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Xylazine, Or ‘Tranq,’ Which Makes Fentanyl Even Deadlier, Is Hitting Chicago’s Streets — And Narcan Won’t Save Those Who Use It

In the Midwest, the number of overdose deaths linked to xylazine jumped from 57 in 2020 to 351 in 2021, officials said. Narcan can still prevent fatal overdoses — but not with xylazine in the mix.

Narcan being handed out by the West Side Opioid and Heroin Task Force at an overdose hotspot at Cicero and Madison.
Keerti Gopal/Block Club Chicago
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GARFIELD PARK — Fentanyl’s deadly surge through Chicago has begun to slow — but the rise of another drug, xylazine, has officials worried opioid deaths could again skyrocket.

Chicago saw its most fentanyl-related deaths ever in 2022, with the drug — widely responsible for a surge in fatal opioid overdoses in recent years — linked to 1,307 deaths in the city last year, compared to 1,289 in 2021, according to the Cook County Medical Examiner’s Office.

Fentanyl-related deaths skyrocketed during the pandemic, leading to 2022’s record number — but that surge is beginning to slow, though deaths remain high, officials said. There have been at least 391 fentanyl-related overdoses so far this year in Chicago, compared to 669 over the same period in 2022.

Black and Latino Chicagoans have been disproportionately affected by the fatal overdoses.

Sarah Richardson, of the Behavioral Health team at the Chicago Department of Public Health, said steadying numbers are an encouraging sign. Growing public awareness of opioid overdoses and understanding of addiction are helping — as well as the more widespread distribution and use of Narcan, which can reduce fatal overdoses, Richardson said.

“Harm reduction is recognizing that everyone’s life is important and we’ll do everything we can to keep you alive and safe,” Richardson said.

Local officials and groups have worked to bring down opioid overdoses by trying new approaches: Chicago’s public libraries distribute Narcan, people leaving Cook County Jail are given harm reduction kits, the health department will mail people fentanyl test strips and the CTA has a Narcan vending machine coming to its 95th Red Line station.

But the emergence of xylazine — also known as “tranq” — has Richardson and other officials concerned.

Xylazine, a sedative commonly used in horses, is being used more often to cut fentanyl, with the Biden administration calling it an “emerging threat” last month.

And xylazine is immune to the effects of Narcan — which can make reviving people in overdose harder.

“Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” Anne Melissa Milgram, an administrator with the Drug Enforcement Administration, said in a public safety alert from the agency.

In the Midwest, the number of overdose deaths linked to xylazine jumped from 57 in 2020 to 351 in 2021 — a leap of 516 percent, according to the DEA.

There have been 39 deaths linked to xylazine use so far in 2023 in Chicago, and there were 167 such deaths throughout all of 2022, according to Cook County Medical Examiner’s Office data.

Fentanyl has become popular in recent years because it’s cheaper to produce and provides better profit margins than heroin, even though it presents more dangers to people who use it. A trace amount of fentanyl the size of pencil tip is enough to be fatal, DEA spokesperson Luis Agostini said — and adding xylazine on top of that makes the product even more potent at a cheaper price.

“There’s zero regard for human life from the dealers and distributors, but we understand they are business-oriented when it comes to turning a profit,” Agostini said. “This really crosses all demographics and socioeconomic factors because fentanyl is in every kind of drug out there.”

Richardson and Lee Rusch, director of the West Side Opioid Task Force, said the West Side is the largest center of drug deaths in Chicago. Richardson said years of economic divestment and systemic racism with no social safety net in place have made the opioid epidemic hit these neighborhoods the hardest.

Rusch said the task force has taught more than 6,000 people to safely administer Narcan, and he has seen people use it to keep themselves and each other alive.

Rusch said it’s still worth using Narcan to try to reverse an opioid overdose, even if the person overdosing was using a drug mixed with xylazine.

And Rusch and others think making more programs centered around harm reduction, normalization of Narcan use and boosting social services — such as housing and job assistance — can stem the tide of fentanyl and xylazine use and deaths.

“We see people train their friends to reverse overdoses to save a life,” Rusch said. “But we are doing more than training to save a life. We look at what comes next.”

State Rep. La Shawn Ford said more testing at harm reduction sites for the potency of the drugs or presence of xylazine could save lives.

“It’s too risky to continue to go down a path of telling people they should just say ‘no,'” Ford said. “We have to put people in a safe place when they’re using, they can prevent a fatal overdose. We really have to do everything we can to intensify harm reduction.”

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