900% increase in blood infections likely due to opioids cut with animal tranquilizer, UVM Medical Center study finds - VTDigger

"Some of these are very extensive, even down to the bone," said Raymond. 

Two years ago, physicians at the UVM Medical Center began receiving more and more patients  with searing, necrotic flesh wounds. Blood cultures turned up the same diagnosis: group A strep infections, referred to by the acronym 'GAS'.

The wounds looked like the effects of xylazine, an animal sedative known on the streets as 'tranq', that dealers were already mixing with opioids. The drug causes necrotic wounds that serve as entry portals for bacteria. The Vermont Department of Health reported on the increasing role of xylazine in fatal opioid overdoses in the state in October 2021. 

When Raymond studied the UVMMC patients, the timeframe lined up: There were seven GAS infections identified during 2020 and 2021, and 64 from 2022 to October 2023, representing a 900% increase between the two-year periods. 

Of the 64 infections in the 2022-2023 period, 70% occurred in persons who reported injecting drugs, the majority of whom were unhoused. And xylazine exposure was self-reported or suspected by a clinician in nearly half of those cases. 

Raymond presented her results to a small group of journalists via a virtual press conference on Tuesday, alongside Dr. Lindsay Smith, an infectious disease physician at the UVMMC who treated many of the patients. 

"We're seeing ongoing numbers of people admitted with streptococcus," said Smith, emphasizing that while they did not yet have numbers for this year, the rate of patients admitted with GAS infection appeared on par with 2023. 

Although the best solutions would address the root causes of homelessness and substance use, Raymond said that more could be done to protect people who use drugs. 

"Homeless people need places to practice basic hygiene. They need access to wound care," she said, mentioning xylazine test strips as another important tool. 

Smith concurred, adding that people who use drugs need to trust and feel comfortable around those who treat them. Half of the injection drug users diagnosed with GAS infections in the UVMMC study either declined hospital admission or left against medical advice before completing antibiotic therapy. 

Finally, Raymond said the study made clear that the dangers of drug addiction extend beyond just overdoses. 

"We don't hear about many of the other bad outcomes of drug addiction such as these bloodstream infections," she said. 

If left untreated, a GAS infection can become life-threatening, the health providers said. During the length of the study, two of the patients entered sepsis and died from multi-organ failure.

"[They] were way farther down the disease spectrum," said Smith. "They entered health care too late."