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Xylazine, a one-way trip to Dante’s Inferno

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In the whole world, environmental disasters, poverty, inequalities and social injustice are increasing, health care is degrading, same for education and moral values; it is also noted the instrumentalisation of religions and human rights; the metropoles are subject to pollution, crimes, human trafficking and flourishing illicit drug markets. And among the long, impressive and life-threatening list of illicit drugs and New Psychoactive Substances (NPS) -most often produced to circumvent the drug laws- the emergence of a new one, Xylazine, is gaining the attention of the concerned authorities (Rodriguez N. et al., 2008).Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” said Administrator Milgram-U.S.A. Drug Enforcement Administration (2023).

The xylazine (C12H16N2S) is not an opioid like fentanyl but a methyl benzene from the class of phenothiazines. It had been produced by various alternate syntheses, starting in Germany (Bayer Pharmaceutics, 1962). This is a highly lipophilic substance, so easily crosses the membranes and reaches the brain receptors as well as the ones in the body.

This is a drug initially considered for use in humans as an antihypertensive agent, but due to the adverse effects in humans (severe hypotension and Central Nervous System depressant effects), its medical use was discontinued.

In 1972 its use was approved by the U.S. Food and Drug Administration only in veterinary medicine for sedation (for 1-4 hours), analgesia (15-30 min), anaesthesia for surgical procedures, and as a muscle relaxant, in animals such as horses, cattle, sheep, dogs, and others.

Xylazine in human misuse is known under the names of flesh-eating drug, tranq, tranq-dope, zombie drug, sleep-cut, and Philly dope. It is called a “zombie drug” because the users have this particular, confused, hunched and slowed move or in some cases are in a trance-like state, which gives them the appearance of the living dead that people describe as being zombie-like.

In 2022, the Estonian police reported seizing mixtures containing new opioids and the animal sedative and analgesic xylazine. Most often, xylazine is used as a cheap drug adjuvant (online, for 6-20 dollars per kilogram) to inflate doses of hard drugs, including the opioid fentanyl whose mixture is health devastating. The first death in Europe associated with xylazine use was reported in England (UK) in 2022 with a postmortem detection of heroin, cocaine, fentanyl, and xylazine (Rock K. L. et al., 2023).

As an illicit drug, xylazine can be consumed orally, by smoking, snorting, by intramuscular, subcutaneous, or intravenous injection. The drug’s reported duration of effect is longer than that of fentanyl. The adulteration of fentanyl with xylazine allows to extend the feeling of euphoria and analgesia induced by fentanyl and to reduce the frequency of injections (Gupta R. et al. 2023).

Xylazine would be 50 times more powerful than heroin, and 100 times more powerful than morphine. Xylazine is currently responsible for a third of overdose deaths in the United States. Indeed, the Centers for Disease Control and Prevention, Report 30 (June 2023), mentions that the number of drug overdose deaths involving xylazine was 102 in 2018, 627 in 2019, 1 499 in 2020, and 3 468 in 2021.

In users, xylazine causes loss of consciousness, and states of stupor and in injecting users can lead to skin lesions, and ulcers that, easily infected, can cause gangrene and necrosis often requiring amputation to remove the limb with the rotting tissue. The Professor of Neurobiology S. Kourrich (2023) speaks of the devastating effects, beyond addiction, of xylazine on health, including skin lesions worthy of horror movies.

The signs and symptoms of xylazine overdose are similar to those of heroin, fentanyl, and other opioids. When xylazine is added to opioids, severe toxicity and death can occur due to the combined effects of the drugs. But, because xylazine is not an opioid, Naloxone (best antidote for opioid overdose – Jordan M.R. and Morrissonponce D., 2023) is unlikely to be effective in treating people. There is no safe xylazine drug dose to use!

Xylazine acts within the brain to cause sedation and abnormally slow breathing, a life-threatening respiratory depression (that can request tracheostomy) leading to cardiac arrest and death. The effects of severe xylazine intoxication can last for several days.

Xylazine is an adrenergic agonist, having the same action as adrenaline, a hormone and neurotransmitter (Chavez-Arias et al., 2014). Due to its highly lipophilic nature, xylazine directly stimulates the Central Nervous System alpha(α)2-adrenergic receptors as well as other peripheral α-adreno receptors in a great variety of tissues. It has been shown that the human placenta expresses α2-adrenergic receptors that may be implicated in pathogenesis and fetal growth restriction (Motawea H.K.B. et al., 2018).

Note: The 5 main different types of adreno-receptors are:

(Alpha) α-1: present on the smooth muscle fibres of the vessels; α-2: pre-synaptic localization (inhibitory effect on the synapse) located in the central nervous system and heart. α-2 is composed of 3 subtypes A, B, C.

(Beta) β-1: present in the heart where it strengthens the activity (faster and stronger beats); β-2: present locally on certain tissues and allows vasodilation of the arteries or dilation of the bronchi; β-3: present on adipocytes, stimulates thermogenesis.

These receptors are a class of G protein-coupled receptors, a family of transmembrane receptors in mammals, target of many catecholamines as the natural ligands of the α2-receptors which are: the noradrenaline (norepinephrine) which has a greater affinity, the adrenaline (epinephrine), and the dopamine (the molecule of pleasure, part of the reward system in the brain).

Xylazine inhibits the release of both neurotransmitters dopamine and norepinephrine at the neuronal synapse, resulting in depression of the Central Nervous System interfering with behavioural flexibility, working memory, and nociceptive control and it causes the inhibition of the Sympathetic Nervous System (automatic activities of the body) as on smooth muscle contraction and at heart level a bradyarrhythmia, thus responsible for the decrease of alertness, nociception, muscle tone and of the fight-or-flight response.

Xylazine is metabolized in the liver by the cytochrome P450 enzymes, and then 70% is excreted as urine (Barroso M. et al., 2007). So, urine can be used in detecting xylazine through its metabolites but within a few hours, they decrease to undetectable levels.

How come people are voluntarily reaching such a point of self-destruction, debilitating and painful physical deterioration and dependence?

Substance abuse (greed and dependence) has been associated with early emotional deficiencies resulting in an inability to tolerate emotions and regulate self-esteem and relationships with others (Krystal H., 1982).

Before reaching this addiction point there is a long way to go, starting often with alcohol and cannabis (and some medicines). It is not with legalization, decriminalisation, or shooting rooms that the drug problem will be solved, these ways appear to escape the responsibilities in terms of prevention.

Even if there is no ideal age to talk about the harmful effects of drug use, young people must be informed of these risks as early as possible. The role of the parents -when it is not itself a risk factor- by listening, conversing and providing correct information remains the best prevention. This should be reinforced by trained teachers and educators with continuous yearly teaching adapted to the age and with prevention actions carried out by governments, communities, organizations and associations, among youth and parents.

This is what the Say No To Drugs volunteers across Europe with the Foundation for a Drug-Free Europe strive to achieve through the educational materials The Truth About Drugs*.

The Greek philosopher Epictetus (50-135 A.D.) said: Only the educated are free. Indeed, education provides awareness and knowledge of basic elements of life and gives the ability to differentiate the right from the wrong and to take the right decision. Because as said by the humanist L. Ron Hubbard in 1956: It’s a problem in unawareness. The ethics, the morality, the capability of good, sound judgment alike depend upon the ability to be aware.

Instead of living the drug hell torments of a drug addict who can no longer stand life enslaved to the increasing spiral of harmful drug doses, isn’t it better to be able to face life responsibly, and freely, and act with passion and perseverance to make dreams come true?

REFERENCES

www.emcdda.europa.eu/publications/european-drug-report/2023/

www.desdiversion.usdoj.gov/drug_chem_info/Xylazine.pdf

www.poison.org/articles/what-is-xylazine

https://www.cdc.gov/nchs/data/vsrr/vsrr030.pdf

https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine

(*)Visit:

  • wwwdrugfreeworld.org (free materials in 20 languages)
  • Foundation for a Drug-Free Europe: https://fdfe.eu

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Health & Society

Female circumcision in Russia – exists and is not punished

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Every year, millions of women and girls in the world are subjected to the procedure “female circumcision.” In the process of this dangerous practice, women have part or all of their external genitalia removed. Among the victims are also residents of the North Caucasian republics of Russia, and the Russian authorities do not punish the execution of the violent procedure.

How this violent religious-ritual tradition exists in modern Russia, do the authorities and the clergy try to fight it – reveals the Russian publication of Verstka.

What is “female circumcision”

Female circumcision is a procedure that is accompanied by either trauma or partial or complete amputation of the external genitalia. As a result of the procedure, sensitivity is reduced and the woman may lose the ability to have an orgasm.

Not for medical reasons

The procedure is not performed for medical reasons, but for ritual or religious reasons to suppress female sexuality. That is why in the international medical community this term is not used, but is called “female genital mutilation operations”. International law considers them an attack on the health of women and girls, a form of violence and discrimination.

Victims

Victims of female circumcision are girls up to the age of 15. According to data from the World Health Organization (WHO), in 2024, more than 230 million women in the world suffered from such operations. They are mostly carried out in African, Asian, Latin American and Middle Eastern countries. But there are also victims of female circumcision in Russia among the residents of the North Caucasian republics – Dagestan, Ingushetia and Chechnya.

Injuries

The procedure has serious negative consequences for women’s health – from serious injuries to death due to blood loss. In addition to physical trauma and the shock of pain, female circumcision disrupts the natural functioning of the body. Women and girls may suffer from infections, their genitourinary system may be damaged, they may experience pain during sexual intercourse, menstrual disorders may occur, and the risk of complications during childbirth and death of the mother and the newborn increases by 50%.

Why do they do it?

The “necessity” of such operations is justified by honoring traditions or religious motives. In some cultures, it is part of the rite of female initiation or entry into adult life. Female circumcision is often associated with Islam, including in the Russian Federation.

Prevents lust

In the words of Dagestan journalist Zakir Magomedov, “in the local religious press, which is issued by the official clergy, articles are published in which it is written that female circumcision has a beneficial effect on a woman and protects her from lustful thoughts and desires, and is even beneficial for a woman.”

Female circumcision is performed by people without medical training, and old pocket knives or cattle shears are used as tools.

Control over female sexuality

In almost all cases, the purpose of the procedure is defined as control over female sexuality: “not to be hoika”, “not to freak out”. The official clergy of Dagestan include female circumcision in religious duties, although it is not mentioned in the Koran. Some Muslims, in addition to the Koran, are also guided by the Sunnah – traditions from the life of the Prophet Muhammad and statements of authoritative religious figures. Therefore, in some cases, female circumcision among Muslims can be interpreted as permissible, desirable and even mandatory.

Officially, the Russian authorities are against it

“All women should be circumcised so that there is no debauchery on Earth, to reduce sexuality”, this is how the head of the Coordination Council of Muslims of the North Caucasus, Ismail Berdiev, reacted to the revelations of the “Legal Initiative” organization in 2016, which confirmed the existence of practice. Later, Berdiev clarified that “he did not call for female circumcision”, but only spoke about the “problem of debauchery”, with which “something must be done”.

The Russian Ministry of Health condemns the procedure, and the prosecutor’s office of Dagestan conducts an investigation and finds no confirmation of the facts presented in the report of “Legal Initiative.”

The deputy of the State Duma from “United Russia” Maria Maksakova-Igenbergs proposes to introduce the concept of “women’s discrimination on religious grounds” into the Penal Code, and that the punishment for “female circumcision” be 10 years in prison. The Ministry of Justice of Russia does not support Maksakova’s initiative, clarifying that the procedure falls under the Criminal Code of the Russian Federation, and more precisely under the paragraphs on “deliberately causing severe, medium and light harm to health, as well as causing harm to carelessness.”

North Caucasus

According to the “Legal Initiative” organization, in the middle of the last decade in Dagestan, at least 1,240 girls were subjected to the procedure annually. The majority of the men surveyed were categorically against the ban on female circumcision, explaining their motive not only with Islam, but also with local traditions and the desire to control the morality of women. Part of the respondents expressed an opinion against the procedure, arguing that the lack of sensitivity in women lowers the quality of sex in men as well.

And in Moscow

In 2018 one of the Moscow medical clinics announces the service of “female circumcision” for ritual and religious reasons for girls from 5 to 12 years old. On the clinic’s website, it was noted that “the operation should be performed not at home, but in a medical clinic.” After a wide public response, the clinic removed the information from its website, but an investigation was carried out, which found the existence of the procedure and other violations. A warning has been issued and the clinic is still open!

First conviction without penalty

Despite the fact that in its second report the organization “Legal Initiative” notes the disappearance of the practice in Chechnya and Ingushetia, the inhabitants of these regions remain in danger. In the spring of 2020, the father of a 9-year-old girl invited him to Magas (the capital of Ingushetia) for a visit and took him to a vaccine clinic. There, female circumcision was forcibly performed on the child. The value of the “service” is 2000 rubles. The little girl, in her bloodstained dress, was then put on a bus back to Chechnya, where she was hospitalized for severe blood loss. The father explains his motive as follows: “So that he doesn’t get excited.”

A criminal case has been opened against the gynecologist who performed the circumcision for intentionally causing minor harm to health. The case has been going on for a year and a half. The judge called on the parties to reconcile, adding that “the girl cannot be helped anyway”. In the end, the doctor was found guilty and fined 30,000 rubles, but was released from serving the sentence due to the statute of limitations. No criminal proceedings have been initiated against the clinic.

In the same year, the mufti of Dagestan issued a fatwa and recognized the removal of the external genitalia as forbidden in Islam, but clarified that “female circumcision” meant only hudectomy — the removal of the foreskin of the clitoris. This is also a crippling procedure, human rights defenders insist.

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Four executed for producing illegal alcohol in Iran

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Iranian authorities have executed end of October four people convicted of selling illegal alcohol, which poisoned and killed 17 people last year. More than 190 people who consumed the dangerous drink were hospitalized.

The death sentence against the accused in the case was carried out in the Karaj Central Jail.

According to human rights organizations including Amnesty International, Iran carries out the highest number of executions per year after China.

After the Islamic Revolution in 1979, Tehran banned the production and consumption of alcoholic beverages. Since then, the sale of illegal alcohol on the black market has flourished, leading to mass poisonings. The latest case, reported by Iranian media, has killed around 40 people in northern Iran in recent months.

Only Iran’s recognized Christian minorities, such as the country’s Armenian community, are allowed to produce and consume alcohol, but discreetly and only at home.

Illustrative Photo by Amanda Brady: https://www.pexels.com/photo/elegant-champagne-coupes-in-sunlit-setting-29157921/

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What is food neophobia – the fear of trying new dishes

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Everyone has heard of anorexia and bulimia. But these eating disorders are far from the only ones.

There are people around the world who can only eat certain colored foods. Still others are addicted to water. About 5% of women between the ages of 15 and 35 are affected by some type of eating disorder. Among them are those with neophobia – the inability to try a new type of food. This problem sometimes also affects young children. For them, experts advise parents not to force them, but to explain to them the benefits of a given product. It is also an option to put them on the table in the company of other children who will set a good example.

Neophobia usually disappears around the age of 6. For some people, however, it remains a problem for much longer.

A possible explanation for this condition could be something happening in the person’s life – like choking on food, for example. As a result, a person may begin to avoid a certain type of food and thus give his phobia a “field of expression”.

The reasons for neophobia may lie not only in the psyche, but also in physical features. This disorder is genetically transmitted.

Illustrative Photo by Chan Walrus: https://www.pexels.com/photo/white-and-brown-cooked-dish-on-white-ceramic-bowls-958545/

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