PITTSBURGH — Megan Norris, who lives outside Pittsburgh, has battled a serious addiction to heroin and fentanyl for more than a decade.

When she relapsed during her pregnancy earlier this year, Norris knew that the opioids she was buying on the street probably contained something new and toxic: xylazine.

“It was the beginning of my pregnancy,” Norris said. “Xylazine is so addictive, so physically addictive, that you just can’t stop. It’s like the flu was a hundred times worse. I was throwing up a lot. I was just in a spinning pit of hell. So I was using.”

Drug overdoses are already one of the main causes of death for pregnant women in the U.S. Research shows that up to 1 in 20 women use addictive substances at some point during their pregnancy. A study from the National Institutes of Health found that “substance use during pregnancy is common.” Opioid use among pregnant women had already quadrupled before fentanyl arrived, according to the Centers for Disease Control and Prevention.

Now, public health experts warn that xylazine poses an increasing threat to women, their fetuses and newborns.

“Almost 100% of our drug supply is fentanyl, and 80% to 90% of that fentanyl is adulterated with xylazine,” said Dr. Elizabeth Krans, a physician and researcher at UPMC Magee-Womens Hospital in Pittsburgh.

Krans is one of the country’s leading experts on pregnancy and drug addiction. He said the impact of xylazine is like nothing he’s seen before. “Patients come in with really intense injuries that add a layer of pain and discomfort,” he said.

Xylazine is a powerful animal tranquilizer commonly used by veterinarians. For reasons that aren’t entirely clear, drug gangs began mixing it with street fentanyl a couple of years ago. The chemical is toxic to humans and causes skin lesions and wounds that heal slowly, if at all.

“It starts to necrotize the skin and they just don’t heal,” said Norris, 33, who has been dealing with xylazine wounds during her pregnancy. “A little needle mark and it turns into that big hole.”

Norris said he felt deep shame and experienced severe stigma because of his drug use.

She said the feeling of guilt increased when it was confirmed that her fetus had been exposed to xylazine. “It’s scary not knowing what’s going to happen to my baby or what the long-term effects will be,” she said.

It may seem easy for pregnant women to stop using illicit drugs. Studies show that many women desperately try to recover when they become pregnant.

“People think it’s easy to just stop using it and it’s not,” Norris said.

Jamar Coach / Jackson Sun/USA TODAY NETWORK via Reuters

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Jackson Sun/USA TODAY NETWORK via Reuters

In fact, researchers say xylazine appears to be even more addictive than fentanyl or heroin, illegal drugs that are already notoriously difficult to escape.

Medical experts say fentanyl is already so powerful that even without xylazine in the mix, it is It is recommended that pregnant women seek medical attention. before stopping drug use. Xylazine also appears to complicate the use of medications such as methadone and buprenorphine, which have been shown to relieve opioid cravings.

“They are afraid, they are terrified”

Dr. Ilana Hull, a physician at the University of Pittsburgh, said it’s clear that most women who experience the type of severe addiction that exposes them to fentanyl and xylazine care deeply about their fetuses and newborns, but to They often feel trapped and overwhelmed.

“Our patients know this exists,” Hull said. “They are scared, terrified and very concerned about the possible impacts on their pregnancies, births and babies.”

He said a challenge for pregnant women who want medical help is that they often face legal risks. Drug use is a crime, and seeking care and admitting to using substances like fentanyl and xylazine often costs women custody of their children.

Co-authored helmet one of the first studies on the impact of xylazine on pregnant womena report he described as a “wake-up call.”

“We don’t really know much about xylazine exposure in humans, so this is really a call to action to focus attention (and research) on this,” Hull said.

In one study, 74% of babies tested positive for xylazine.

What is clear is that many more pregnant women suffering from addiction are exposed to xylazine.

A new study A study by Washington University in St. Louis found that the rate of positive tests for xylazine in opioid-addicted patients cared for in one of the city’s maternity wards increased from zero percent in December 2022 to 100% in July 2023.

American Journal of Obstetrics and Gynecology, Dr. Cassandra Trammel / American Journal of Obstetrics and Gynecology, Dr. Cassandra Trammel

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American Journal of Obstetrics and Gynecology, Dr. Cassandra Trammel

“These results underscore the critical need to continue studying the impact of xylazine on obstetric outcomes,” concluded lead author Dr. Cassandra Trammel.

In an interview with NPR, he said it has now been conclusively shown that the toxic chemical is transferred from mothers to newborns.

“73 percent of those babies ultimately tested positive for xylazine after delivery,” Trammel said.

There is no research or data to show how the chemical could be affecting the reproductive systems of women, their fetuses or newborns. The good news is that, so far, the growing number of babies born with xylazine in their bodies have not experienced the type of lesions or superficial wounds seen in adults.

of the helmet study noted that the best data available It currently draws from previous studies on the impacts of xylazine on unborn farm animals when used by veterinarians.

Possible harmful effects include reduced blood flow and oxygenation of the fetus, which “raises concerns during the critical stage of development.”

DIDIER PALLAGES / AFP

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AFP

The National Institutes of Health currently funds research on xylazine, but according to Hull, doctors caring for pregnant women exposed to the chemical are forced to improvise, with little scientific data.

“It’s very frustrating and makes it difficult to treat people,” Hull said. “It seems like we’re always trying to catch up.”

In fact, most doctors and scientists interviewed for this article said they fear that the supply of illegal drugs will continue to evolve in ways that pose new dangers to pregnant women. The drugs sold on the streets are already laced with a mix of synthetic opioids, powerful tranquilizers and industrial chemicals.

“We are desperately trying to keep up,” said Dr. Krans of Magee-Womens Hospital. “We’re right behind.”

For now, a key strategy is to identify as many pregnant women as possible experiencing fentanyl-xylazine addiction and transition them to medication and counseling. But according to Krans, too many women don’t receive that kind of high-quality medical care.

“We have these medications (that have been shown to help), but we also have these systems that prevent patients from accessing those medications,” she said, pointing to the lack of affordable health care, stigma and legal risks faced by many women who use drugs. .

Megan Norris / Photo provided, used with permission

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Photo provided, used with permission.

Megan Norris finally received treatment. When he spoke to NPR, he had been off fentanyl and xylazine for months and taking a prescribed dose of methadone. Tests showed that her fetus appeared to be healthy and she tried to remain hopeful:

“They were worried about his heart, at first his heart wasn’t growing properly,” Norris said. “She’s fine now, she’ll just be little.”

After her interview with NPR, Norris gave birth to a daughter. She and her little girl are doing well. Norris said she hopes more moms and their babies receive the same type of quality care that helped her and her son.

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