Injection on the floor

What is ‘tranq’? Deadly fentanyl-xylazine combo worsens the addiction epidemic

USC experts discuss the new drug cocktail that doesn’t respond to naloxone, the opioid-reversal drug that has averted many deaths from fentanyl.

April 27, 2023 Leigh Hopper

Amid a catastrophic addiction epidemic, a new drug cocktail known as “tranq” has emerged as a serious threat across the U.S.

According to the U.S. Department of Justice Drug Enforcement Administration, tranq — a mixture of the synthetic opioid fentanyl and the animal tranquilizer xylazine — has been found in 48 states. The DEA recently issued a dire warning about the potential for overdoses and severe skin ulcers that may lead to amputations.

Tranq does not respond to naloxone, the opioid-reversal drug that has averted many deaths from fentanyl. Consequently, more people who use tranq are dying. Adam Leventhal, director of the USC Institute for Addiction Science, says that the drug is an urgent threat that requires a strong response.

“People with fentanyl-use disorders might not want xylazine in their product, but suppliers are adding it to the fentanyl supply,” Leventhal said. “This drug, combined with the effects of fentanyl, creates a different type of psychoactive effect that’s a new experience for the user. Risk of overdose increases when these two powerful drugs are combined.

Addiction will always be a constantly evolving problem.

Adam Leventhal, USC Institute for Addiction Science

“Addiction will always be a constantly evolving problem. We need policy experts, public health researchers, economists and legal analysts who study the drug industry to inform policies that regulate the supply side. And we need social workers, psychologists and neuroscientists to understand the demand side: Why is a certain drug addicting? What treatments will reduce that demand?”

What is tranq? Trend began on the East Coast

The tranq trend began on the East Coast and quickly moved west, according to Daryl Davies, an expert on the pharmacology and toxicology of drugs of addiction in the Titus Family Department of Clinical Pharmacy at the USC Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences. He warns that people who feel safer using fentanyl because of naloxone may be unaware of new dangers posed by the cocktail drug.

The Street Medicine Team at the Keck School of Medicine of USC is working on procuring test strips so patients can identify when their drug is contaminated with xylazine. Jungeun Olivia Lee, an associate professor at the USC Suzanne Dworak-Peck School of Social Work, wants to see nonstigmatizing, developmentally appropriate messages for teens, to warn them away.

“The initiation of substance use reaches its peak during adolescence,” Lee said. “The consequences of substance use — particularly potent drugs like fentanyl combined with xylazine — can be a lot more substantial for teenagers compared to adults, given that their social, psychological and physiological functioning is still developing. …

“Prevention and intervention strategies developed for adults may not be necessarily effective for teenagers.”

Fentanyl addiction still rocking U.S., but safe sites remain unpopular

Illicit fentanyl on its own has rocked California’s cities and the nation. One proposed policy solution is the creation of drug-use site pilot programs — also known as safe injection sites — in Oakland, Los Angeles and San Francisco where drug addicts can safely use illegal drugs while under supervision to prevent overdoses.

But the USC Schwarzenegger Institute for State and Global Policy’s latest California Issues poll shows that a majority of Californians — 54% overall — disapprove of the sites (42% strongly disapproved and 12% slightly disapproved). Meanwhile, 36% overall supported them, with 17% saying they strongly approved and 19% saying they slightly approved.

“Gov. Newsom in 2022 vetoed a bill that would have created these drug-use pilot sites,” said Christian Grose, the academic director of the USC Schwarzenegger Institute and a political science and public policy professor at the USC Dornsife College of Letters, Arts and Sciences. “While the fentanyl crisis is important, the issue of pilot drug-use sites has been politically unpalatable to Newsom. If Newsom hopes to run for president, this is an unpopular reform across the United States. And even here in California, voters are very split on the issue.”

Despite an aversion to safe-use sites, governments are increasingly active in curbing the addiction epidemic, Leventhal says. “It’s unprecedented what they’re doing recently for addiction and overdose prevention and harm reduction.

“We are aligned with the belief that keeping people who use substances alive is a human right. Everyone deserves an opportunity to get on a path to recovery.”