他們稱之為“Tranq”——它導致街頭上的毒品甚至變得更加危險

資料來源：瑪莎·貝賓格 / 2022 年 8 月 11 日 / Kaiser Health News/ 財團法人台灣紅絲帶基金會編譯

在麻薩諸塞州青田市 (greenfield)，一名叫凱爾的男子走近一輛分發安全藥物用品的箱型車，他注意到有關甲苯噻嗪(Xylazine)（註1）的警報。

「賽拉嗪」（註1）？他問道，說出了這個陌生的詞。「告訴我更多」。

  

Tapestry Health Systems 護士凱蒂·羅賓斯 (Katy Robbins) 將瓶裝水遞給凱爾 (Kyle)，當他參觀了位於麻薩諸塞州青田市的移動式減害服務站。

Tapestry Health Systems 的一個街頭外展團隊發布了現已成為常規的警告內容。甲苯噻嗪是一種動物鎮靜劑。它尚未被批准用於人類，但在 Tapestry Health 於麻薩諸塞州西部連綿起伏的丘陵中所測試的藥物樣本中約有一半出現了這種情況。它主要出現在非法的芬太尼供應中，但也出現在可卡因中。

「過去一周，我們都在絞盡腦汁——比如，到底『發生了什麼事？』 」凱爾說。「因為如果我們把它加熱然後吸入它，我們就會睡著了」。

凱爾的深度睡眠也可能是由芬太尼引發的，但凱爾說他的一個朋友用試紙檢查阿片類藥物，但沒有檢測到。

甲苯噻嗪，也被稱為“tranq”或“tranq dope”，首先在波多黎各的一些地區激增，然後在費城，在最近的報告期內，91% 的阿片類樣本中都發現了甲苯噻嗪。 1 月至 6 月中旬的數據顯示，甲苯噻嗪存在於麻薩諸塞州藥物供應數據流所測試的 28% 的藥物樣本中，這是一個由國家資助的社區藥物檢查和諮詢小組網絡，使用質譜儀讓人們知道街上購買的藥丸或袋子裡裝的是什麼。

無論進入藥物供應的途徑是什麼，甲苯噻嗪的存在都在麻薩諸塞州及其他地區引發了警告，原因有很多。

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隨著甲苯噻嗪使用量的增加，藥物過量服用量也增加

也許最大的問題是甲苯噻嗪是否在美國最近的過量死亡人數增加中發揮了作用。在一項針對 10 個城市和州的研究中，在 2015 年不到 1% 的過量死亡病例中檢測到了甲苯噻嗪，但在 2020 年這一比例為 6.7%，美國設立了一年過量死亡的記錄。該記錄在 2021 年再次被打破，死亡人數超過 107,000 人。

該研究並未聲稱甲苯噻嗪是導致死亡人數增加的原因，但該研究的合著者 Chelsea Shover 表示它可能有所貢獻。甲苯噻嗪是一種鎮靜劑，可減緩人們的呼吸和心率並降低血壓，這可能會加劇芬太尼或海洛因等阿片類藥物的某些作用。

加州大學洛杉磯分校大衛格芬醫學院的流行病學家 Shover 說：「如果你有一種阿片類藥物和一種鎮靜劑，這兩種藥物在一起會產生更強的效果」。

在青田市，隨著越來越多的測試顯示甲苯噻嗪的存在，Tapestry Health 正在應對更多的過量用藥。 「這與上升有關，也與 Narcan （註2）無法有效逆轉甲苯噻嗪有關」，Tapestry 農村減害行動助理主任艾米戴維斯說。 Narcan 是納洛酮的品牌名稱，納洛酮是一種阿片類藥物過量逆轉藥物。

「聽到周圍有一些新的東西可能比我所擁有的更強大，這很可怕」，一位在 Tapestry Health 的箱型車旁停下來的女士說。梅說她對芬太尼有很強的耐受性，但幾個月前，她開始得到一些感覺不像芬太尼的東西，這種東西「在我收拾東西之前就把我擊倒了」。

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不斷變化的藥物過量反應

戴維斯和她的同事正在加強安全信息：切勿單獨使用，始終從小劑量開始，並始終攜帶 Narcan。

  

Tapestry Health Systems 的減害團隊從箱型車上分發管子、過濾器和其他用品，以便藥癮者能更安全地使用藥物。

 

戴維斯也在改變他們談論藥物過量的方式。他們首先解釋甲苯噻嗪不是阿片類藥物。將納洛酮噴入某人的鼻子不會逆轉甲苯噻嗪的深度鎮靜——施救者不會看到在阿片類藥物服用過量後使用納洛酮時所常見的劇烈覺醒現象。

如果有人服用了甲苯噻嗪，直接目標是確保使用者的大腦獲得氧氣。因此戴維斯和其他人建議人們在第一劑 Narcan 後開始人工呼吸。即使人沒有醒來，它也可能有助於重新啟動肺部。

「我們不想專注於意識——我們想專注於呼吸」，戴維斯說。

給予 Narcan 仍然很重要，因為甲苯噻嗪經常與芬太尼混合使團，而芬太尼正在殺人。

「如果你看到任何你懷疑服用過量藥物的人，請給 Narcan」，麻薩諸塞州春田市 Baystate 醫療中心的急診室醫生和減少傷害服務主任比爾蘇亞雷斯博士說。

蘇亞雷斯說，撥打 911 也很重要，尤其是當有人服用了甲苯噻嗪時，「因為如果這個人沒有按預期醒來，他們將需要更高級的照護」。

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「深度鎮靜作用」令健康提供者擔憂

麻薩諸塞州總醫院物質使用障礙橋樑診所的醫療主任 Laura Kehoe 博士說，一些吸毒者說甲苯噻嗪會使他們昏迷六到八小時，這引起了人們對這種「深度鎮靜」期間可能造成嚴重傷害的擔憂。

Kehoe 和其他臨床醫生擔心那些被甲苯噻嗪鎮靜並躺在陽光或雪地中的病人，也許是處在一個偏僻的地方。除了暴露在這些元素之外，他們可能會因為長時間躺在一個位置而容易患上腔室症候群（註3），或者他們可能會受到攻擊。

「我們看到有人遭到性侵犯」，基歐說。「他們醒來會發現褲子掉了或衣服不見了，他們完全不知道發生了什麼」。

在青田市，護士凱蒂·羅賓斯（Katy Robbins）拿出一張照片四月份甲苯噻嗪污染飆升時從一名病人身上看到的。「我們確實經歷此種情境，『哇，那是什麼？』」羅賓斯回憶道，一邊研究著她的手機。圖像顯示像深路皮疹一樣的傷口，有暴露的肌腱和蔓延的感染。 

在麻薩諸塞州西部經營行為和公共衛生服務的 Robbins 和 Tapestry Health 建立了網絡，因此顧客可以在當天與當地醫生或醫院預約治療此類傷害。但是讓人們去看看他們的傷口是很難的。「注射吸毒有很多污名標籤和恥辱」，羅賓斯說。「通常，人們會等到感染危及生命的時候才求醫」。

這可能是費城吸毒者截肢人數增加的原因之一。一種理論是甲苯噻嗪減少的血流量使傷口無法癒合。

費城坦普爾大學醫院醫學毒理學和成癮醫學主任喬·德奧拉齊奧博士說：「我們肯定看到了更多的傷口，而且我們看到了一些嚴重的傷口」。「幾乎每個人都與甲苯噻嗪有關聯」。

 

本文是包括 WBUR、NPR 和 KHN 等人在內之合作夥伴關係的一部分，（NPR 和 KHN 只用於本文中，指某一位使用非法藥物者的姓）。

 

註1. Xylazine：西班牙文Xylazine賽拉嗪，中文名甲苯噻嗪是一種未被批准用於人類的非阿片類獸用鎮靜劑，在不斷演變的吸毒成癮和用藥過量危機中，與美國國內越來越多的用藥過量死亡有關。研究顯示，接觸甲苯噻嗪的人經常有意或無意地將其與其他藥物，尤其是非法芬太尼。雖然美國國內涉及甲苯噻嗪的過量死亡的範圍尚不清楚，但研究顯示，與甲苯噻嗪有關的過量死亡已經向西蔓延到整個美國，其中東北部的影響最大。從 2015 年到 2020 年，賓夕法尼亞州所有涉及甲苯噻嗪的藥物過量死亡的百分比從 2% 增加到 26%。 2021 年馬里蘭州 19% 的藥物過量死亡和 2020 年康乃迪克州 10% 的藥物過量死亡都與甲苯噻嗪有關。研究顯示，甲苯噻嗪經常被添加到包括芬太尼在內的非法阿片類藥物中，並且人們還報告使用含有甲苯噻嗪的芬太尼來延長其欣快作用。大多數與甲苯噻嗪和芬太尼有關的過量死亡還涉及其他物質，包括可卡因、海洛因、苯二氮卓類藥物、酒精、加巴噴丁、美沙酮和處方阿片類藥物。

甲苯噻嗪亦被稱為「tranq」，是一種中樞神經系統抑製劑，可導致嗜睡和健忘症以及呼吸緩慢、心率和血壓降至危險的低水平。將阿片類藥物與甲苯噻嗪和其他中樞神經系統聯合使用抑製劑（如酒精或苯二氮卓類藥物）會增加危及生命的過量服用的風險。。如果懷疑甲苯噻嗪過量，專家建議給予阿片類藥物過量逆轉藥物納洛酮，因為甲苯噻嗪經常與阿片類藥物聯合使用。然而，由於甲苯噻嗪不是阿片類藥物，納洛酮不能解決甲苯噻嗪對呼吸的影響。因此，專家擔心非法阿片類藥物供應中甲苯噻嗪的日益流行可能會降低納洛酮對某些過量服用的效果。始終應提醒緊急醫療服務人員懷疑服用過量。更多信息可以從美國疾病控制和預防中心 (CDC) 網站以了解更多有關服用一種以上藥物（使用多種藥物）的影響暨有關停止藥物服用過量的資訊。

重複使用甲苯噻嗪還與皮膚潰瘍、膿腫和相關併發症有關。人們報告透過注射、吸食、吞嚥或吸入使用甲苯噻嗪或含有甲苯噻嗪的藥物。美國國家藥物濫用研究所(National Institute on Drug Abuse,NIDA) 支持的研究正在進行中，以繼續闡明美國新出現的藥物使用模式和非法藥物供應的變化，包括甲苯噻嗪、合成阿片類藥物的使用以及多種藥物使用模式的變化。

 

註2. Narcan：納洛酮（Naloxone），又常以商品名「Narcan」販售。 該藥物可以緩解攝入過量鴉片類藥物所造成的影響。 納洛酮可以與鴉片類藥物混入同一藥品中，以減少誤用時中毒的風險。 納洛酮常被製成鼻噴劑。可參考下列連結 https://www1.nyc.gov/assets/doh/downloads/pdf/basas/naloxone-palm-card-ch.pdf。

 

註3. compartment syndrome：「腔室症候群」是對肢體、生命產生威脅的一種狀況，是由於身體某部位神經、血管及肌肉在一個封閉的的空間（腔室）中受到壓迫。起因於腔室中升高的壓力，造成血管灌流不足，導致組織缺氧而壞死。腔室症候群最常發生在前臂及小腿，並可分成急性、亞急性及慢性腔室症候群。根據蘭金（Rankin, 1981）的定義，腔室症候群的起因是一個密閉空間中的壓力，使得該空間的循環及組織功能的受到阻礙。

 

 

They Call It ‘Tranq’ — and It’s Making Street Drugs Even More Dangerous

Martha Bebinger / August 11, 2022 / Kaiser Health News

Approaching a van that distributes supplies for safer drug use in Greenfield, Massachusetts, a man named Kyle noticed an alert about xylazine.

“Xylazine?” he asked, sounding out the unfamiliar word. “Tell me more.”

 

Tapestry Health Systems nurse Katy Robbins hands bottles of water to Kyle as he visits the harm reduction mobile unit in Greenfield, Mass.

A street-outreach team from Tapestry Health Systems delivered what’s becoming a routine warning. Xylazine is an animal tranquilizer. It’s not approved for humans but is showing up in about half the drug samples that Tapestry Health tests in the rolling hills of western Massachusetts. It’s appearing mostly in the illegal fentanyl supply but also in cocaine.

“The past week, we’ve all been just racking our brains — like, ‘What is going on?'” Kyle said. “Because if we cook it up and we smoke it, we’re falling asleep after.”

(NPR and KHN are using only first names in this article for people who use illegal drugs.)

Kyle’s deep sleep could also have been triggered by fentanyl, but Kyle said one of his buddies used a test strip to check for the opioid and none was detected.

Xylazine, which is also known as “tranq” or “tranq dope,” surged first in some areas of Puerto Rico and then in Philadelphia, where it was found in 91% of opioid samples in the most recent reporting period. Data from January to mid-June shows that xylazine was in 28% of drug samples tested by the Massachusetts Drug Supply Data Stream, a state-funded network of community drug-checking and advisory groups that uses mass spectrometers to let people know what’s in bags or pills purchased on the street.

Whatever its path into the drug supply, the presence of xylazine is triggering warnings in Massachusetts and beyond for many reasons.

As Xylazine Use Rises, So Do Overdoses

Perhaps the biggest question is whether xylazine has played a role in the recent increase in overdose deaths in the U.S. In a study of 10 cities and states, xylazine was detected in fewer than 1% of overdose deaths in 2015 but in 6.7% in 2020, a year the U.S. set a record for overdose deaths. The record was broken again in 2021, which had more than 107,000 deaths.

The study does not claim xylazine is behind the increase in fatalities, but study co-author Chelsea Shover said it may have contributed. Xylazine, a sedative, slows people’s breathing and heart rate and lowers their blood pressure, which can compound some effects of an opioid like fentanyl or heroin.

“If you have an opioid and a sedative, those two things are going to have stronger effects together,” said Shover, an epidemiologist at UCLA’s David Geffen School of Medicine.

In Greenfield, Tapestry Health is responding to more overdoses as more tests show the presence of xylazine. “It correlates with the rise, and it correlates with Narcan not being effective to reverse xylazine,” said Amy Davis, assistant director for rural harm-reduction operations at Tapestry. Narcan is a brand name of naloxone, an opioid overdose reversal medication.

“It’s scary to hear that there’s something new going around that could be stronger maybe than what I’ve had,” said May, a woman who stopped by Tapestry Health’s van. May said that she has a strong tolerance for fentanyl but that a few months ago, she started getting something that didn’t feel like fentanyl, something that “knocked me out before I could even put my stuff away.”

A Shifting Overdose Response

Davis and her colleagues are ramping up the safety messages: Never use alone, always start with a small dose, and always carry Narcan.

 

Tapestry Health Systems’ harm reduction team hands out pipes, filters, and other supplies for safer drug use from a van.

Davis is also changing the way they talk about drug overdoses. They begin by explaining that xylazine is not an opioid. Squirting naloxone into someone’s nose won’t reverse a deep xylazine sedation — the rescuer won’t see the dramatic awakening that is common when naloxone is administered to someone who has overdosed after using an opioid.

If someone has taken xylazine, the immediate goal is to make sure the person’s brain is getting oxygen. So Davis and others advise people to start rescue breathing after the first dose of Narcan. It may help restart the lungs even if the person doesn’t wake up.

“We don’t want to be focused on consciousness — we want to be focused on breathing,” Davis said.

Giving Narcan is still critical because xylazine is often mixed with fentanyl, and fentanyl is killing people.

“If you see anyone who you suspect has an overdose, please give Narcan,” said Dr. Bill Soares, an emergency room physician and the director of harm reduction services at Baystate Medical Center in Springfield, Massachusetts.

Soares said calling 911 is also critical, especially when someone has taken xylazine, “because if the person does not wake up as expected, they’re going to need more advanced care.”

“Profound Sedation” Worries Health Providers

Some people who use drugs say xylazine knocks them out for six to eight hours, raising concerns about the potential for serious injury during this “profound sedation,” said Dr. Laura Kehoe, medical director at Massachusetts General Hospital’s Substance Use Disorders Bridge Clinic.

Kehoe and other clinicians worry about patients who have been sedated by xylazine and are lying in the sun or snow, perhaps in an isolated area. In addition to exposure to the elements, they could be vulnerable to compartment syndrome from lying in one position for too long, or they could be attacked.

“We’re seeing people who’ve been sexually assaulted,” Kehoe said. “They’ll wake up and find that their pants are down or their clothes are missing, and they are completely unaware of what happened.”

In Greenfield, nurse Katy Robbins pulled up a photo from a patient seen in April as xylazine contamination soared. “We did sort of go, ‘Whoa, what is that?’ ” Robbins recalled, studying her phone. The image showed a wound like deep road rash, with an exposed tendon and a spreading infection.

Robbins and Tapestry Health, which runs behavioral and public health services in Western Massachusetts, have created networks so clients can get same-day appointments with a local doctor or hospital to treat this type of injury. But getting people to go get their wounds seen is hard. “There’s so much stigma and shame around injection drug use,” Robbins said. “Often, people wait until they have a life-threatening infection.”

That may be one reason amputations are increasing for people who use drugs in Philadelphia. One theory is that decreased blood flow from xylazine keeps wounds from healing.

“We’re certainly seeing a lot more wounds, and we’re seeing some severe wounds,” said Dr. Joe D’Orazio, director of medical toxicology and addiction medicine at Temple University Hospital in Philadelphia. “Almost everybody is linking this to xylazine.”

This article is part of a partnership that includes WBUR, NPR, and KHN.