AILSA CHANG, HOST:
Something deadly and mysterious is happening on American streets. A chemical called xylazine, which is normally used as a horse tranquilizer, is being mixed with illegal drugs sold in cities and small towns across the U.S. But officials acknowledge that they don't understand why this new poison is being added to so many street drugs, and they don't know who's doing it. Here's NPR addiction correspondent Brian Mann.
BRIAN MANN, BYLINE: In recent weeks, the U.S. drug czar, Rahul Gupta, has raised growing alarms about xylazine.
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RAHUL GUPTA: I'm deeply concerned about - what does this threat mean for the nation?
MANN: Known as tranq on the streets, xylazine has been around for years. But over the last 12 months it suddenly went viral, turning up mixed into fentanyl, methamphetamines and other drugs across the U.S. Overdose deaths and severe medical complications, including terrible flesh wounds caused by the chemical, are soaring in the South and West, where xylazine had been almost unknown. While making his announcement, Gupta acknowledged public health experts and police are mostly in the dark about why this latest drug threat is happening.
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GUPTA: Testing for xylazine is uneven across the United States, which makes it hard to get the national picture. Many communities are not even aware of this threat in their backyard.
MANN: NPR spoke to many of the country's top experts on street drugs and found similar bafflement about why xylazine surged. Nabarun Dasgupta tracks samples of street drugs from his lab at the University of North Carolina.
NABARUN DASGUPTA: Why has it gone national? I don't know why - tough question out the gate, man.
MANN: This mystery is rooted in the way illegal synthetic drugs get made and sold. Often, the bulk of the fentanyl and methamphetamines come from overseas, usually in powder form. Then they're cut or given a final mix locally by drug gangs inside the U.S.
DASGUPTA: You could think of a kitchen table. You're sourcing powder, and you're mixing it together the same way you would mix up the baking soda and the salt and sugar for pancakes with the flour.
MANN: So it's possible drug gangs mixing fentanyl at kitchen tables all over the U.S. suddenly started adding xylazine. But some experts think it could be happening earlier in the supply chain, before the drugs cross the border from Mexico. Nora Volkow, head of the National Institute of Drug Abuse, says new drug sample data collected inside Mexico lends support to that theory.
NORA VOLKOW: So that led me to suspect that maybe the products are coming already mixed into the United States.
MANN: However this is happening, whoever's doing it, the impact is devastating for people struggling with fentanyl addiction like Jessica. (ph)
JESSICA: It just eats your skin away, and you just have a hole, and then it leaves a scar.
MANN: NPR agreed not to use Jessica's last name. She turned up at a harm reduction van on a street in Newcastle, Del., with bandages on her legs from xylazine-related wounds, which she says are really hard to treat.
JESSICA: Because it goes fast, and it just literally eats your skin away.
MANN: Xylazine also makes it much harder to revive people after fentanyl overdoses, and the chemical adds another layer of intense addiction and cravings. K.C. (ph) uses street fentanyl in Dover, Del., and says xylazine is making addiction deadlier and harder to escape.
K C: People who are in this are just getting sucked further and further and further, and it just feels kind of hopeless right now.
MANN: There are some theories about why people mixing drugs, whoever they are, suddenly adopted this deadly new ingredient. It may be simple convenience. Fentanyl is so powerful, it has to be diluted with other stuff. Nora Volkow at the National Institute of Drug Addiction says until now, xylazine has been relatively easy to get.
VOLKOW: Xylazine is a perfect filler. It's basically very, very cheap. On top of that, it may be enhancing the duration of these drugs.
MANN: This is another theory about xylazine. While it's incredibly dangerous, some street users believe it extends their high or delays onset of withdrawal symptoms. That could be appealing in part because law enforcement has been squeezing the supply of street fentanyl, trying to make it harder to get and more expensive. Maritza Perez Medina, a researcher at the Drug Policy Alliance, thinks those crackdowns on fentanyl may actually be pushing drug dealers to change their recipes in risky new ways.
MARITZA PEREZ MEDINA: That's really driven drug manufacturers to start to integrate xylazine into the supply. It's cheaper, and it also makes the high lasts longer.
MANN: Nabarun Dasgupta, the street drug researcher in North Carolina, points out drug dealers have always been highly adaptive, experimenting with the products they put on the streets.
DASGUPTA: I think there's a huge demand for innovation in the illicit drug market.
MANN: He says xylazine going national could mirror the way other legal consumer products take off.
DASGUPTA: Consumer goods are replete with copycats, you know? It could have been just a handful of folks figuring this out, giving it a try, seeing that the product was selling better and then other people copying it.
MANN: Again, these are all just theories. Here's one thing experts say they do know. In this new, deadlier era of synthetic drugs, xylazine is likely a sign of things to come as drug cartels and street drug gangs expect and push new drug cocktails. Again, here's White House drug czar Rahul Gupta.
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GUPTA: We're also looking ahead to what potentially comes after xylazine as an additive to fentanyl in order to get in front of the next additive in the drug supply.
MANN: By the time this mystery is solved, experts say there may be some new synthetic drug on the street, possibly more deadly than fentanyl and xylene. Brian Mann, NPR News.
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