‘Tranq,’ a street drug fanning out across the U.S., is fresh horror of opioid abuse syndrome

By LISA EISENHAUER

Dr. Zachary Risler can count on treating at least one patient every shift in the emergency room at Nazareth Hospital in Philadelphia who is either in the midst of an acute drug overdose, in need of care for recalcitrant wounds caused by injecting street drugs or dealing with another medical condition that has been spawned or worsened by substance abuse.

Most likely, he says, many of the patients have injected opioids cut with xylazine, a drug known on the street as tranq. Xylazine is a veterinary tranquilizer and painkiller with no approved uses in humans. It is widely present in opiates sold on the street in Philadelphia.

Routine toxicology tests done by hospitals don’t screen for xylazine, so Risler and his colleagues look for the clues that point

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XYLAZINE INFILTRATES STREET DRUG SUPPLY

WHAT IS XYLAZINE? Xylazine has federal approval for use in animals as a sedative and pain reliever.

Known on the street as “tranq.”

PHILADELPHIA: THE EPICENTER OF TRANQ

From 2015 to 2020, the percentage of all drug overdose deaths involving xylazine increased from 2% to 26% in Pennsylvania.

Repeated exposure to xylazine may lead to severe, necrotic skin ulcerations.

In 2021, 90% of street opioid samples in Philadelphia contained xylazine.

A WAVE OF WOUNDS Xylazine is not safe for use in humans and may result in serious and life-threatening side effects that appear to be similar to those commonly associated with opioid use.

SIGNS OF GROWTH ELSEWHERE Xylazine was involved in 19% of all drug overdose deaths in Maryland in 2021 and 10% in Connecticut in 2020.

3D baby images

From page 1 rolling, the baby appearing to sleep — but Ashton craved details.

Life hacks

Prior to that imaging appointment at the CHI Health Clinic Women’s Health, Ashton and her husband had done research about best practices and life hacks for visually impaired parents. They came across articles about physicians in Brazil who were making three-dimensional models of ultrasound images for patients who couldn’t see traditional ultrasounds.

The Johnsons casually talked about the value of those models during the fetal ultrasound. The technician made a mental note and related that conversation to Dr. Katie Sekpe, Ashton’s obstetrician. A colleague at CHI Health Clinic Women’s Health, Dr. John Coté, had printed 3D models of Sekpe’s own twins from fetal ultrasound images.

Sekpe approached Coté about creating the 3D models for Ashton, her first patient with a serious visual impairment.

Molding better outcomes

Coté is a clinical obstetrician-gynecologist with CHI Health and an assistant professor at Creighton University who has been researching, among many other subjects, the use of 3D printing for better patient outcomes.

He says his interest in 3D printing began when his family got a home 3D printer for Christmas several years ago. At first, he was mainly printing Star Wars figures and other toys for his kids but then the self-described “tech nerd” started experimenting with sending medical images — including computerized tomography and magnetic resonance imaging scans and ultrasounds — to the printer.

When Sekpe approached him, he was eager to help. He printed one of the several 3D models Ashton received in December. His is an FDM printer, short for fused deposition modeling. The printer extrudes and layers plastic filaments to replicate in three dimensions the flat two-dimensional image that it is interpreting. Coté says he’s learned over time how to refine electronic files like ultrasounds to remove the image distortions that can translate to physical shapes on a 3D model.

At Coté’s suggestion, Sekpe also enlisted a technician at the hospital to create additional models of Ashton’s ultrasound on the Stratasys brand PolyJet 3D printer used to create medical models at CHI Health Creighton University Medical Center — Bergan Mercy. The polymer it uses in printing has a different hardness when it is cured than the materials Coté’s printer uses. Coté says the colleagues wanted to give Ashton models of varying pliability so she could experience the contours of the baby’s face