Horse Sedative Use Among Humans Spreads in Deadly Mixture of ‘Tranq’ and Fentanyl

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TREASURE ISLAND, Fla. — Andrew McClave Jr. loved to lift weights. The 6-foot-4-inch bartender resembled a bodybuilder and once posed for a photo flexing his muscles with former pro wrestler Hulk Hogan.

“He was extremely dedicated to it,” said his father, Andrew McClave Sr., “to the point where it was almost like he missed his medication if he didn’t go.”

But the hobby took its toll. According to a police report, a friend told the Treasure Island Police Department that McClave, 36, suffered from back problems and took unprescribed pills to reduce the pain.

In late 2022, the friend discovered McClave in bed. He had no pulse. A medical examiner determined he had a fatal amount of fentanyl, cocaine, and xylazine, a veterinary tranquilizer used to sedate horses, in his system, an autopsy report said. Heart disease was listed as a contributing factor.

McClave is among more than 260 people across Florida who died in one year from accidental overdoses involving xylazine, according to a Tampa Bay Times analysis of medical examiner data from 2022, the first year state officials began tracking the substance. Numbers for 2023 haven’t been published.

The death toll reflects xylazine’s spread into the nation’s illicit drug supply. Federal regulators approved the tranquilizer for animals in the early 1970s and it’s used to sedate horses for procedures like oral exams and colic treatment, said Todd Holbrook, an equine medicine specialist at the University of Florida. Reports of people using xylazine emerged in Philadelphia, then the drug spread south and west.

What’s not clear is exactly what role the sedative plays in overdose deaths, because the Florida data shows no one fatally overdosed on xylazine alone. The painkiller fentanyl was partly to blame in all but two cases in which the veterinary drug was included as a cause of death, according to the Times analysis. Cocaine or alcohol played roles in the cases in which fentanyl was not involved.

Fentanyl is generally the “800-pound gorilla,” according to Lewis Nelson, chair of the emergency medicine department at Rutgers New Jersey Medical School, and xylazine may increase the risk of overdose, though not substantially.

But xylazine appears to complicate the response to opioid overdoses when they do happen and makes it harder to save people. Xylazine can slow breathing to dangerous levels, according to federal health officials, and it doesn’t respond to the overdose reversal drug naloxone, often known by the brand name Narcan. Part of the problem is that many people may not know they are taking the horse tranquilizer when they use other drugs, so they aren’t aware of the additional risks.

Lawmakers in Tallahassee made xylazine a Schedule 1 drug like heroin or ecstasy in 2016, and several other states including Pennsylvania, Ohio, and West Virginia have taken action to classify it as a scheduled substance, too. But it’s not prohibited at the federal level. Legislation pending in Congress would criminalize illicit xylazine use nationwide.

The White House in April designated the combination of fentanyl and xylazine, often called “tranq dope,” as an emerging drug threat. A study of 20 states and Washington, D.C., found that overdose deaths attributed to both illicit fentanyl and xylazine exploded from January 2019 to June 2022, jumping from 12 a month to 188.

“We really need to continue to be proactive,” said Amanda Bonham-Lovett, program director of a syringe exchange in St. Petersburg, “and not wait until this is a bigger issue.”

‘A Good Business Model’

There are few definitive answers about why xylazine use has spread — and its impact on people who consume it.

The U.S. Drug Enforcement Administration in September said the tranquilizer is entering the country in several ways, including from China and in fentanyl brought across the southwestern border. The Florida attorney general’s office is prosecuting an Orange County drug trafficking case that involves xylazine from a New Jersey supplier.

Bonham-Lovett, who runs IDEA Exchange Pinellas, the county’s anonymous needle exchange, said some local residents who use drugs are not seeking out xylazine — and don’t know they’re consuming it.

One theory is that dealers are mixing xylazine into fentanyl because it’s cheap and also affects the brain, Nelson said.

“It’s conceivable that if you add a psychoactive agent to the fentanyl, you can put less fentanyl in and still get the same kick,” he said. “It’s a good business model.”

In Florida, men accounted for three-quarters of fatal overdoses involving xylazine, according to the Times analysis. Almost 80% of those who died were white. The median age was 42.

Counties on Florida’s eastern coast saw the highest death tolls. Duval County topped the list with 46 overdoses. Tampa Bay recorded 19 fatalities.

Cocaine was also a cause in more than 80 cases, including McClave’s, the Times found. The DEA in 2018 warned of cocaine laced with fentanyl in Florida.

In McClave’s case, Treasure Island police found what appeared to be marijuana and a small plastic bag with white residue in his room, according to a police report. His family still questions how he took the powerful drugs and is grappling with his death.

He was an avid fisherman, catching snook and grouper in the Gulf of Mexico, said his sister, Ashley McClave. He dreamed of being a charter boat captain.

“I feel like I’ve lost everything,” his sister said. “My son won’t be able to learn how to fish from his uncle.”

Mysterious Wounds

Another vexing challenge for health officials is the link between chronic xylazine use and open wounds.

The wounds are showing up across Tampa Bay, needle exchange leaders said. The telltale sign is blackened, crusty tissue, Bonham-Lovett said. Though the injuries may start small — the size of a dime — they can grow and “take over someone’s whole limb,” she said.

Even those who snort fentanyl, instead of injecting it, can develop them. The phenomenon is unexplained, Nelson said, and is not seen in animals.

IDEA Exchange Pinellas has recorded at least 10 cases since opening last February, Bonham-Lovett said, and has a successful treatment plan. Staffers wash the wounds with soap and water, then dress them.

One person required hospitalization partly due to xylazine’s effects, Bonham-Lovett said. A 31-year-old St. Petersburg woman, who asked not to be named due to concerns over her safety and the stigma of drug use, said she was admitted to St. Anthony’s Hospital in 2023. The woman, who said she uses fentanyl daily, had a years-long staph infection resistant to some antibiotics, and a wound recently spread across half her thigh.

The woman hadn’t heard of xylazine until IDEA Exchange Pinellas told her about the drug. She’s thankful she found out in time to get care.

“I probably would have lost my leg,” she said.

This article was produced in partnership with the Tampa Bay Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

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  • Stay away from collarium sunbeds to avoid the big risk of collapsing with a bad tan.

    What are ‘collarium’ sunbeds? Here’s why you should stay away

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Reports have recently emerged that solariums, or sunbeds – largely banned in Australia because they increase the risk of skin cancer – are being rebranded as “collarium” sunbeds (“coll” being short for collagen).

    Commercial tanning and beauty salons in Queensland, New South Wales and Victoria are marketing collariums, with manufacturers and operators claiming they provide a longer lasting tan and stimulate collagen production, among other purported benefits.

    A collarium sunbed emits both UV radiation and a mix of visible wavelength colours to produce a pink or red light. Like an old-school sunbed, the user lies in it for ten to 20 minute sessions to quickly develop a tan.

    But as several experts have argued, the providers’ claims about safety and effectiveness don’t stack up.

    Why were sunbeds banned?

    Commercial sunbeds have been illegal across Australia since 2016 (except for in the Northern Territory) under state-based radiation safety laws. It’s still legal to sell and own a sunbed for private use.

    Their dangers were highlighted by young Australians including Clare Oliver who developed melanoma after using sunbeds. Oliver featured in the No Tan Is Worth Dying For campaign and died from her melanoma at age 26 in 2007.

    Sunbeds lead to tanning by emitting UV radiation – as much as six times the amount of UV we’re exposed to from the summer sun. When the skin detects enough DNA damage, it boosts the production of melanin, the brown pigment that gives you the tanned look, to try to filter some UV out before it hits the DNA. This is only partially successful, providing the equivalent of two to four SPF.

    Essentially, if your body is producing a tan, it has detected a significant amount of DNA damage in your skin.

    Research shows people who have used sunbeds at least once have a 41% increased risk of developing melanoma, while ten or more sunbed sessions led to a 100% increased risk.

    In 2008, Australian researchers estimated that each year, sunbeds caused 281 cases of melanoma, 2,572 cases of squamous cell carcinoma (another common type of skin cancer), and $3 million in heath-care costs, mostly to Medicare.

    How are collarium sunbeds supposed to be different?

    Australian sellers of collarium sunbeds imply they are safe, but their machine descriptions note the use of UV radiation, particularly UVA.

    UVA is one part of the spectrum of UV radiation. It penetrates deeper into the skin than UVB. While UVB promotes cancer-causing mutations by discharging energy straight into the DNA strand, UVA sets off damage by creating reactive oxygen species, which are unstable compounds that react easily with many types of cell structures and molecules. These damage cell membranes, protein structures and DNA.

    Evidence shows all types of sunbeds increase the risk of melanoma, including those that use only UVA.

    Some manufacturers and clinics suggest the machine’s light spectrum increases UV compatibility, but it’s not clear what this means. Adding red or pink light to the mix won’t negate the harm from the UV. If you’re getting a tan, you have a significant amount of DNA damage.

    Collagen claims

    One particularly odd claim about collarium sunbeds is that they stimulate collagen.

    Collagen is the main supportive tissue in our skin. It provides elasticity and strength, and a youthful appearance. Collagen is constantly synthesised and broken down, and when the balance between production and recycling is lost, the skin loses strength and develops wrinkles. The collagen bundles become thin and fragmented. This is a natural part of ageing, but is accelerated by UV exposure.

    Sun-damaged skin and sun-protected skin from the same person, and the microscopic image of each showing how the collagen bundles have been thinned out in the sun-damaged skin.
    Sun-protected skin (top) has thick bands of pink collagen (arrows) in the dermis, as seen on microscopic examination. Chronically sun-damaged skin (bottom) has much thinner collagen bands.
    Katie Lee/UQ

    The reactive oxygen species generated by UVA light damage existing collagen structures and kick off a molecular chain of events that downgrades collagen-producing enzymes and increases collagen-destroying enzymes. Over time, a build-up of degraded collagen fragments in the skin promotes even more destruction.

    While there is growing evidence red light therapy alone could be useful in wound healing and skin rejuvenation, the UV radiation in collarium sunbeds is likely to undo any benefit from the red light.

    What about phototherapy?

    There are medical treatments that use controlled UV radiation doses to treat chronic inflammatory skin diseases like psoriasis.

    The anti-collagen effects of UVA can also be used to treat thickened scars and keloids. Side-effects of UV phototherapy include tanning, itchiness, dryness, cold sore virus reactivation and, notably, premature skin ageing.

    These treatments use the minimum exposure necessary to treat the condition, and are usually restricted to the affected body part to minimise risks of future cancer. They are administered under medical supervision and are not recommended for people already at high risk of skin cancer, such as people with atypical moles.

    So what happens now?

    It looks like many collariums are just sunbeds rebranded with red light. Queensland Health is currently investigating whether these salons are breaching the state’s Radiation Safety Act, and operators could face large fines.

    As the 2024 Australians of the Year – melanoma treatment pioneers Georgina Long and Richard Scolyer – highlighted in their acceptance speech, “there is nothing healthy about a tan”, and we need to stop glamorising tanning.

    However, if you’re desperate for the tanned look, there is a safer and easy way to get one – out of a bottle or by visiting a salon for a spray tan.The Conversation

    Katie Lee, PhD Candidate, Dermatology Research Centre, The University of Queensland and Anne Cust, Professor of Cancer Epidemiology, University of Sydney

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    Share This Post

  • Missing Microbes – by Dr. Martin Blaser

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    You probably know that antibiotic resistance is a problem, but you might not realize just what a many-headed beast antibiotic overuse is.

    From growing antibiotic superbugs, to killing the friendly bacteria that normally keep pathogens down to harmless numbers (resulting in death of the host, as the pathogens multiply unopposed), to multiple levels of dangers in antibiotic overuse in the farming of animals, this book is scary enough that you might want to save it for Halloween.

    But, Dr. Blaser does not argue against antibiotic use when it’s necessary; many people are alive because of antibiotics—he himself recovered from typhoid because of such.

    The style of the book is narrative, but information-dense. It does not succumb to undue sensationalization, but it’s also far from being a dry textbook.

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  • How To Rebuild Your Cartilage

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    We’ve covered before the topic of wear-and-tear on joints such as:

    Avoiding/Managing Osteoarthritis

    But what of cartilage, in particular? A common belief is “once it’s gone, it’s gone”, but that’s not quite right.

    Cartilage is living tissue (metabolically active, with living cells). Within this tissue, specialist cells called chondrocytes produce extracellular cartilage matrix and collagen fibers, which provide smooth joint gliding as well as shock absorption.

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    • However, impact loading strengthens the subchondral bone plate (layer under cartilage)

    Strengthening this bone layer can help in long-term adaptation for high-impact sports.

    See also: Resistance Is Useful! (Especially As We Get Older)

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    Building up

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    4. Slowly transition to running and jumping over a long period to allow tissues to adapt.

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    • Indoor* cycling
    • Cross trainer
    • Leg press machine
    • Tennis

    *Why indoor? It’s so that you can control the resistance level at the twist of a knob, and get on and off when you want.

    See also: Treadmill vs Road ← for similar considerations when it comes to walking/running. Outdoor definitely has its advantages, but so does indoor!

    And the very related: How To Do HIIT (Without Wrecking Your Body)

    Note that HIIT is High Intensity Interval Training, not High Impact Interval Training!

    Strength from the inside

    One of the most important things for cartilage is collagen. You can supplement that, or if you’re vegetarian/vegan, you can take its constituent parts to improve your own synthesis of it.

    See: Collagen For Your Skin, Joints, & Bones: We Are Such Stuff As Fish Are Made Of

    Another supplement that can be helpful is glucosamine & chondroitin, which is best taken alongside a good omega-3 intake:

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    Want to know more?

    This book is technically about (re)building strength and mobility in the case of arthritis specifically, but if your joints have more wear than you’d like, you may find this one an invaluable resource:

    Yoga Therapy for Arthritis: A Whole-Person Approach to Movement and Lifestyle – by Dr. Steffany Moonaz & Erin Byron

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    Bell Peppers: A Spectrum Of Specialties

    We were going to do this as part of our ongoing “This Or That?” challenge, but as there are four main types all with many different benefits, we thought this bunch of fruits deserved a main feature.

    And yes, they’re botanically fruits, even if culinarily used as vegetables—much like tomatoes, famously!

    They’re all the same (but also very much not)

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    Notwithstanding the “Capiscum” genus, they don’t contain capsaicin (as is found in hot peppers). Capsaicin’s a wonderful phytochemical:

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    …but today we’re all about the bell peppers.

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    Green peppers have most of this important carotenoid, though the others all have some too. See also:

    Brain Food? The Eyes Have It!

    💛 Yellow for vitamin C

    Yellow peppers are technically highest in vitamin C, but all of them contain far more than the daily dose per fruit already, so if there’s any color of pepper that’s nutritionally the most expendable, it’s yellow, since any other color pepper can take its place.

    Watch out, though! Cooking destroys vitamin C, so if you want to get your Cs in, you’re going to want to do it raw.

    🧡 Orange for zeaxanthin and cryptoxanthins

    Similar in their benefits to lutein, these antioxidant carotenoids are found most generously in orange peppers (20x as much as in yellow, 10x as much as in red, and slightly more than in green).

    ❤️ Red for vitamins A & B6

    Red peppers are richest by far in vitamin A, with one fruit giving the daily dose already. The others have about 10% of that, give or take.

    Red peppers also have the most vitamin B6, though the others also have nearly as much.

    ❤️ Red for lycopene

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    Red is the only color of pepper to have lycopene.

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    Lycopene becomes 4x more bioavailable when cooked:

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  • Yoga Nidra Made Easy – by Dr. Uma Dinsmore-Tuli and Nirlipta Tuli

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  • Ultra-Processed People – by Dr. Chris van Tulleken

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    It probably won’t come as a great surprise to any of our readers that ultra-processed food is—to make a sweeping generalization—not fabulous for the health. So, what does this book offer beyond that?

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