The UK is now facing the same public health disaster that has affected the US and Canada, with the spread of the flesh-rotting “zombie drug” xylazine in drug overdoses. A toxicology report showed that a man from Solihull, England, died from the effects of xylazine, heroin, fentanyl, and cocaine. Xylazine is a veterinary drug used for sedation, pain relief, and muscle relaxation but is not approved for human use. It is now being combined with heroin and fentanyl to reduce the cost of producing large batches of heroin. The addition of xylazine extends the feeling of euphoria to mimic the effects of heroin. However, many users are unaware that the heroin is adulterated with these other substances, leading to unintended side-effects and overdose.

In the US, heroin supplies are commonly adulterated with fentanyl and xylazine to reduce the cost of producing batches of heroin. Some regions report that over 90% of heroin contains this combination. With long-term use, the injection of xylazine can cause open wounds such as skin ulcers and abscesses to form, leading to tissue death and the nickname “zombie drug”.

Although xylazine was first detected in the US illicit drug supply in the early 2000s, the first evidence of its use outside of North America was its detection in the drug-related death that occurred in Solihull. The man’s death was concluded to have occurred from a combination of heroin, fentanyl, cocaine, and xylazine. Xylazine is not included in standard toxicology drug screens in the UK, so its identification in this case was due to the vigilance of the toxicologist. This means that there could be additional deaths with xylazine in the UK that have gone undetected.

Subsequent submissions to the voluntary drug testing service Wedinos have found xylazine in drug samples of opioids, benzodiazepines, and THC. Most of the heroin in the UK has historically come from Afghanistan, whereas heroin in the US usually originates from central and South America. However, the Taliban appear to be holding firm to their promise to eradicate poppy field cultivation in Afghanistan. While the origin of the heroin used in this death in the UK has not been confirmed, this may represent a resulting shift in the UK heroin supply to central and Southern American origins.

Heroin users should be aware of the additional risks of using “tranq dope”, especially as the opioid overdose reversal agent naloxone is not effective against the sedative effects of xylazine. The drug is causing havoc in the US, and it is now in the UK. Drug overdoses in the US have been increasing over the last 20 years, with over 100,000 overdose deaths reported in 2021, largely driven by opioids. It is one of the worst public health disasters to have ever affected the US and Canada. The spread of xylazine in the UK is alarming, and authorities need to take immediate action to prevent further deaths.

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