Drugs and Crime

Synthetic ‘Tranq’ disfigures, kills VT opioid users

Synthetic opioids are killing more Americans as they render treatment options less effective

Xylazine wound – Federalist.com photo

by Taylor Sisk, KFF Health News

BURLINGTON — “You can’t inject a horse tranquilizer and think nothing bad is gonna happen” to you, said Ty Sears, 33, a longtime drug user now in recovery.

Sears was referring to xylazine, a sedative used for animal surgeries that has infiltrated the illicit drug supply across the country, contributing to a steady climb in overdose deaths.

Sears divides his time between Burlington and Morrisville, a village an hour to the east. In Burlington, he visits clusters of drug users, offering water, food, and encouragement.

He has been there, been down, done time, struggled to adhere to treatment regimens. But this, he said, is different: first, fentanyl — estimated to be 50 to 100 times as potent as morphine — and now xylazine, and the life-threatening wounds and sores it can cause.

Sears implores those he encounters who suffer the effects of these drugs to look at what they’re doing to themselves. But to little avail.

“They say they’re unable to get out of it — that they don’t have a plan to get out of it.”

Worse, those who seek help breaking their addictions face treatment options rendered less effective by the prevalence of fentanyl, xylazine, and other synthetic drugs. Vermont’s pioneering efforts in establishing a statewide program for medication for opioid use disorder, known as Hub and Spoke, now face significant new challenges.

Launched in 2012, Hub and Spoke put prescription medicines at the center of the treatment strategy, which many addiction specialists say is the most effective approach. Vermont offers methadone treatment at regional hub sites for those with the most intense needs, while smaller community clinics and doctors’ offices — the “spokes” — provide care such as dispensing the opioid withdrawal drug buprenorphine.

Advocates and experts in Vermont honed the model, and today hub-and-spoke systems or variations are in place nationwide, including in CaliforniaColoradoMaineNew Hampshire, and South Carolina.

But the rise of fentanyl, xylazine, and stimulants is undercutting the effectiveness of addiction medications.

Commonly administered doses of buprenorphine, better known as Suboxone — the brand name for a combination of buprenorphine and naloxone — have proved less effective against fentanyl, and commonly used doses can trigger violent, immediate withdrawal. Neither Suboxone nor methadone is designed to treat addiction to xylazine or stimulants.

The Centers for Disease Control and Prevention estimates that of the more than 111,000 drug-overdose deaths in the U.S. in the 12-month period ending in April, more than 77,000 involved fentanyl and other synthetic opioids. The nation has also seen a significant increase in overdose deaths from co-use of stimulants and opioids. Vermont has experienced a spike in the use of cocaine and, more recently, methamphetamine.

“There was a time when we couldn’t have pictured things being worse than heroin,” said Jess Kirby, director of client services for Vermonters for Criminal Justice Reform, which offers services to counter substance use disorder. “Then we couldn’t picture things being worse than fentanyl. Now we can’t picture things being worse than xylazine. It keeps escalating.”

In Vermont, the Hub and Spoke program is part of the statewide Blueprint for Health, with hubs in relatively populous areas of this largely rural state.

A patient enters the system for assessment and initial induction at one of nine hubs, and then, once stable, is transferred to a spoke. If that patient relapses or needs more intensive care, they can be transferred back to the hub. The spokes typically offer Suboxone — most effective for those with mild to moderate opioid dependence — but not methadone, which is more regulated.

Kirby — who began using opioids in her early teens, has been in recovery for about 15 years, and is Ty Sears’ longtime case manager — said a benefit of the hub-and-spoke model is that it offers support to primary care doctors and other practitioners who might otherwise be hesitant to prescribe medications to treat addiction. (Federal officials recently relaxed rules governing which doctors can prescribe buprenorphine.)

Erin O’Keefe, who runs the Burlington-based Howard Center Safe Recovery program, said the model’s flexibility has been key: from being fully integrated into primary care, whereby addiction is treated like any other chronic disease, to the other end of the spectrum, “making sure that people who are still in chaotic-use cycles receive harm reduction approaches” to keep them alive another day.

Vermont had the 10th-largest increase in fentanyl deaths for the 12-month period ending in April. Tony Folland, clinical services manager with the Vermont Department of Health’s Division of Substance Use Programs, said fentanyl is now implicated in about 96% of overdose deaths.

Meanwhile, xylazine, commonly called “tranq,” is causing extreme concern. State Department of Health records indicate that almost 1 in 3 opioid overdose deaths so far this year involved xylazine. And those working on the front lines report seeing a marked increase in the extreme wounds it often causes.

The challenges providers now face underscore the need to be prepared to respond in the moment. It’s essential, O’Keefe said, to capitalize on someone’s motivation for change, “and that motivation can be so fleeting — like, ‘I have enough in the tank to make one phone call, and if that phone call doesn’t go well, I’m back in the game.’”

Folland said Vermont now prescribes more medication for opioid use disorder per capita than any other state. He estimates between 45% and 65% of people with opioid use disorder receive medication.

But these challenges are unprecedented. “We have a drug supply that’s contaminated with xylazine, with fentanyl, and we know that people are struggling a lot more and are at a lot higher risk,” Kirby said. “It’s not just overdose to be concerned about anymore. It’s life-threatening wounds and infections.”

In response, advocates have asked state officials to fund more contingency management, a treatment approach that provides rewards to patients who refrain from illicit drug use. They also strongly encourage more widespread access to methadone as an alternative to buprenorphine, which is often proving less effective in countering the potency of fentanyl.

According to Folland, eight opioid treatment programs in communities throughout the state offer methadone, with one more soon to come. The goal, he said, is to prevent anyone from having to travel farther than a half-hour or so to access it.

Easier access to methadone would also require loosening federal restrictions.

“Methadone is probably the most regulated medication in the United States. We’ve got to figure out a way to make it more accessible,” said Kelly Peck, director of clinical operations for the University of Vermont Center on Rural Addiction. “We’ve got decades worth of data at this point, showing that methadone is safe and efficacious.”

For Kirby, O’Keefe, and their colleagues, more resources can’t come quickly enough.

“People dying — that’s what I’m seeing, every day,” Sears said.

Sears has been fortunate. What has served him in his recovery is the tolerance of those who’ve helped him along the way, and flexibility. There have been times when he was allowed to remain on Suboxone while still using stimulants. He is a recent graduate of a contingency management program administered by Vermonters for Criminal Justice Reform, the organization for which Kirby works.

“She counsels me,” Sears said. “She hears me out.”

Glimpsing a flicker at the end of the tunnel, advocates acknowledge, will require availing an arsenal of options to counter a shifting, and lethal, crisis.

“It’s almost like our understanding is changing from really seeing this, on a social level, as episodic to seeing it as chronic,” O’Keefe said, emphasizing that as the drug-supply landscape shifts, approaches to countering it must evolve as well.

Taylor Sisk is a Nashville-based health care reporter whose work is primarily focused on how policies and practices affect people’s lives. Among the print and digital publications in which his articles have appeared are 100 Days in Appalachia, The Daily Yonder, the Economic Hardship Reporting Project, KFF Health News, Mother Jones and National Geographic.

10 replies »

  1. Interesting the non-profits, NGOs, and government officials see the situation getting worse, but can’t seem to come to grips as to why it is getting worse. Job security perhaps? Can’t bite the hand that is manufacturing and supplying the drug trade? I believe the goal is to eliminate or disable as many humans as possible and make a tidy profit off the misery and destruction that ensues. At this point, fighting a forest fire with a garden hose isn’t going to change a thing. In the meantime, they can all gaslight themselves and the public pretending they’re doing their best to address and help the situation. The Masters approve and applaud the complicit obedience.

  2. Drugs are a false economy a false hope, they are being used to tear down our people, our families, our state and country. See, much is coming from China…this is a war. If people were more versed in history, Opium Wars, Sun Tzu….they would know what is going on. Everybody “profits” from drug use, except the users and their family.

    We are allowing the destruction. This is not a party issue. This is a humanity issue, and some are using it to their advantage…..we need to break free from our overlords……we only need to change our direction, the most important would be loving your neighbor enough to prevent, restrict, make difficult what is going on. Our laws are supposed to mimic natural law, natural consequences.

    Instead, we fight and put-up fronts for legitimate business, Costco Gas, for example and let the drug dealers run free.

    Affordability, Drugs and School Funding are the main issues in Vermont, people are getting stinking rich off keeping things just the way they are, which is why nobody wants any change.

    Money and power are the currency and idol

    You can only pay $500 for hammers and $750 for toilet seats for so long. You can’t run a life, a family or a state on perpetual corruption. It goes against all laws, nature, economics, science and God…..we should know better.

  3. I wrote to my local Papers assistant editor asking why they put nothing in the paper concerning individuals overdosing or dying because of these drugs in town but nothing, no response! This photo could cause a few individuals to not start this terrible habit! I stated back in 1963 when cigarettes were causing cancer in so many people a Warning was put on each pack of cigarets, education! Maybe if local papers would report on the overdoses and deaths because of these terrible drugs some people may not start! It worked with cigarettes as America went from 80 percent of the population smoking to about 17 percent today!! It’s worth a try, public education may work!

  4. There seems to be a certain historical pattern in Western Civilization. God blesses certain people who are hardworking, but who are also humble, thankful, and who depend on God in their day-to-day living. Over time they experience a certain degree of abundance and wealth.

    And then slowly they begin to take credit for all of their prosperity, their hearts then become proud, and they forget about God.

  5. “It’s almost like our understanding is changing from really seeing this, on a social level, as episodic to seeing it as chronic,” O’Keefe said, emphasizing that as the drug-supply landscape shifts, approaches to countering it must evolve as well.

    The black market is so much more prosperous. Maybe the addicts can clean up and go into drug sales. That’s where I see their evolution going.

  6. On a serious note. Are these addicts former normal people?
    Perhaps they just can’t handle the weirdness of our society.

    Really, they must have looked around them and seen the unnatural hair colors and obesity and all sorts of ugliness and 6 foot clowns dressed as prostitutes in children’s spaces. They see weirdo people somehow getting special jobs paying really well…
    These same weird people are also running our cities, making strange gestures in city council meetings, screaming and accusing people of a variety of isms, transing their kids, crying when someone calls them a pronoun as if they were 2 year olds.
    They also see how a huge number of local leaders are from some remote part of the world with completely different cultures. And they’re working for the govt. while damning Americans for everything that has ever happened to the world since the dinosaurs.

    Yeah, some young people are wanting to check the F out from this stupidity.

    • Your comment, while certainly providing valid reasons to inspire one to check out of reality, made me wonder….why DID a person initially turn to drugs, especially hard drugs. Maybe if we knew and understood the “why” …we might be able to stop others in a similar situation from heading down that path. Yea, it’s a nice idea I guess, but in reality, I believe that drug addiction, like cancer, will never be cured. Too many powerful people make obscene amounts money by letting the suffering continue. We are all just collateral damage to them.

    • Years ago, a man who taught foreign exchange students English assigned the students to watch television programming to assist in learning the language. When he asked the students their thoughts on watching American television, they opined Americans take a lot of drugs. Why did they say that? Every other advertisement on American television is for drugs!

      It is a no brainer that American society has an extraordinary reliance on drugs. The drug addicts on the street are not much different than “normal” people with medicine cabinets full of pills. Any discomfort whatsoever requires bolting to the doctor for a pill to feel better. Not to mention the culture of music, movies, and television make it all look normal, helpful, acceptable, and cool. Do you notice drug ads feature cartoon characters? Flemmy the flu monster – get your shot children!

      Make no mistake, the war on drugs and the drug culture was designed and perpetrated for the profit of the wealthy. Recall the story from 2020 of a ship seized in New York harbor loaded with cocaine. Who owned that ship? JP Morgan. Cocaine found in the White House? Nothing done about that – no one knows how it got there even though there are cameras trained in every corner of the place. So if it’s good enough for the pResident[sic], his cabinet and his family, what’s the problem?

      Sick and evil deeds going on for decades and now we are at the breaking point.

    • The left has made victimhood and oppression fashionable as a social currency to be spent on gaining attention, sympathy. For those who are white, straight and middle class, and have no overt victimhoods or oppressions to boast, a serious drug addiction is the perfect way to become a victim and to have all the trappings of social attention and taxpayer largess rained down upon your poor, addicted head. If you are able-bodied and are not a person of color, of palestinian descent or member of the LGBT+++ contingent, you can become an addict, declare you are LGB/Transgender or say you are hearing voices and some Vermont agency will crawl on broken glass to come serve your needs and assuage your anxieties with taxpayer funds.

  7. Instead of calling it a “hub and spoke”, call it a “cluster f”! What a mess you’ve made!