Welcome to Public Health On Call, a podcast from the Johns Hopkins Bloomberg School of Public Health,

where we bring evidence, experience, and perspective to make sense of today's leading health challenges.

If you have questions or ideas for us, please send an email to public health question at jhhhu.edu.

That's public health question at jhhhu.edu for future podcast episodes.

This is Lindsay Smith-Rogers, and today the topic is xylasein, an animal tranquilizer that's showing up in

illicit opioid supplies. I speak with Rachel McFadden, a Bloomberg fellow at the School of Public

Health, and a wound care nurse at a harm reduction organization, and nurse in the emergency

department at the hospital of the University of Pennsylvania, and Dr. Matthew Salsman, also a fellow,

and assistant professor of medicine at Cooper University Hospital in Camden, New Jersey.

We talk about why xylasein is so dangerous and why this could be a pivotal moment in the opioid crisis.

Let's listen.

Rachel McFadden and Matthew Salsman, thank you so much for joining us on public health on call to talk about xylazine. So we're going to start out first of all by talking about what is xylazine? Where is it showing up? Why is this such a problem? Rachel, I'm going to start with you. Thanks, Lindsay. It's great to be here. So xylazine, which we also call

trank, is a veterinary sedative, and it is not FDA approved for use in humans, but in the last

several years, it has found its way into the illicit drug supply and primarily the illicit

opioid supply. And this isn't the first time this has happened. So really the

first published literature on xylosine in the illicit drug supplies from Puerto Rico in the early

2010s. And at that time, researchers and harm reduction workers noticed a much more significant

sedation and a very distinct kind of wound in folks who are chronically exposed to xylasein in the drug supply.

Now, in addition to the emergency department, I work in a wound care clinic partnered with the local syringe exchange.

And in early 2020 or late 2019, people coming into the clinic started noticing these strange

ulcerations or wounds in addition to a largely undesirable change in how they felt after using

illicit opioids. And they could actually avoid these things initially if they switched to a different

...