Treasure Island, Florida — 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 alongside former professional wrestler Hulk Hogan.
“He was extremely dedicated to it,” said his father, Andrew McClave Sr., “to the point where it almost felt like he missed his medication if he didn’t go.”
However, the hobby took its toll. According to a police report, a friend told the Treasure Island Police Department that McClave, 36, had back problems and took unprescribed pills to relieve pain.
In late 2022, the friend found McClave in bed. He had no pulse. An autopsy report revealed that he had a fatal amount of fentanyl, cocaine, and xylazine, a veterinary tranquilizer used to sedate horses, in his system. Heart disease was identified as a contributing factor.
McClave is one of over 260 people in Florida who died in one year from accidental xylazine overdoses, according to a Tampa Bay Times analysis of medical examiner data from 2022, the first year state officials began tracking the substance. The numbers for 2023 have yet to be published.
The death toll reflects xylazine’s spread throughout the country’s illicit drug supply. Federal regulators approved the animal tranquilizer in the early 1970s, and it is now used to sedate horses for procedures such as oral exams and colic treatment, according to Todd Holbrook, an equine medicine specialist at the University of Florida. Reports of xylazine use began in Philadelphia, and the drug spread south and west.
It’s unclear what role the sedative plays in overdose deaths, as the Florida data show no one died from xylazine alone. According to the Times analysis, the painkiller fentanyl was partially to blame in all but two of the cases where the veterinary drug was listed as the cause of death. Cocaine or alcohol played a role in cases where fentanyl was not present.
According to Lewis Nelson, chair of the emergency medicine department at Rutgers New Jersey Medical School, fentanyl is the “800-pound gorilla,” while xylazine may slightly increase the risk of overdose.
But xylazine appears to complicate the response to opioid overdoses when they occur, making it more difficult to save lives. According to federal health officials, Xylazine can slow breathing to dangerous levels and does not respond to the overdose reversal drug naloxone, also known as Narcan. Part of the problem is that many people may not realize they are taking a horse tranquilizer while taking other drugs, so they are unaware of the additional risks.
In 2016, Tallahassee lawmakers designated xylazine as a Schedule 1 drug, just like heroin or ecstasy, and several other states, including Pennsylvania, Ohio, and West Virginia, have followed suit. However, it is not prohibited at the federal level. Legislation
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.”
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.
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