In January, the UNC Street Drug Analysis Lab received a drug sample from Cumberland County. It tested positive for xylazine, a veterinary sedative that’s increasingly popping up in illicit drugs across the country, particularly in the South.
According to the lab, 70% of Cumberland County’s drug samples sent through November 2023, when the lab has most recently updated its statewide xylazine map, tested positive for xylazine. That’s one of the highest rates among the 26 North Carolina counties where the lab has detected xylazine.
Fayetteville State University researchers are partnering with the Cumberland County Department of Public Health’s Cumberland-Fayetteville Opioid Response Team (C-FORT) to investigate xylazine. The study, “Understanding the Role of Xylazine in the Opioid Crisis,” will examine the prevalence of xylazine in the county’s drug supply and its impacts on people who use drugs and the physicians treating them.
“There really isn’t a lot of data on this. It’s really limited,” Greg Berry, C-FORT coordinator, said. “There’s only a couple of areas where they’ve done research. The level of the type of research that we’re proposing hasn’t been done at all. So there’’s a lot that we don’t know and that we really hope to learn through this study.”
What is xylazine?
Xylazine is a U.S. Food and Drug Administration-approved veterinary drug used to sedate, immobilize or relax dogs, cats and horses. While crucial to veterinarians, xylazine is increasingly being found in the illicit drug supply to cut drugs like fentanyl, cocaine and heroin.
Some people using xylazine or drugs cut with xylazine reported to the DEA that the substance prolongs the high from fentanyl and other opioids. Its use is not without side effects — in a study published in the international journal Drug and Alcohol Dependence, 87% of respondents said they developed open sores. The Centers for Disease Control also reports people who use xylazine have difficulty breathing, dangerously low blood pressure, slow heart rates and severe withdrawal symptoms.
Berry is particularly concerned about the sores. He and other C-FORT members have seen more and more community members seeking resources and treatment with increasingly severe wounds, likely as a result of xylazine.
Shangshong Luo, one of the three FSU researchers conducting the study, aims to find out if there is a prejudice against people with such wounds when they seek care. In the Drug and Alcohol Dependence study, about 21% of respondents reported being turned away from rehabilitation programs because of their wounds.
Expanding the body of research
To assess prejudice along with other impacts of xylazine on Cumberland County’s residents who use drugs, the study will include a questionnaire for those who use drugs and the physicians who might treat them.
The questionnaire for people who use drugs will address three lines of questioning: how prevalent the individual believes xylazine is in the community; how much they know about the drug and stereotypes associated with its usage; and which kinds of drugs they use, in hopes of determining which drugs xylazine might be mixed into besides opioids.
Physicians will be asked similar questions. They’ll be asked how big of a problem they believe xylazine is in the community and their perceptions of people who use xylazine, knowingly or unknowingly. And they’ll be asked how they treat those individuals and whether treatment differs based on the drug mixed with xylazine.
The research team will also collect drug samples to send to the UNC Street Drug Analysis Lab. The lab’s test kits only need a residual amount of a drug, a swab from a baggie being enough to tell if the drug was cut with xylazine. These test results will provide numerical data on the prevalence of xylazine in the county’s drug supply to support the qualitative data supplied by the questionnaires.
Those who donate drug samples can also track their sample using the unique but anonymous identification number associated with each test kit. Those results will be available before the study concludes and Berry hopes it will immediately help those who use drugs if their results come back positive for xylazine.
“It may serve as an intervention in a way to help them make better choices about their health,” Berry said.
The team’s goal is to recruit 900 people who use drugs and 300 health professionals and test 900 drug samples for the study. Luo said it’d be the largest sample size for a U.S.-based, xylazine-specific study.
Luo and the two graduate students working with her found just 20 existing studies on xylazine in people in their literature review for the study.
“There’s a great lack of understanding of this chemical because it’s not really supposed to be used on human beings, and it just kind of popped up in illegal street drug supply,” Luo said.
The trio found most human studies were published in the last two years. Almost all had sample sizes at or under 100 participants. Even C-FORT’s own study, conducted last summer, only garnered about 60 responses, Luo said.
“Some of them are just based on qualitative study data — interviews, which is very valuable at this stage — but small sample sizes do have limitations,” she said. “And they’re not specifically designed to look at xylazine effects. It just kinds of tags along with one of the questions [in the study] asking about xylazine.”
It’s why Luo and Berry believe their study is so crucial. But it’s not just them; the North Carolina Collaboratory, a research funding agency out of UNC-Chapel Hill, is providing a $200,000 grant to make the research possible.
“We’re contributing to a field of knowledge that everybody around the country could benefit from,” Berry said. “Folks can look at this in their community and glean insights from it. So it definitely is going to have a lot of positive impacts here, but those impacts are going to bleed over our county lines and bleed over our state lines and they’re going to help a lot of people.”
The impact of quantitative data
Berry said xylazine was first detected in the county’s drug supply in 2022. However, it’s been hard to get others to focus on xylazine when the only proof he has of its devastating impacts is stories from his and others’ on-the-ground harm reduction work, which involves evidence-based strategies that work to improve the lives of those who use drugs by meeting them where they are in their substance use journey.
Berry hopes the study’s results will help C-FORT, the public health department and, ultimately, the Cumberland County Board of Commissioners effectively utilize the county’s allocation of national opioid settlement dollars.
“Instead of someone coming in there and just telling them [the county commissioners] what they think or what they heard, they’ll be coming in with the hard facts about what’s going on,” Berry said. “It’ll help us in a huge way when we are doing our strategic planning and we’re thinking about what strategies we need to put forward for funding.”
Per the terms of the national opioid settlements, Cumberland County is allotted over $31.8 million in available funds through 2028. The county has already spent or allocated around $9.8 million.
The public health department is preparing the next round of requests for proposals for opioid settlement funds. However, the study’s results won’t be published by then — the team is awaiting final approval from the FSU’s ethics commission. Luo expects to receive approval around the end of March and said her team is ready to hit the ground running once approved.
“We are patiently waiting, actually more like impatiently waiting, for the review,” Luo said.
CityView Reporter Morgan Casey is a corps member with Report for America, a national service program that places journalists into local newsrooms. Morgan’s reporting focuses on health care issues in and around Cumberland County and can be supported through the CityView News Fund.