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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  • The Fast-Mimicking Diet

    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.

    Live, Fast, Live Long

    This is Dr. Valter Longo. He’s a biogerontologist and cell biologist, whose work has focused on fasting and nutrient response genes, and how we can leverage them against diseases and aging in general.

    We reviewed his book recently:

    The Longevity Diet: Discover The New Science To Slow Aging, Fight Disease, And Manage Your Weight – by Dr. Valter Longo

    What does he want us to know?

    What to eat

    Dr. Longo recommends a mostly plant-based diet (especially vegetables, whole grains, and legumes), but also having some fish. The bulk of our dietary fats, however, he says are best coming from olive oil and nuts.

    He also advises aiming for nutritional density of vitamins and minerals in our diet, and/but supplementing with a multivitamin once every few days to cover any gaps.

    If in doubt choosing between plant-based whole foods, he recommends that we choose those our ancestors will have eaten.

    Read more: Longevity Diet For Adults

    When to eat

    Dr. Longo recommends time-restricted eating within a 12-hour window per day.

    See also: Intermittent Fasting: We Sort The Science From The Hype

    However, he also recommends (additionally or separately; it’s up to us; additionally is better but the point is it still has excellent benefits separately too) his “fast-mimicking diet” (FMD), which involves eating according to what we said in “What to eat”, but restricting it to 750 kcal per day, 5 days in a row, but not necessarily 5 days per week.

    For example, the following was a 3-month study that involved doing this for only one 5-day cycle per month:

    ❝Three FMD cycles reduced body weight, trunk, and total body fat; lowered blood pressure; and decreased insulin-like growth factor 1 (IGF-1). No serious adverse effects were reported.

    A post hoc analysis of subjects from both FMD arms showed that body mass index, blood pressure, fasting glucose, IGF-1, triglycerides, total and low-density lipoprotein cholesterol, and C-reactive protein were more beneficially affected in participants at risk for disease than in subjects who were not at risk.

    Thus, cycles of a 5-day FMD are safe, feasible, and effective in reducing markers/risk factors for aging and age-related diseases.❞

    ~ Dr. Min Wei et al. ← Dr. Longo was

    Note: the introduction mentions FMD in mice, but this is just referencing previous studies. This study is about FMD in humans!

    Read in full: Fasting-mimicking diet and markers/risk factors for aging, diabetes, cancer, and cardiovascular disease

    Want to know more?

    You might like this (text-based) interview with Dr. Longo, with the Health Sciences Academy:

    Eat, fast and live longer? Interview with Professor Valter Longo

    Take care!

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  • Cost of living: if you can’t afford as much fresh produce, are canned veggies or frozen fruit just as good?

    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.

    The cost of living crisis is affecting how we spend our money. For many people, this means tightening the budget on the weekly supermarket shop.

    One victim may be fresh fruit and vegetables. Data from the Australian Bureau of Statistics (ABS) suggests Australians were consuming fewer fruit and vegetables in 2022–23 than the year before.

    The cost of living is likely compounding a problem that exists already – on the whole, Australians don’t eat enough fruit and vegetables. Australian dietary guidelines recommend people aged nine and older should consume two serves of fruit and five serves of vegetables each day for optimal health. But in 2022 the ABS reported only 4% of Australians met the recommendations for both fruit and vegetable consumption.

    Fruit and vegetables are crucial for a healthy, balanced diet, providing a range of vitamins and minerals as well as fibre.

    If you can’t afford as much fresh produce at the moment, there are other ways to ensure you still get the benefits of these food groups. You might even be able to increase your intake of fruit and vegetables.

    New Africa/Shutterstock

    Frozen

    Fresh produce is often touted as being the most nutritious (think of the old adage “fresh is best”). But this is not necessarily true.

    Nutrients can decline in transit from the paddock to your kitchen, and while the produce is stored in your fridge. Frozen vegetables may actually be higher in some nutrients such as vitamin C and E as they are snap frozen very close to the time of harvest. Variations in transport and storage can affect this slightly.

    Minerals such as calcium, iron and magnesium stay at similar levels in frozen produce compared to fresh.

    Another advantage to frozen vegetables and fruit is the potential to reduce food waste, as you can use only what you need at the time.

    A close up of frozen vegetables (peas, carrot and corn).
    Freezing preserves the nutritional quality of vegetables and increases their shelf life. Tohid Hashemkhani/Pexels

    As well as buying frozen fruit and vegetables from the supermarket, you can freeze produce yourself at home if you have an oversupply from the garden, or when produce may be cheaper.

    A quick blanching prior to freezing can improve the safety and quality of the produce. This is when food is briefly submerged in boiling water or steamed for a short time.

    Frozen vegetables won’t be suitable for salads but can be eaten roasted or steamed and used for soups, stews, casseroles, curries, pies and quiches. Frozen fruits can be added to breakfast dishes (with cereal or youghurt) or used in cooking for fruit pies and cakes, for example.

    Canned

    Canned vegetables and fruit similarly often offer a cheaper alternative to fresh produce. They’re also very convenient to have on hand. The canning process is the preservation technique, so there’s no need to add any additional preservatives, including salt.

    Due to the cooking process, levels of heat-sensitive nutrients such as vitamin C will decline a little compared to fresh produce. When you’re using canned vegetables in a hot dish, you can add them later in the cooking process to reduce the amount of nutrient loss.

    To minimise waste, you can freeze the portion you don’t need.

    Fermented

    A jar of red peppers in oil.
    Fermented vegetables are another good option. Angela Khebou/Unsplash

    Fermentation has recently come into fashion, but it’s actually one of the oldest food processing and preservation techniques.

    Fermentation largely retains the vitamins and minerals in fresh vegetables. But fermentation may also enhance the food’s nutritional profile by creating new nutrients and allowing existing ones to be absorbed more easily.

    Further, fermented foods contain probiotics, which are beneficial for our gut microbiome.

    5 other tips to get your fresh fix

    Although alternatives to fresh such as canned or frozen fruit and vegetables are good substitutes, if you’re looking to get more fresh produce into your diet on a tight budget, here are some things you can do.

    1. Buy in season

    Based on supply and demand principles, buying local seasonal vegetables and fruit will always be cheaper than those that are imported out of season from other countries.

    2. Don’t shun the ugly fruit and vegetables

    Most supermarkets now sell “ugly” fruit and vegetables, that are not physically perfect in some way. This does not affect the levels of nutrients in them at all, or their taste.

    A mother and daughter preparing food in the kitchen.
    Buying fruit and vegetables during the right season will be cheaper. August de Richelieu/Pexels

    3. Reduce waste

    On average, an Australian household throws out A$2,000–$2,500 worth of food every year. Fruit, vegetables and bagged salad are the three of the top five foods thrown out in our homes. So properly managing fresh produce could help you save money (and benefit the environment).

    To minimise waste, plan your meals and shopping ahead of time. And if you don’t think you’re going to get to eat the fruit and vegetables you have before they go off, freeze them.

    4. Swap and share

    There are many websites and apps which offer the opportunity to swap or even pick up free fresh produce if people have more than they need. Some local councils are also encouraging swaps on their websites, so dig around and see what you can find in your local area.

    5. Gardening

    Regardless of how small your garden is you can always plant produce in pots. Herbs, rocket, cherry tomatoes, chillies and strawberries all grow well. In the long run, these will offset some of your cost on fresh produce.

    Plus, when you have put the effort in to grow your own produce, you are less likely to waste it.

    Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South Australia

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

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  • Finding Geriatric Doctors for Seniors

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    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝[Can you write about] the availability of geriatric doctors Sometimes I feel my primary isn’t really up on my 70 year old health issues. I would love to find a doctor that understands my issues and is able to explain them to me. Ie; my worsening arthritis in regards to food I eat; in regards to meds vs homeopathic solutions.! Thanks!❞

    That’s a great topic, worthy of a main feature! Because in many cases, it’s not just about specialization of skills, but also about empathy, and the gap between studying a condition and living with a condition.

    About arthritis, we’re going to do a main feature specifically on that quite soon, but meanwhile, you might like our previous article:

    Keep Inflammation At Bay (arthritis being an inflammatory condition)

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  • How often should you really weigh yourself?
  • Is A Visible Six-Pack Obtainable Regardless Of Genetic Predisposition?

    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.

    Have a question or a request? We love to hear from you!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small 😎

    ❝Is it possible for anyone to get 6-pack abs (even if genetics makes it easier or harder) and how much does it matter for health e.g. waist size etc?❞

    Let’s break it down into two parts:

    Is it possible for anyone to get 6-pack abs (even if genetics makes it easier or harder)?

    Short answer: no

    First, a quick anatomy lesson: while “abs” (abdominal muscles) are considered in the plural and indeed they are, what we see as a six-pack is actually only one muscle, the rectus abdominis, which is nestled in between other abdominal muscles that are beyond the scope of our answer here.

    The reason that the rectus abdominis looks like six muscles is because there are bands of fascia (connective tissue) lying over it, so we see where it bulges between those bands.

    The main difference genes make are as follows:

    • Number of fascia bands (and thus the reason that some people get a four-, six-, eight-, or rarely, even ten-pack). Obviously, no amount of training can change this number, any more than doing extra bicep curls will grow you additional arms.
    • Density of muscle fibers. Some people have what has been called “superathlete muscle type”, which, while prized by Olympians and other athletes, is on bodybuilding forums less glamorously called being a “hard gainer”. What this means is that muscle fibers are denser, so while training will make muscles stronger, you won’t see as much difference in size. This means that size for size, the person with this muscle type will always be stronger than someone the same size without it, but that may be annoying if you’re trying to build visible definition.
    • Twitch type of muscle fibers. Some people have more fast-twitch fibers, some have more slow-twitch fibers. Fast-twitch fibers are better suited for visible abs (and, as the name suggests, quick changes between contracting and relaxing). Slow-twitch fibers are better for endurance, but yield less bulky muscles.
    • Inclination to subcutaneous fat storage. This is by no means purely genetic; hormones make the biggest difference, followed by diet. But, genes are an influencing factor, and if your body fat percentage is inclined to be higher than someone else’s, then it’ll take more work to see muscle definition under that fat.

    The first of those items is why our simple answer is “no”; because some people are destined to, if muscle is visible, have a four-, eight, or (rarely) ten-pack, making a six-pack unobtainable.

    It’s worth noting here that while a bigger number is more highly prized aesthetically, there is literally zero difference healthwise or in terms of performance, because it’s nothing to do with the muscle, and is only about the fascia layout.

    The density of muscle fibers is again purely genetic, but it only makes things easier or harder; this part’s not impossible for anyone.

    The inclination to subcutaneous fat storage is by far the most modifiable factor, and the thus most readily overcome, if you feel so inclined. That doesn’t mean it will necessarily be easy! But it does mean that it’s relatively less difficult than the others.

    How much does it matter for health, e.g. waist size etc?

    As you may have gathered from the above, having a six-pack (or indeed a differently-numbered “pack”, if that be your genetic lot) makes no important difference to health:

    • The fascia layout is completely irrelevant to health
    • The muscle fiber types do make a difference to athletic performance, but not general health when at rest
    • The subcutaneous fat storage is a health factor, but probably not how most people think

    Healthy body fat percentages are (assuming normal hormones) in the range of 20–25% for women and 15–20% for men.

    For most people, having clearly visible abs requires going below those healthy levels. For most people, that’s not optimally healthy. And those you see on magazine covers or in bodybuilding competitions are usually acutely dehydrated for the photo, which is of course not good. They will rehydrate after the shoot.

    However, waist size (especially as a ratio, compared to hip size) is very important to health. This has less to do with subcutaneous fat, though, and is more to do with visceral belly fat, which goes under the muscles and thus does not obscure them:

    Visceral Belly Fat & How To Lose It

    One final note: fat notwithstanding, and aesthetics notwithstanding, having a strong core is very good for general health; it helps keeps one’s internal organs in place and well-protected, and improves stability, making falls less likely as we get older. Additionally, having muscle improves our metabolic base rate, which is good for our heart. Abs are just one part of core strength (the back being important too, for example), but should not be neglected.

    Top-tier exercises to do include planks, and hanging leg raises (i.e. hang from some support, such as a chin-up bar, and raise your legs, which counterintuitively works your abs a lot more than your legs).

    Take care!

    Don’t Forget…

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  • Natural Tips for Falling Asleep

    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.

    Questions and Answers at 10almonds

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    How to get to sleep at night as fast and as naturally as possible? Thank you!

    We’ll definitely write more on that! You might like these articles we wrote already, meanwhile:

    Don’t Forget…

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    Learn to Age Gracefully

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  • When Did You Last Have a Cognitive Health Check-Up?

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    When Did You Last Have a Cognitive Health Check-Up?

    Regular health check-ups are an important part of a good health regime, especially as we get older. But after you’ve been prodded, probed, sampled and so forth… When did you last have a cognitive health check-up?

    Keeping on top of things

    In our recent Monday Research Review main feature about citicoline, we noted that it has beneficial effects for a lot of measures of cognitive health.

    And that brought us to realize: just how on top of this are we?

    Your writer here today could tell you what her sleep was like on any night in the past year, what her heart rate was like, her weight, and all that. Moods too! There’s an app for that. But cognitive health? My last IQ test was in 2001, and I forget when my last memory test was.

    It’s important to know how we’re doing, or else how to we know if there has been some decline? We’ve talked previously about the benefits of brain-training of various kinds to improve cognition, so in some parts we’ll draw on the same resources today, but this time the focus is on getting quick measurements that we can retest regularly (mark the calendar!)

    Some quick-fire tests

    These tests are all free, quick, and accessible. Some of them will try to upsell you on other (i.e. paid) services; we leave that to your own discretion, but the things we’ll be using today are free.

    Test your verbal memory

    This one’s a random word list generator. It defaults to 12 words, but you can change that if you like. Memorize the words, and then test yourself by seeing how many you can write down from memory. If it gets too easy, crank up the numbers.

    Click here to try it now

    Test your visual memory

    This one’s a series of images; the test is to click to say whether you’ve seen this exact image previously in the series or not.

    Click here to try it now

    Test your IQ

    This one’s intended to be general purpose intelligence; in reality, IQ tests have their flaws too, but it’s not a bad metric to keep track of. Just don’t get too hung up on the outcome, and remember, your only competition is yourself!

    Click here to try it now

    Test your attention / focus

    This writer opened this and this three other attention tests (to get you the best one) before getting distracted, noting the irony, and finally taking the test. Hopefully you can do better!

    Click here to try it now

    Test your creativity

    This one’s a random object generator. Give yourself a set period of time (per your preference, but make a note of the time you allow yourself, so that you can use the same time period when you retest yourself at a later date) in which to list as many different possible uses for the item.

    Click here to try it now

    Test your musical sense

    This one’s a pitch recognition test. So, with the caveat that it is partially testing your hearing as well as your cognition, it’s a good one to take and regularly retest in any case.

    Click here to try it now

    How often should you retest?

    There’s not really any “should” here, but to offer some advice:

    • If you take them too often, you might find you get bored of doing so and stop, essentially burning out.
    • If you don’t take them regularly, you may forget, lose this list of tests, etc.
    • Likely a good “sweet spot” is quarterly or six-monthly, but there’s nothing wrong with testing annually either.

    It’s all about the big picture, after all.

    Don’t Forget…

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    Learn to Age Gracefully

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