By 

Andrew John Tucker, LCSW, CASAC 

“Death is not the greatest loss in life. The greatest loss is what dies inside us while we live.” 

~ Norman Cousins

Introduction 

If my experience working in Harm Reduction clinics has taught me anything, it is that meeting people where they’re at constantly builds toward something better in a dignified civilized way. As a clinician, I get the honor of seeing the relief on people’s faces when they know Im going to help them, regardless of where they’re starting. Harm Reduction is a set of strategies and interventions to reduce the negative consequences of substance use while recognizing that complete abstinence may not be immediately achievable or desirable for all individuals. We always say – if not us – then who? This means we get to interact with people who would never come in or be seen by abstinence-only models. We get to treat them, refer them, increase their general health, counsel them, and decrease all sorts of issues that plague individuals and entire societies.  It is a love story of recovery, and I’ve personally witnessed the impossible be possible. The hard part? Fentanyl and Xylazine…..as if Heroin weren’t enough….

The Meet them Where They’re at and Potatoes 

I loved working in opioid treatment. The clinic ensured we were never short on paperwork, so there I was puttering away with my door open (of course, always door open), and someone would eventually drag in. I loved these moments of connection. First of all, if they were in my office, it meant they were still alive, and if they were still alive, they could recover. But the key ingredient was to accept them where they were and believe them when they said they wanted to get better. The scary part was the toxicology vs. perception. Tox screens were mandatory to stay in the program, and of course, we did urines, but we also did very accurate swabs. It was always horrifying to me how people who were actively using and working with me on cutting down didn’t know what they were using. One person after another would tell me they “knew” the dealer and “knew” fentanyl wasn’t in their heroin, and one after another tested positive for Fentanyl. The look on their face told the whole story. We were looking at an epidemic, and people started dropping like flies.  

Fentanyl is considered to be significantly stronger than heroin. In fact, fentanyl is estimated to be approximately 50 to 100 times more potent than morphine, while heroin is roughly 2 to 5 times more potent than morphine. 

The Centers for Disease Control and Prevention (CDC) reported that in the United States, there were approximately 93,000 drug overdose deaths in 2020, with synthetic opioids like fentanyl being the primary driver of the increase in overdose deaths. That number has skyrocketed since then. 

But that wasn’t enough. More dead is good for business in the mental health analgesic disease model. They introduced Xylazine. If you don’t know what it is, that’s ok, but please know the drugs out there are getting deadlier and deadlier. Some say it started in South America, and others say Mexico. Either way – the results are the same. As if Fentanyl weren’t enough. 

Xylazine is a medication that belongs to the class of drugs known as alpha-2 adrenergic agonists. It is used in veterinary medicine as a sedative, muscle relaxant, and analgesic (pain reliever) for animals, particularly horses and other large animals.

Xylazine works by binding to and activating specific receptors in the brain and spinal cord called alpha-2 receptors. This leads to decreased activity of the nervous system, causing sedation, relaxation of the muscles, and pain relief.

While xylazine is not approved for use in humans, it has been used illicitly as a recreational drug in some parts of the world due to its sedative and hallucinogenic effects. However, such use is dangerous and can lead to severe adverse effects, including respiratory depression, coma, and even death. 

Conclusion

The Opioid crisis never lets up, and Opioid Treatment Programs are more critical than ever. They give people a chance to find a landing area of safety and counsel and a chance to receive education, stay alive, get better, and teach others. If you or anyone you know is struggling, you are not alone – reach out – ask for help. We are here. 

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If you or a loved one is experiencing substance misuse, depression, or anxiety – call or text for a free 15-minute consultation. 646-504-6212.