Have you heard the news?
“Flesh-eating ‘zombie’ drug ‘kills you from the inside out,'” headlines a CNN article.
“Tacoma market busted for selling ‘zombie’ drug,” barks out a Seattle-area news affiliate.
” Zombie drugs? Florida man stabs couple, eats dead man’s face in ‘random’ attack,” shouts a Syracuse news outlet.
Surely by now, you have heard chilling stories about Xylazine, a substance colloquially called “tranq” that originated in veterinary sedation but now contaminates street supplies of fentanyl. Perhaps you have read one of the above-linked reports from major and minor news outlets about the flesh-eating zombie drug this week.
Except that you have not, because none of these headlines references Xylazine, and no one was published in the current decade. The first article from 2013 warned of the looming threat of krokodil, an injectable extract of codeine that was common in Russia when codeine was available over the counter there. Krokodil was always a suboptimal choice for opioid-dependent people as extracting the active desomorphine from codeine requires “alkali solutions, organic solvent, acidified water, iodine, and red phosphorus,” which cause predictable damage when injected. You had not heard of krokodil since the mid-2010s because that is when Russia stopped selling codeine over the counter, making the garage extraction of desomorphine moot. Despite warnings about its inevitable North American takeover, krokodil never became popular in the U.S. because codeine has not been available over the counter for several decades and because people who use drugs generally prefer not to inject red phosphorus if given the option to choose just about anything else.
The second article from 2018 sounded the alarm on spice, a general term for synthetic cannabinoids that was purported to cause everything from panic attacks to extreme aggression but has somehow faded off the public radar despite the “delta-8” THC variant being almost entirely synthetic and almost entirely legal at the federal level.
The third article red-flagged flakka in 2016, a synthetic cathinone that carved out an endemic niche in South Florida in the mid-2010s. Its purported ability to confer monster-like strength has no scientific grounding, and the cannibal variant of the zombie myth was debunked when the face-eating offender was found to have no flakka in their system at all. Like PCP before it, flakka’s spurious reputation gave wide latitude for law enforcement to use notable force to subdue anyone suspected of being intoxicated by the drug. (A 2019 report by Cleveland 19 news took drug panic to the illogical extreme by conflating flakka with Xylazine, apparently based on both being zombifying drugs, declaring confidently that “Flakka is a man-made crystal drug similar to bath salts, and now officials say it’s being mixed with opioids like fentanyl … Xylazine is the drug’s clinical name.”)
It seems that we do not have so much an epidemic of flesh-eating zombie drugs but a cyclical resurrection of urban legends about drugs that, disappointingly, failed to turn hordes of humans into face-eating zombies or eat their flesh.
Indulge me instead by taking a grounded, clinical approach to Xylazine, especially its severe withdrawals and propensity for causing wounds with its vasoconstrictive effect. Xylazine is a more potent member of the same medication class as clonidine and tizanidine, common medications used for calming opioid withdrawals by muting the effects of adrenaline. This commonality gives us a clear pathway to trial treating withdrawals from Xylazine with similar, milder analogs, much as we use methadone or buprenorphine to stabilize withdrawals from opioids.
Because Xylazine is FDA-approved for veterinary use, we clearly understand how it affects mammalian physiology – unlike novel psychoactive substances or “research chemicals” where we may have no data on its effects and drawbacks. We can use that understanding to develop and optimize overdose reversal, withdrawal management, wound prevention, and other treatment protocols.
Xylazine is not the first or last drug contaminant to cause tissue damage and infection, from krokodil’s ravaging tissue necrosis to bacterial contamination that causes heart, bone, and deep tissue infections. Ironically, in my fifteen years working in opioid treatment, I see far fewer wounds in today’s fentanyl users – Xylazine or no xylazine – than in yesterday’s heroin users, as fentanyl is cheap and strong enough that a surprising number of people never progress to injecting it to maintain the effect. Moreover, we live in a nation with an advanced medical care system that includes such technologies as skin grafting, wound vacs, and hyperbaric chambers that can effectively heal wounds of all sorts.
Once grounded in clinical perspective, the hyperbole of yet another exhausting drug panic becomes clear. Why is this over-exaggeration a problem? The scare-mongering endemic in the “zombie,” “flesh-eating,” “cannibal,” and even “demon” narratives shore up arguments for ongoing prohibition and mass incarceration – in fact, in two extrajudicial police killings of black men, the victims were described with the same zombie imagery invoked in these drug-panic narratives. The unfounded idea that any drug can give a person superhuman strength justifies aggressive policing of anyone exhibiting signs of intoxication. This exotification of drugs stigmatizes aspects of drug use that are, in reality, often mundane to the point of being boring, like basic wound care. Drug panics blind us to policies that reduce drug use’s dangers. If we truly wanted to rid the drug supply of Xylazine, we could legalize and regulate fentanyl tablets, but the goal here is not to secure a safer drug supply. The goal is to stoke cynical panic to justify incarceration rates that outstrip even Russia during the Gulag era.
On a final note, the persistent efforts of journalist Keri Blakinger revealed that the Los Angeles County Sheriff’s crime lab was aware of the presence of Xylazine in the local opioid supply as far back as 2019 and on the opposite coast from where it was first publicized and vilified. People who use drugs in Los Angeles have somehow been coping with this episodic exposure to this contaminant for years. Medical providers have been somehow reversing overdoses, calming withdrawals, and addressing wounds of xylazine-poisoned patients for years without even being aware of the burgeoning panic that would emerge when the words “tranq dope” hit the streets. In other words, we can all take a breath and realize that despite the media frenzy to the contrary, Xylazine is another drug in a long line of drugs, another contaminant in a long line of contaminants. We can use established knowledge and experimental science to optimize treatment of people who have been exposed without exacerbating the stigma and harm done to people who use drugs every time a new panic sets in about flesh-eating zombie drugs.
Julie Craig is an addiction medicine specialist.
