(NewsNation) — For years, West Virginia has led the nation in drug overdose deaths per capita — an epidemic recently fueled by fentanyl and its analogs — but a powerful sedative known as “tranq” is bringing new challenges.
The so-called “zombie drug” xylazine is on the rise in major urban areas like New York City and Philadelphia. But the rural state with the worst opioid crisis hasn’t been spared.
Tranq, which is often mixed with fentanyl, showed up in about 5% of syringes when researchers at West Virginia University (WVU) started tracking the data just over a year ago. By August, the drug was detected in nearly 20% of samples tested, according to WVU’s data.
“The xylazine shows us that, even if we think we are tackling the right problem, that can change,” said Charles Mueller, a research associate with the Health Affairs Institute at WVU who oversaw the project.
The drug can cause serious skin ulcers, leaving users with gaping wounds that can sometimes require amputation. It also makes treating an overdose more difficult.
“This can be very, very dangerous,” Leigh Brooks, a nurse practitioner at Bluestone Primary Care, told NewsNation affiliate WVNS earlier this year. “There is no reversal for this, so if an overdose occurs, the Narcan can reverse the opioid in your system but it’s not going to reverse the Xylazine.”
Now, xylazine threatens to undermine decades of progress in the battle against opioid addiction.
How did the opioid problem get so bad in West Virginia?
In 1985, the U.S. coal mining industry employed nearly 180,000 people. Just eight years later, the coal workforce was half that. The transition devastated local economies in major coal states like West Virginia.
With fewer jobs, many people left. Those who stayed struggled to find well-paying work. The state’s drug problem has been linked, in part, to higher unemployment.
But lost opportunities are just part of the story. By the time miners were out of work, the grueling nature of the job had left its mark.
“You had a lot of former miners and families of miners with various aches, pains, and essentially broken bodies from supplying the nation with coal,” said Sam Workman, director of the Institute for Policy Research and Public Affairs at WVU and a native West Virginian.
The physical wear and tear laid the foundation for a broader crisis. As blue-collar jobs dried up, pharmaceutical companies like Purdue Pharma started promoting new pain-relief medications like OxyContin.
Four years after it was introduced, the drug was being prescribed in some West Virginia counties nearly 5 times more than the national average.
By 2000, total OxyContin sales had grown to almost $1.1 billion, up from $48 million in 1996.
With pills easy to come by, abuse rates ticked up, kicking off a cycle that’s become generational.
“You have children growing up in an environment where one or both parents may be addicted to these prescription drugs,” Workman said. “Addiction sort of breeds addiction.”
That dynamic has put more stress on other family members who have needed to step in. Today, West Virginia is among the top states where grandparents raise grandchildren.
With 90.9 drug overdose deaths per 100,000 people, West Virginia leads the nation. The next closest state, Tennessee, had 56.6 overdose deaths per 100,000 people in 2021, according to the CDC.
Mueller, who grew up in the state capital Charleston, thinks cultural attitudes also play a role. He says a deep-rooted sense of pride and self-reliance may make people less likely to seek help.
“Stigma is one of the hardest parts of the fight,” he said.
The crisis is deeply personal for Mueller, who became aware of the opioid problem in high school after several friends passed away.
Since then, prescription opioids have been replaced by deadlier synthetic opioids like fentanyl. Dangerous chemicals like tranq could make the problem worse.
“I’m not even 40 yet and I’ve been to more funerals than I’ve got fingers and toes,” Mueller said.
$1 billion in prescription drug settlements earmarked for solutions
West Virginia has reached more than a dozen settlements stemming from lawsuits brought against companies for their role in the prescription painkiller epidemic. The state now has around $1 billion in opioid litigation money, which will go toward combatting the crisis.
Counties along major interstates where drugs are more likely to flow into the state may put more emphasis on law enforcement to curb supply, Workman said. Whereas other areas away from heavily trafficked arterials may focus more on treatment and outreach.
Mueller thinks more access to real-time data — like the rapid-response needle-testing he oversaw — will be key in the future. That information could help police identify new threats like tranq, but it would also help harm reduction centers.
With rapid-response testing, treatment centers could tell people whether their syringes have traces of xylazine. From there, they could offer specific treatment.
The needle testing project was just a pilot program but Mueller hopes the research will continue.
“There’s a potential real value to doing this that extends beyond just knowing the fentanyls of the day,” he said.
At the federal level, lawmakers, including West Virginia Senators Shelley Moore Capito and Joe Manchin, have introduced legislation to classify xylazine as a controlled substance to crack down on illicit trafficking. The drug is currently approved in veterinary contexts but has no approved human usage.