Test strips for the dangerous street drug xylazine could save lives

There’s a new tool that may help address the dangers of xylazine, a powerful animal tranquilizer increasingly found in street drugs.

A handful of harm reduction programs in Massachusetts have started handing out test strips for xylazine, a drug that can produce gaping skin wounds and increase the risk of an overdose, or even death. The strips, similar to those used to detect fentanyl, are dipped in small amounts of a liquid drug for a positive or negative result.

Fenway Health, a Boston medical group, began offering the test strips in early June through programs in Cambridge and Somerville, as the presence of xylazine in drug samples tested in Massachusetts grew.

“It’s a great opportunity to help our clients keep themselves safe while they’re using drugs,” said Dr. Julia Fleming, medical director for public health programs at Fenway Health. “The more we learn about xylazine in the local drug supply, the more we learn about the negative consequences for our patients.”

Xylazine is typically found in drug samples that contain fentanyl and extends that drug’s effect of deep sedation. Naloxone — widely known as Narcan — reverses the effects of overdoses of fentanyl or other opioids and restores breathing. But it does not work on xylazine. Some drug users report “falling out” and not waking up or moving for hours on end. This can be especially dangerous if someone is outside in extreme heat or cold.

With the new test strips, there’s little guidance about what to do if xylazine is found to be present. Some people who use drugs say they are trying to avoid the ones that test positive for fentanyl and xylazine together, to limit the compounding effects. Fleming said it’s important not to do drugs alone, so there’s someone who could assist in case of an overdose.

Xylazine test strips came on the market in March. The first trial of their use was in Philadelphia, where public health leaders have been warning about xylazine for at least five years. Early and ongoing research there shows the strips accurately detected xylazine in more than 80% of drug and urine samples.

“They aren’t perfect, no drug screening test is. But they are a useful tool,” said Alex Krotulski, an associate director at the Center for Forensic Science Research and Education in Willow Grove, Pennsylvania, who is analyzing the strips in partnership with the Philadelphia Department of Public Health.

Researchers at Brandeis University are collaborating with colleagues in Philadelphia to help first responders, community outreach workers and people who use drugs learn more about how to deal with xylazine. Waltham-based Brandeis, in collaboration with Massachusetts Department of Public Health, is using a grant to assess the effectiveness of the test strips. And the school’s street drug-checking program was the first to detect xylazine on the rise in Massachusetts in 2020.

“If not for drug-checking data, we would be completely in the dark about xylazine’s presence in the commonwealth,” Brandeis professor Traci Green told state lawmakers in June. “How many people would have had to have their limbs amputated or bodies scarred by painful skin lesions before we would know that xylazine is here?”

BTNX Inc., the Ontario-based company that makes the test strips, said sales have been rising steadily since March, to about 200,000 kits this month.

“We’re seeing evidence that a lot of the fentanyl is spiked with xylazine,” said BTNX CEO Iqbal Sunderani. “I can see demand going up and up and up.”

The strips cost $2 each. Sunderani said he hopes to drop the price below $1 as production ramps up.

The state’s Department of Public Health is not buying the strips directly, but community groups may be using state funds to buy them. A spokeswoman for DPH said the state will consider bulk purchasing xylazine test strips, as it does for fentanyl test strips, if more research shows they work.