Experts with the USC Price School and the Keck School of Medicine of USC discuss the new drug cocktail and policy solutions that could save lives.
By Leigh Hopper and Jenesse Miller
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.
Tranq increases overdose risk
“This new drug is clearly concerning, particularly because of its lethality,” says Rosalie Liccardo Pacula, professor and Elizabeth Garrett Chair in Health Policy, Economics & Law at the USC Sol Price School of Public Policy.
Pacula, who co-directs the RAND-USC Schaeffer Opioid Policy Tools & Information Center of Excellence, warns that tranq is “just the latest drug of concern and others will continue to flood our markets unless and until we figure out how to build a stronger prevention and treatment systems.”
A major challenge is that the drug is not routinely tracked, says Jason Doctor, chair of the Health Policy and Management Department at the USC Price School, where he holds the Norman Topping Chair in Medicine and Public Policy. He says it’s unclear how much xylazine is diverted from its legitimate use as a veterinary tranquilizer and how much is being manufactured illicitly.
Adam Leventhal, director of the USC Institute for Addiction Science and a professor of preventive medicine and psychology at the Keck School of Medicine of USC, says tranq is an urgent threat.
“People with fentanyl-use disorders might not want xylazine in their product, but suppliers are adding it to the fentanyl supply,” he says. “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.”
Fentanyl test strips – small strips of paper that can detect the presence of fentanyl in a batch of drugs – are used as a simple, proven and inexpensive method of avoiding drug overdoses. 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.
“Getting test strips to drug users is very important, as is research on antagonists that might work to reverse human overdose,” says Doctor, who also co-directs the Behavioral Sciences Program at the USC Leonard D. Schaeffer Center for Health Policy & Economics.
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 Price School’s Schwarzenegger Institute for State and Global Policy conducted a poll that showed 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.
Christian Grose, academic director of the USC Schwarzenegger Institute and a professor of political science and public policy, notes that California Gov. Gavin Newsom vetoed a 2022 bill that would have created drug-use pilot sites. “While the fentanyl crisis is important, the issue of pilot drug-use sites has been politically unpalatable to Newsom,” he says.
Despite an aversion to safe-use sites, governments are increasingly active in curbing the addiction epidemic, according to Leventhal, and it’s “unprecedented what they’re doing recently for addiction and overdose prevention and harm reduction.”
Comprehensive approach is needed to fight addiction
Pacula says the recent funding from the federal government through the CURES Act and CARES Act are “valuable injections of funding support.” But, she says, policymakers need to more seriously consider revamping existing health care and prevention systems to better address addiction – “particularly that which is fed by different substances such as polydrug use” including tranq.
Leventhal agrees that addiction is a constantly evolving problem that requires a comprehensive response. “We need policy experts, public health researchers, economists and legal analysts who study the drug industry to inform policies that regulate the supply side,” he says. “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?”
A version of this story originally appeared on USC News.