PRESENTING AUTHOR: DAN CICCARONE

Introduction: ‘Tranq dope’ is a combination of xylazine and fentanyl that is increasingly common in the United States, especially concentrated on the East Coast. Typically injected, its use appears related to severe skin and soft tissue injury (SSTI) through an unknown mechanism. Previous research suggests that the high acidity of certain heroin source-forms contributes to vein damage and SSTI. We explore the possibility of an etiologic role between the acidity of tranq dope and SSTI.

Methods: A convenience sample of persons who use drugs in Philadelphia, PA, participated in semi-structured interviews in October 2023 (n=30). Video and photographic evidence documented observations of wounds and injection practices, and we analyzed narrative data for perceptions of wound causation. Our partner lab analyzed the pH of independently obtained samples of tranq dope (n= 6), in addition to drug samples devoid of xylazine to allow for comparison (n=4).

Results: Observed SSTI were extraordinarily severe. Several themes emerged related to wound etiology: 1) Tranq dope injection caused burning sensations; 2) vein loss occurred following chronic use of tranq dope; 3) vein loss resulted in increased injection attempts, the use of large central veins (e.g., jugular and brachial), as well as more frequent ‘skin-popping’; and 4) wounds, called ‘tranq burns’, rapidly followed vein loss. The average pH of samples was 4. Lab work is ongoing to test additional samples and replicate “real-world” solution preparation conditions.

Discussion: Combined use of xylazine and fentanyl leads to vein loss which increases the risk of subsequent SSTI. The acidity of the combination likely plays an etiologic role. Possible harm reduction interventions include dilution and buffering. Stigma reduction and enhanced wound care are required in harm reduction and clinical settings.