Suffolk Stop Addiction

Xylazine is becoming more common in the illegal drug supply, and is being mixed with opioids like heroin and fentanyl. Xylazine can cause drowsiness, slow breathing, decrease blood pressure, and lower heart rate. When mixed with other opioid drugs, like heroin, fentanyl, and benzodiazepines (like Xanax®, Valium®, Klonopin®, Ativan® and others), the risk of opioid overdose is higher. Xylazine can also make it more difficult to tell is naloxone (NARCAN®) is working, because a person may start breathing again, but remain unconsciousness. If you suspect that someone is experiencing an opioid overdose, always use naloxone (NARCAN®), call 911, and stay with them until help arrives. Remember, naloxone (NARCAN®) cannot hurt someone if they have not used an opioid, so always use it if an opioid overdose is a possibility.

Xylazine can also cause severe wounds to appear on the skin. These wounds have been seen with people who smoke, snort, or inject drugs that have xylazine in it. These wounds can away from injection or use sites, and can get worse quickly. These wounds can be very difficult to heal, so it is important to get medical attention if you see them. Medical providers can help prevent infections and stop the wounds from getting worse.

Following these harm reduction practices may reduce the risk of fatal opioid overdose:

• CARRY NALOXONE (NARCAN®): Show others where it is and how to use it. More than one dose may be needed.
• USE WITH SOMEONE ELSE: If you overdose, it's important to have someone around to help.
• TAKE TURNS USING: Be prepared with naloxone (NARCAN®) and have a phone on hand in case you need to call 911.
• TEST YOUR DRUGS: A small amount of fentanyl can cause an overdose. Use fentanyl test strips to see if fentanyl is in your drugs. This can help you make safer use decisions.
• USE SLOW AND USE LESS: Use a small amount first to see how strong your drugs are.
• AVOID MIXING DRUGS: Mixing drugs - including alcohol - increases your risk of overdose.

If you suspect that someone is experiencing an opioid overdose, always use naloxone (NARCAN®), call 911, and stay with them until help arrives.

Naloxone (NARCAN®) will have a direct effect on the opioid, like fentanyl or heroin. The most important reason to use naloxone (NARCAN®) is to restore normal breathing. When someone is experiencing an overdose, their breathing is very slow or shallow. Giving naloxone (NARCAN®) to a person experiencing an overdose will work to restore normal breathing.

Xylazine is not an opioid, so naloxone (NARCAN®) will not have a direct effect on the symptoms that xylazine causes. Xylazine can cause drowsiness, slow breathing, decrease blood pressure, and lower heart rate.

When you give naloxone (NARCAN®) to a person that has used an opioid mixed with xylazine, the most important thing to look for is normal breathing. Because the xylazine can cause heavy sedation, the person may remain unconscious, even though the naloxone (NARCAN®) is working on the opioid, and the person is breathing more normally. Because some opioids, like fentanyl, are stronger than others, it may take more than 1 dose of naloxone (NARCAN®) to restore breathing. After you give 1 dose of naloxone, monitor the person for changes in breathing. If breathing has not improved after 3-5 minutes, give a second dose of naloxone (NARCAN®) into the other nostril. Always call 911 so you have backup on the way to help save the person’s life!

The U.S. Drug Enforcement Administration (DEA) has issued a public safety alert about xylazine, and the risk it poses to health and safety. Visit their website now to read more: https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine

The New York State Department of Health has issued a summary document on xylazine for healthcare providers, titled Xylazine: What Clinicians Need to Know. This document provides information to providers about what xylazine is, current trends, diagnostic testing, presentation and management of xylazine-involved overdoses, and wound care. The document also includes information on how to message basic harm reduction methods with their patients, and relevant resources. Use the following link to access Xylazine: What Clinicians Need to Know:

https://www.health.ny.gov/publications/12044.pdf

Yes, you can test for xylazine in your drugs using xylazine test strips.

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. People who use drugs may not be ready to enter treatment, or stop their use. Harm reduction strategies recognize this, and support people to make changes, when they are ready, to reduce their health and safety risks.

If you are going to use drugs, there are a few different steps you can take to reduce your risk of opioid overdose. These harm reduction steps include:

• CARRY NALOXONE (NARCAN®): Show others where it is and how to use it. More than one dose may be needed.
• NEVER USE ALONE: If you overdose, it's important to have someone around to help.
• TAKE TURNS USING: Be prepared with naloxone (NARCAN®) and have a phone on hand in case you need to call 911.
• TEST YOUR DRUGS: A small amount of fentanyl can cause an overdose. Use fentanyl test strips to see if fentanyl is in your drugs. Use xylazine test strips to see if xylazine is in your drugs. Testing can help you make safer use decisions.
• USE SLOW AND USE LESS: Use a small amount first to see how strong your drugs are.
• AVOID MIXING DRUGS: Mixing drugs - including alcohol - increases your risk of overdose.

Along with these harm reduction strategies, like carrying naloxone (NARCAN®), another tool you can use is xylazine test strips (XTS). In the unregulated, illegal drug supply, you will not always know what is in your drugs. Xylazine test strips can be used to test your drugs for the presence of xylazine, before you use them. You can test most drugs for the presence of xylazine using xylazine test strips. XTS can be used with most drugs that are in liquid, powder, or pill form, such methamphetamine, heroin, or street pills stamped as Xanax or Adderall. It is NOT recommended to test cocaine with xylazine test strips. Cocaine is often cut with lidocaine, which will give a false positive for xylazine (the test strip will show a positive result, but there actually may not be any xylazine in the drug).

Xylazine test strips will only tell you if your drugs contain xylazine, but WILL NOT tell you how much xylazine there is, or how strong it is. Because you do not know if there is a little, or a lot, of xylazine mixed into your drug, it is important to follow the harm reduction practices described. Xylazine test strips do not guarantee that your drugs are safe to use, but the results can help you to make an informed decision about what to do next, to help keep you safer if you use drugs.

Using xylazine test trips to know if xylazine is mixed with your drugs is simple. To use a xylazine test strip, you will need:

• A sealed, unused test strip
• 1 teaspoons of water
• A mixing vessel like a clean cup, cooker, or large bottle cap
• The drug you need to test

The general steps to test a drug are to take a small sample of your drug and mix it with water, dip in the test strip, and read the results. The exact steps you will take depends on if you are testing a powder, pill, or liquid.

POWDER:

1. STEP ONE: PREPARE THE SAMPLE - Empty the powdered drug from the baggie. The residue left behind can be enough to test. Or, add 10mg of your drug to a small cup or cap. 10mg is enough to cover Abraham Lincoln’s hair on a penny.
2. STEP TWO: ADD WATER - Add 1 teaspoon of water (5 milliliters) to the baggie or small container. NOTE: If you are testing MDMA, Ecstasy, Methamphetamine or if you suspect it may be cut with Benadryl, DOUBLE the amount of water.
3. STEP THREE: DIP & SWISH THE STRIP - With clean hands, take the xylazine test strip out of the package. Pick up the strip by the large, red end. Then, dip the strip into the baggie/ container with the water and drug mixture, up to the red line. Then, stir and swirl the end in the water for 15 seconds. Remove the test strip and lay on a clean, dry surface, and wait 5 minutes.

PILL:

1. STEP ONE: PREPARE THE SAMPLE – Crush the pill into a fine powder, and mix it well. Xylazine is almost always found with fentanyl. If there is xylazine in the pill, it may not be evenly distributed throughout the pill. It may form little clumps inside the pill, like chocolate chips in a cookie. Crushing the whole pill and mixing it makes sure you are getting a good sample to test. Add 10mg of your drug to a small cup or cap. 10mg is enough to cover Abraham Lincoln’s hair on a penny.
2. STEP TWO: ADD WATER - Add 1 teaspoon of water (5 milliliters) to the small container.
3. STEP THREE: DIP & SWISH THE STRIP - With clean hands, take the xylazine test strip out of the package. Pick up the strip by the large, red end. Then, dip the strip into the baggie/ container with the water and drug mixture, up to the red line. Then, stir and swirl the end in the water for 15 seconds. Remove the test strip and lay on a clean, dry surface, and wait 5 minutes.

LIQUID:

1. STEP ONE: PREPARE THE SAMPLE – Add a few drops of the drug to a small cap or cooker.
2. STEP TWO: ADD WATER - Add 1 teaspoon of water (5 milliliters) to the small cap or cooker.
3. STEP THREE: DIP & SWISH THE STRIP - With clean hands, take the xylazine test strip out of the package. Pick up the strip by the large, red end. Then, dip the strip into the baggie/ container with the water and drug mixture, up to the red line. Then, stir and swirl the end in the water for 15 seconds. Remove the test strip and lay on a clean, dry surface, and wait 5 minutes.

If there is ONE dark red line on the strip, the test is positive. That means that there IS xylazine in the drug.

If there are TWO red lines on the strip, the test is negative. That means that the strip did not detect xylazine in the drug.

If there are NO red lines on the strip, or only a faint red line on the left, the test was invalid. That means that something went wrong with the test, and you need to try again with a NEW strip. Xylazine test strips can only be used ONCE.

Remember, xylazine test strips will only tell you if your drugs contain xylazine, but WILL NOT tell you how much xylazine there is, or how strong it is. Because you do not know if there is a little, or a lot, of xylazine mixed into your drug, it is important to follow the harm reduction practices like carrying naloxone, and never using drugs alone. Xylazine test strips do not guarantee that your drugs are safe to use, but the results can help you to make an informed decision about what to do next, to help keep you safer if you use drugs.

There are many resources for no-cost xylazine test strips available to you! If you, or someone you know, is using drugs, use these resources below to get and use xylazine test strips. You can get xylazine test strips mailed directly to you, or meet with local programs to get them in person.

1. In- Person: Drug User Health Hub & Syringe Exchange Program (SEP) - The New York State Department of Health has organized Drug User Health Hubs in each region of the State to improve the availability and accessibility of physical health, mental health, and medication for addiction treatment (MAT) services for people who use drugs, especially people use inject drugs. Drug User Health Hubs focus their work around harm reduction, with a special emphasis on preventing and responding to opioid overdose.
   1. On Long Island, our Drug User Health Hub is called Community Action for Social Justice (CASJ): https://casj.org/
   2. You can contact CASJ via email at info@nysocialjustice.org, or call 1-866-599-7260
2. By Mail: New York State Office of Addiction Services and Supports - In an effort to curb the overdose epidemic in NYS, the NYS Office of Addiction Services and Supports (OASAS) is making test strips available to all New Yorkers. No-cost test strips and naloxone (NARCAN®) can be mailed directly to you.
   1. Follow the https://oasas.ny.gov/harm-reduction link to the Harm Reduction page on the OASAS website.
   2. Near the top of the page, click on the "order now" button.
   3. Answer the following questions about what supplies you need, and where to ship them, and then complete your order.
   4. You can learn more about fentanyl and xylazine by using this link to access the OASAS Community Overdose Prevention Education page: https://oasas.ny.gov/projectcope
3. By Mail: NY MATTERS - NY MATTERS is working with the New York State Department of Health to make xylazine test strips more available. No-cost xylazine test strips can be mailed directly to you.
   1. Follow the https://mattersnetwork.org/request-test-strips/ link to the test strip order page on the NY MATTERS website
   2. Click the large “I am an Individual” box on the left side of the page
   3. Answer the following questions about what supplies you need, and where to ship them, and then complete your order.