SouthCoast experts worry this drug may boost the opioid crisis. Here's what to know.

NEW BEDFORD — After over a decade of what has come to be known as the "opioid crisis" in the U.S., public awareness on the dangers of opioids is more than established. However, despite years of bolstered efforts around things like addiction treatment and the availability of naloxone — the life-saving overdose reversal drug — the latest state data shows overdose death rates in Massachusetts continue to climb, reaching a new high of 2,331 in 2022.

With troubling new trends continuing to emerge — like increased findings of the animal tranquilizer xylazine mixed into supplies of drugs like fentanyl — many working in drug treatment, public safety and related fields feel they're fighting an uphill battle.

"Everytime you think you're making progress, there's something right around the corner more deadly than the last," said Laura Washington, chief operating officer at JH Schwartz Psychiatry and Addiction Medicine in New Bedford.

"It's like you're constantly chasing your tail with it," said New Bedford Fire Chief Scott Kruger.

According to the Mass. Department of Public Health's report released in December, there were 2,359 opioid-related overdose deaths statewide in 2022 — six more than in 2021, and well-over triple the number from a decade earlier in 2012 (733).

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The last time Mass. opioid overdose deaths were below 1,000 for the year was 2013.

What do local SouthCoast communities' data show?

Like the statewide data, a look at opioid overdose deaths by community shows that in the SouthCoast's urban centers of New Bedford and Fall River, rates showed little to no difference between 2021 and 2022. However, both cities' totals are pronouncedly higher than they were five years ago.

The total number of opioid overdose deaths for both communities, by year, is as follows:

Fatal overdose data for the SouthCoast towns of Dartmouth, Fairhaven, Acushnet, Freetown, Westport, Somerset and Swansea all remained in the single-digits throughout those same years, not surpassing eight deaths in any case.

Xylazine: the next fentanyl?

Many experts have credited sharp increases in drug overdoses seen during the early 2010s to the emergence of the synthetic opioid fentanyl, according to the DEA. From 2012 to 2021, deaths involving synthetic opioids, excluding methadone, multiplied over 26 times, going from roughly 2,600 to 68,000.

"Opioid-related overdose deaths are driven by the overwhelming presence of fentanyl in the drug supply, with over 93% of fatal opioid-related overdoses in the Commonwealth testing positive for fentanyl from January-April 2023," reads an overview of Mass DPH's report.

Now, national, state and local officials have a watchful eye on a more recent trend that some say has the potential to mirror the rapid spread and devastation of fentanyl.

"Xylazine is a huge problem right now," said Washington. "It's being mixed in with the fentanyl and it's ramping up at an alarming rate."

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According to DPH's report, xylazine — a tranquilizer/sedative for large animals — may increase fatal overdose risk and is being found in drug supplies at a rapidly growing rate, having become "routinely reported among opioid-related overdose deaths" starting in June 2022. Xylazine is also referred to as "Tranq" according to the DEA.

"In the first quarter of 2023, xylazine was present in 7% of opioid-related overdose deaths where toxicology screening was available. From January-June 2022, xylazine was detected in 28% of tested opioid samples throughout Massachusetts," the report reads.

Asked if she believes xylazine has the potential to match the scope and severity of the fentanyl problem, Washington said, "Oh, yeah."

Xylazine spotted in SouthCoast

Jennifer Reilly — a nurse practitioner involved with addiction treatment at Steppingstone Inc., JH Schwartz, and the Dartmouth House of Correction — agrees with her colleague's assessment.

"It's scary, and they're finding it's coming down here," said Reilly. "I've seen a couple people on it come through the jail. They do act a little different than someone who just used straight fentanyl."

Reilly said findings of xylazine have been more prevalent in the Greater Boston area, but "it's only a matter of time before there's more of it here."

Travis Rebello, a New Bedford firefighter and state hazmat coordinator, is known among the local public safety community as New Bedford's xylazine expert. The first time he encountered it relatively close to home, Rebello said, was in January 2022 during a hazmat response to Falmouth Hospital.

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"They shut down the ER because of a white powder that escaped, and when we field tested it, we saw it had fentanyl and xylazine," he said, noting that accidental exposure to either can be harmful or fatal.

Counterfeit prescription pills are everywhere

Rebello says his work with the state's Joint Hazards Incident Response, MSP Bomb Squad and Clandestine Laboratory Enforcement Team has given him a front row seat to the latest trends in the illicit drug trade. Through that lens, Rebello says xylazine becoming prevalent in the SouthCoast appears quite possible, as counterfeit prescription pills — most often comprised of fentanyl or a mixture that includes it — have become the dominant illicit drug presence on the street.

That said, buyers of these drugs — even those knowingly seeking fentanyl — can never be sure what's in their pills, which Rebello says are being made in makeshift labs "in all corners of Massachusetts."

In fact, it seems fentanyl and fentanyl mixtures have become an accepted stand-in for a range of commonly abused prescription medications, opioid or not.

"Counterfeit OxyContin 30 [mg] tabs are by far the most common, then Xanax bars are the second most common," Rebello said.

The closest illicit pill lab to home he's seen on the job was one in Fall River, Rebello said. However, in that 2019 case, it was MDMA pills shaped like SpongeBob Squarepants characters being made rather than counterfeit prescription meds.

NBFD: 'We're ready for xylazine'

New Bedford Fire Chief Scott Kruger says he's grateful that New Bedford benefits from Rebello's knowledge gained through his state hazmat work. It's a heightened awareness that's put the city in a better position to handle any challenges xylazine may bring, he said.

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NBFD's preparations, Kruger said, include select vehicles having field test strips for the drug and — as far as he's aware — having one of the only working dogs in the country trained to detect it.

"We're ready for xylazine," Kruger said.

Kruger also noted he and Rebello attended a seminar on xylazine sometime in 2022 at Harvard Medical School.

Challenges include shortcomings in detection, overdose treatment capabilities

While first responders say New Bedford may be relatively ahead of the pack on xylazine preparedness, there are some universal challenges to address as the public safety sector races to catch up.

One challenge is detection, New Bedford EMS Director Michael Thomas said, as xylazine field tests aren't yet standard carry items for first responders, and paramedics' focus is on sustaining life in the moment rather than investigating the finer details behind an apparent overdose.

"It all gets categorized as a narcotic overdose," Thomas said. "If they respond to Narcan [brand name for naloxone] we know it was a narcotic, but we can't really differentiate."

Conversely, if a suspected narcotic overdose patient doesn't respond to naloxone, it may mean xylazine is present, but that's still far from conclusive, Thomas said, as there can be a number of reasons naloxone doesn't work.

"Sometimes it's just the strength of what was taken," Thomas said.

Naloxone ineffective

This segues into another challenge: Because xylazine is not an opioid, overdoses brought on by the drug cannot be reversed with naloxone. Furthermore, since xylazine is approved for animals only, so is the antidote that could help in the event of an overdose, according to Rebello.

"There are a couple different reversal agents but they're not ready for human consumption," Rebello said.

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Considering the efforts made in recent years to combat the opioid crisis in Massachusetts, including making naloxone available over-the-counter, Washington says she found DPH's 2022 data on fatal overdoses surprising, and she wouldn't be shocked to learn that xylazine is playing some role.

"They're pumping out Narcan everywhere, so I do wonder about that," she said.

Fentanyl comes in many forms

Factoring out xylazine or any other new threat, Rebello said fentanyl alone continues to pose a constant learning curve, as there have come to be many variations of the drug birthed in illicit labs like the ones he's seen.

"I think we've dealt with 1,400 analogs of fentanyl, and different analogs will require different amounts of naloxone to reverse it," he said, noting the likelihood of illicitly-used fentanyl being from a diverted medical prescription is minimal these days. "We've had to give more doses for years now."

Incomplete 2023 data hints at possible progress

While 2023 data wasn't yet processed at the time of the report, DPH estimated there'd be approximately 1,718 opioid overdose deaths statewide for the year. The last time opioid deaths were nearly as low was 2015, at 1,748.

While not revealing the local number, New Bedford Health Department Director Stephanie Sloan said "data available to the Health Department and the Greater New Bedford Opioid Task Force, through November 2023, indicate that fatal overdoses in New Bedford in 2023 are stable, or potentially trending lower, than fatal overdoses in New Bedford in 2022."

Sloan said her department offers a number of resources at no cost to residents who are interested. These include free naloxone, trainings on how to administer it, and testing strips for fentanyl and xylazine. (See below for contact info.)

Sloan also noted the health department's role, starting in 2016, in co-chairing the Greater New Bedford Opioid Task Force. That work, she said, is currently supporting a number of programs and initiatives, including:

• Law Enforcement Assisted Diversion (LEAD) program;

• Post Overdose Program;

• Embedding Peers in the Emergency Department;

• Implementing Overdose Prevention Strategies at the Local Level;

• First Responder Comprehensive Addiction Recovery Act;

• Department of Labor’s Dislocated Worker Grant;

• Equitable Approaches to Public Safety;

• Strategic Opioid Response-Prevention in Early Childhood;

• Massachusetts Collaborative for Action, Leadership, and Learning III.

"In addition to those efforts, the Task Force hosts an International Overdose Awareness Day event every year and is part of the Bristol County Regional Alliance, which hosts quarterly meetings and events across the region," Sloan said.

DPH recommends supervised injection sites

One topic of debate in the opioid crisis is the idea of overdose prevention centers, or OPCs, where drug users can consume drugs with medical staff on hand to assist in the event of an overdose and supply things like clean needles. The problem is, they're federally illegal.

"OPCs have operated for more than 30 years in Canada, Australia, and much of Europe; no overdose death has ever been reported at a sanctioned OPC," reads the December DPH report. "There is significant evidence on the positive impact of OPCs on mortality, health outcomes, addiction treatment, crime, and cost...."

According to the report, DPH officials favor passage of pending legislation, H.1981/S.124, that would protect municipal or private entities operating OPCs, the staff, and "participants" against legal action.

"Absent this legislation, individuals and entities face significant exposure to both civil and criminal liability as well as risk to their professional licensure," the report reads.

Local experts not sure on DPH's suggestion

Reilly and Washington say for now they haven't formed hard opinions on the state's recommendation.

"I kind of have mixed feelings on that," said Reilly, who says she might try expanding resources like detox beds and MAT (medication-assisted treatment) clinics to sufficient levels first before resorting to OPCs.

"I can see it both ways — it's good that if they overdose there's a nurse there ... but we also need more resources to get them help, to get them off the streets, into programming."

With long waits for detox beds, Reilly said patients desperately trying to get clean are sometimes put in compromising positions.

"I have people who’ve had to use everyday because in order to get a detox bed, you have to have fentanyl in your system," Reilly said.

One new drawback she sees with OPCs is the threat of xylazine-based overdoses.

"With no antidote to xylazine, as a nurse, I can't save them," she said. "What would that do to a person's psyche?"

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Washington, who says she's also a proponent of more MAT and detox availability, said if the state is going so far as to consider OPCs, perhaps it should go further.

"Maybe we need to look at legalizing these drugs then if you're going to have safe injection sites," Washington said, noting the current legal hazards around OPCs. "Maybe people would stick around more and help when their friend overdoses, because they wouldn't be afraid of getting in trouble."

Giving/getting help

To access any of the New Bedford city programming mentioned in this article, including free Narcan and training; or to learn how to help, call 508-991-6199 or visit the Greater New Bedford Opioid Taskforce website at gnbotf.org.

Steppingstone Inc., with New Bedford and Fall River locations, can be reached at 508-674-2788 or online at steppingstone.org.

ConciergeTMS, home to JH Schwartz Psychiatry and Addiction Medicine, can be reached at 508-997-6091, ext. 2103, or at concierge-tms.org.

Did you know?: According to the DPH report, there were 13,268 patients treated by EMS in opioid-related incidents from January-September 2023. Out of those, more than half were males (9,035 of 13,268). The biggest age group was 35-44 (3,976) representing just under 30%.

This article originally appeared on Standard-Times: Greater New Bedford experts weigh in on opioids, new xylezine trend