A drug ravaged rural America: Bracing for the battle against Tranq

The opioid epidemic has, indiscriminately, ravaged both urban and rural communities in the United States. However, there is a new drug taking over the country, and concern over how this may impact rural America is at the forefront of many heath service providers. As they brace for the inevitable impact, the question remains how rural communities can combat pervasive drug use while battling the systemic issues that made them vulnerable to this drug crisis in the first place. Fortunately, there may be some legislative relief on the horizon.

Until a few months ago, fentanyl was thought to be the most lethal drug on the streets of America. According to the California Department of Public Health, “fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine.” The Center for Disease Control and Prevention (CDC) reported that in 2021,synthetic opioid-related drug use accounted for over 100,000 deaths. Of that number, fentanyl-related deaths account for over half of all opioid related deaths. This number is consistently rising every year.

The CDC also noted that in five states, "California, Connecticut, North Carolina, Vermont, and Virginia, the rate of drug-overdose deaths in rural counties were higher than those in urban counties." The entire country is marred by the effects of the drug epidemic, however, rural Americans face particular challenges for several reasons discussed in class. These include restricted access to health care, treatment facilities, and doctors. Other more structural issues include, special isolation, poverty, housing insecurity, transportation, and even lack of internet access which impacts rural American’s ability to see online health providers.

In fact, in 2021,"rural children and adults under 65 were more likely than their urban peers to be uninsured." This data is significant because it shows that rural America is already suffering from health care disparities that will limit their response to the latest drug emerging in already decimated communities: Tranq.

Tranq is a street name for the animal tranquilizer, Xylazine, and is typically an additive to already lethal opioid drugs like heroin, cocaine, and fentanyl. While, the origins of this concoction are thought to have emerged from Puerto Rico, the New York Times recently reported its rising prevalence in the United States. It is currently unregulated and not criminalized.

One of the most alarming symptoms of Tranq is that persistent use causes open, gapping wounds in or around the injection sites of people struggling with addiction. While this symptom is not seen when the drug is used as intended, namely for animals, it is leading to an alarming rise in infections. This sometimes necessitates amputations after tissue becomes necrotic and, in some case, completely dies off.

Other side effect of this deadly drug include amnesia, drowsiness, slow breathing, and dangerously low heart rate and blood pressure. It has been dubbed a “zombie” maker for the way in which it causes those consuming it to immediately enter a deep stupor.

Ironically, rural America needs Xylazine. The drug is commonly used to treat cattle and other commercial live stock. While the White House designated Xylazine as a national drug threat, there are other considerations for animal caregivers that need the drug to do their jobs. For example, veterinarians fear that if the drug were regulated, the medicine and their access would be heavily policed. Another consideration is that “[p]roduction of a classified drug would require additional quality control and security measures so costly that a manufacturer could raise the drug’s price or just stop making it altogether.”

However, if Xylazine were regulated by the FDA, police would be able to criminalize distribution for human use. Significantly, the police can’t arrest a person for sales or distribution of xylazine. Therefore, there is virtually no law enforcement ability to effectively curtail sales.

In an effort to appease both those who want to criminalize Xylazine and those who do not want to, Sen. Catherine Cortez Masto, a Nevada Democrat, Sen. Chuck Grassley, an Iowa Republican, and Sen. Maggie Hassan, a New Hampshire Democrat introduced a bipartisan bill that would make anybody purchasing the drug pay the same fines as if it were classified as a Schedule III drug. Their hope is to keep the drug accessible to those who would suffer from its regulation but punish those profiting from its illegal uses.

Unfortunately, paying fines does little to stop the harm already underway. In March, the DEA reported that it 2022, it had found Tranq in confiscated fentanyl mixtures in 48 out of 50 states. In a separate report, the DEA noted it had found Xylazine in all four regions of the United States: Northeast, South, Midwest, and West. The South experienced the worst increase over a two-year period with Xylazine-related drug incidents up by 193%.

All the data suggests Tranq is taking over and while the full scope of the problem is not yet known, it is clear that trouble is brewing.

Ironically, Republican legislators may offer some hope. In an uncharacteristically timely move, a bill led by Iowans Sen. Chuck Grassley and Rep. Randy Feenstra to prevent opioid addiction, overdoses and deaths in rural communities was signed into law in December of 2022. The Rural Opioid Abuse Prevention Act, allows grants to be used for pilot programs for rural areas to implement community response programs that focus on reducing opioid overdose deaths, which may include presenting alternatives to incarceration.

The Rural Opioid Abuse Prevention Act is a step in the right direction, and as rural America prepares for another battle, it is a measure of assistance in a dessert of need.