Inside the worse ‘tranq’ cases surgeons are treating

Exposed tendons and bones. Wounds that attract maggots. A foul smell from dead tissue.

Even as more potent drugs have hit the streets, the flesh-rotting animal tranquilizer xylazine is still wreaking havoc across the US. Known as “tranq,” the illegal sedative is often mixed with fentanyl to enhance and extend the high.

In 2023, 30% of fentanyl powder samples and 6% of fentanyl pills tested by the DEA were contaminated with xylazine.

And in Philadelphia — widely identified as “ground zero” for the tranq crisis — the drug was involved in 38% of all unintentional overdose deaths in 2023.

Now, a Philadelphia orthopedic surgeon is warning that the tranq crisis is showing no signs of abating, even as the powerful veterinary sedative medetomidine and the industrial chemical BTMPS are increasingly being mixed into fentanyl.

“In terms of the frequency with which we’re seeing patients with xylazine-related wounds, five years ago we were not seeing any,” Dr. Asif Ilyas, an orthopedic surgeon and opioid use researcher at Rothman Orthopaedics and Drexel University in Philadelphia, told The Post.

“Now we are seeing at the larger university hospitals around Philadelphia daily, if not weekly, these patients with these problems.”

Xylazine has been around for decades. The pharmaceutical company Bayer synthesized it in Germany in 1962 to lower blood pressure, but it was found to cause severe side effects, including central nervous system depression and very low blood pressure. Xylazine was adapted for veterinary use instead.

It emerged as a street drug in Puerto Rico in the early 2000s. Fentanyl’s high is short-lived compared to other opioids, so xylazine is added to prolong the sedative effects.

Within a few minutes of injection, xylazine relaxes the muscles, relieves pain and triggers a zombie-like trance by decreasing the release of the “fight or flight” neurotransmitter norepinephrine in the central nervous system.

The bad news for users — lower levels of norepinephrine can lead to a dangerously slow heart rate, low blood pressure and breathing troubles. Xylazine also significantly narrows blood vessels, paving the way for the distinctive, grotesque skin wounds that have become its trademark.

“Xylazine is an animal sedative that causes both local tissue toxicity and local vasoconstriction, which basically means it decreases blood supply and oxygen to an area, thereby making the tissue more susceptible to dying,” Ilyas said.

Xylazine wounds can mimic flesh-eating bacteria and even require amputation.

“Most individuals who inject illicit drugs inject into their arms and legs — that’s where most of the damage is occurring,” Ilyas said.

“The worst case is the limbs literally auto-amputate all of the soft tissue necrosis off the bones and patients will come in essentially mummified or their limbs are auto-amputated.”

The severity of the wounds depends on the amount of xylazine in the injections, the frequency of the drug use and the patient’s physiological response to tissue damage.

One major issue, Ilyas said, is that patients often don’t stick around the hospital long enough to get the proper surgical care and addiction medicine they need.

“We can debride these wounds, and we can potentially reconstruct them depending upon the severity and depth of the injury,” Ilyas said.

“But if the individual goes on to continue injecting, then the intervention, the surgical reconstruction, has been for naught, and there’s significant cost and time associated with that.”

Patients may be able to regain function if they are treated early, before vital tissues are lost.

If there is irreversible loss of muscle, tendons or nerves, full recovery is impossible.

The good news is that a xylazine addiction can be overcome. A millennial in her 40s who splits time between Philadelphia and St. Louis managed to get clean in 2022 after undergoing a 45-day rehab program.

Tracey McCann, who got hooked on street drugs after being prescribed opioids following a car crash, suffered blackened bruises, septic infections and festering, flesh-rotting sores, prompting her to perform surgery on herself.

She sought treatment when she realized how much she needed xylazine to live. Now, she documents on social media how she embraces life without it.

Stories like McCann’s help raise public awareness of xylazine risks.

Unfortunately, it’s not possible to tell if fentanyl contains xylazine just by looking at it. There are test strips that show the presence of xylazine, but they don’t reveal the potency, which limits the user’s ability to gauge the risk of harm.

“The important thing for people to understand is that if you are injecting illicit drugs like fentanyl, there is an increasing likelihood that that fentanyl is being mixed with xylazine, which will not only increase the severity of the high from the fentanyl but also can result in the secondary complication of these wounds,” Ilyas said.