we need a tobacco program, one for alcohol, another for Rx meds, one for marijuana etc.  It is as if we wanted to make a patchwork quilt without a plan to ever sew the squares together.

Beyond that obstacle lies the evidence-based factor requiring $50,000 – $100,000 in research before a program can have that reverenced stamp of approval. The research can take from 5-15 years. By the time a program is deemed evidence-based the drug of concern has been replaced over a dozen times or more.  Clearly a new approach is needed to allow for prevention that addresses current trends.

Statistics show we are missing the mark 

In 2020, when statistics revealed that deaths from drug poisoning among 14–18-year-olds increased a stunning 94%! The CDC determined that fentanyl was responsible for 84% of those deaths. Non-profits are struggling to fill the gaps. A “Song for Charlie” is the website and resource for fentanyl that far exceeds anything coming from the federal government’s Substance Abuse and Mental Health Services Administration (SAMHSA)

While it remains true that most teens don’t experiment with drugs, those who do represent a considerable segment of the teen population now at incredible risk. The National Institute on Durg Abuse published the Monitoring the Future survey showing that in 2021 nearly 20% of teens in 8th, 10 and 12th grades used illicit drugs in 2021.

The CDC points out five factors relating to the deaths of youth aged 10-19 that should be driving prevention:

  1. Overdose/poisoning deaths among adolescents ( persons aged 10-19 years) are increasing substantially
  2. Most of the deaths as of 2023 involved illicitly manufactured fentanyl (IMF)
  3. 25% of deaths included evidence of counterfeit pills
  4. In 66% of adolescent deaths, a bystander was present but most provided no overdose response
  5. Approximately 41% had a history of mental health conditions or treatment

What should be added are the following factors:

  • There were no scheduled programs in the community to inform residents on drug trends
  • No parent and child co-ed learning programs were offered regularly on the community calendar
  • Parents and schools were largely uniformed on emerging trends
  • Parents were first hearing  about fentanyl from a toxicology report after their child died
  • Prevention indicators pointing out the need for education for the public were ignored

we should Be Doing better by now

The conclusion has been made, as in studies of drug trends over the past few decades, that educating on the dangers of fentanyl and other deadly drugs to our youth and the public at large would have the most impact. In addition, the findings always recognize that treating any underlying mental health disorders would reduce deaths in this age group.

Prevention providers, with the help of the federal government. used to have more tools to:

  1. Connect providers across the United States for a free exchange of drug trends, resources and information.
  2. Be able to visit a government website to explore drug prevention programs that were researched and able to meet needs

                                                           ALL THESE TOOLS ARE GONE! 

Prevention providers effectiveness is greatly diminished by a missing tool that used to be provided by the Office of National Drug Control Policy’s “ListServ”. This service connected providers across the county with a free exchange of information. Trends could be discovered early and resources were freely shared. Yet, this service was suddenly discontinued in 2011. One can only imagine what this service would have meant to address the fentanyl crisis that would emerge in 2013.

If there was ever an “Amazon” shopping site for drug prevention programs it used to be on SAMHSA, a government website. In 2018, the federal government’s SAMHSA website pulled the plug on their “prevention program shopping list’ called the National Registry of Evidence-based Drug Programs and Practices. Nothing has replaced this critical tool. It left prevention providers confused as in all of the trainings, providers were directed and even cautioned to choose from this list of programs that had been vetted. It is beyond tragic and lacking in all empathy that this occurred in the midst of the fentanyl crisis.

Nonprofits taking lead in prevention

Preventing drug use has never been more challenging.  In this era, the battle is against something deadly in a pill or even a vape that you cannot detect.

Parents have a primary role in prevention, but they need help to prepare for that role. Parents need voices louder than their own to bring credence to the prevention message. Nonprofits are trying to fill the gap and some are taking the lead in prevention.

The website SongforCharlie.org is the leading resource for information and prevention curriculum for fentanyl. Their professional videos are available from the website to show in the classroom. There are also videos appropriate to view at home along with your adolescent or teen. Start with the “New Drug Talk” series for the most current information for families.

The nonprofit CANDLE, Inc. has a parent/child model for prevention called Reality Tour that any community can replicate. It is unique in that the program is for youth and their caregivers to experience together. The developer of the program states that prevention needs to be always coming up on the community calendar and presents insight for the need in this podcast. The parent/child Reality Tour drug prevention program is continually updated to address the latest trends. Just one caring person is needed to introduce the Reality Tour concept that has served 50,000 in the United States. If you got to the end of this blog, you just might be that caring person and want to take a look at our community prevention planner to get started. (BONUS – If you make it through the first step in the planner – a stakeholder meeting – connect to explore a grant opportunity.)

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Norma Norris

Norma Norris is the Executive Director of the nonprofit CANDLE, Inc.. EIN 71-0962470. Mrs. Norris has been a civic leader all her adult life. She and her husband Charles raised their three sons in Butler, PA. In an effort to preserve the integrity of her community, when heroin first appeared in early 2000, Norma created the parent/child drug prevention program called Reality Tour that is now replicated in the U.S. Her talents have progressed as well as her influence in the prevention field.