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STAT warns us that what is unfolding in Philadelphia is probably heading to your town too. 

A veterinary tranquilizer, xylazine, or “tranq,” exploded in recent years to the point that in 2021, it was found in more than 90% of heroin and fentanyl samples. With its ascendance has come a wave of wounds — sometimes called abscesses, lesions, or, in the words of one volunteer nurse here, something that looks like “it’s eating away your flesh from the inside out.” The city saw the number of emergency department visits for skin and soft tissue injuries quadruple between the beginning of 2019 and the end of 2021.

Already, researchers have found burgeoning prevalences up and down the East Coast, and it’s starting to crop up in Chicago, Texas, and elsewhere. A study earlier this year raised the possibility of xylazine spidering out from the Northeast into markets westward, similar to the pattern illicit fentanyl took as it embedded itself in the drug supply. Researchers caution they can’t predict xylazine’s path or what prevalence it will reach, but warn that a lack of testing for xylazine is limiting detection.

Vice reported that the drug has shown up in 39 states.

These are not wounds that you might associate with infected injection sites.    

The FDA warned about this problem a few weeks ago:

Xylazine is not safe for use in humans and may result in serious and life-threatening side effects that appear to be similar to those commonly associated with opioid use, making it difficult to distinguish opioid overdoses from xylazine exposure. However, we do not know if side effects from xylazine exposure can be reversed by naloxone. Since we do not know if reversal agents regularly used in veterinary medicine (e.g., yohimbine hydrochloride, tolazoline hydrochloride) are safe or effective in humans, they should not be used.

Routine toxicology screens do not detect xylazine, and additional analytical techniques are required to detect xylazine when it might be involved in illicit drug overdoses, particularly when there are other signs or symptoms of xylazine exposure.

The FDA says it does not know the source of xylazine in the illicit drug supply. 

Vice recently talked with a person who used drugs mixed with xylazine:

The high was non-existent, she said, replaced by hours of unconsciousness followed by intense withdrawal—and when she wanted to come off it a couple of months later, the detox was even worse. 

The detox period for users may run weeks. The patient Vice talked with said, “These detox centers, these rehabs, they have no idea what they’re in for. They have no idea how to treat it. Some of them don’t even know what xylazine is.”  

Vice added:

But it’s hard to get a true sense of how many people are using xylazine. While the Centers for Disease Control and Prevention’s overdose stats track synthetic opioids like fentanyl, they don’t yet include xylazine-related deaths. The data we do have is piecemeal, coming from local health departments, coroner’s offices, and drug checking services. 

Pay raises are going up, but so are layoffs

The U.S. Department of Labor just reported that wage raises rose 5.1% from a year ago. And of course, that is still less than the rate of inflation, so it just means you are falling behind more slowly. Before the pandemic, average pay raises reflected the inflation rate of about 2% to 3% a year.  But before you march up to the boss and demand a raise, consider this from MarketWatch:

U.S.-based employers announced 76,835 job cuts in November, a 127% jump from the previous month, according to a report by Challenger, Gray and Christmas released on Thursday, and 417% higher than a year ago. So far this year, companies have announced plans to cut 320,173 jobs, a 6% increase from last year. Tech companies alone have announced more than 60,000 job cuts this year, with indications that there will be more to come.

10,000 Canadians used the nation’s euthanasia laws in 2021

Next year, Canada is expanding its euthanasia laws that have allowed thousands of people a year to die with the help of a physician or by providing the materials that enable people to take their own life.

In a New York Times opinion column, Ross Douthat tells us:

In recent years, Canada has established some of the world’s most permissive euthanasia laws, allowing adults to seek either physician-assisted suicide or direct euthanasia for many different forms of serious suffering, not just terminal disease. In 2021, over 10,000 people ended their lives this way, just over 3 percent of all deaths in Canada. A further expansion, allowing euthanasia for mental-health conditions, will go into effect in March 2023; permitting euthanasia for “mature” minors is also being considered.

A recent AP story, which also referred to Canada’s euthanasia laws as arguably “the world’s most permissive,” reported:

Euthanasia, where doctors use drugs to kill patients, is legal in seven countries — Belgium, Canada, Colombia, Luxembourg, Netherlands, New Zealand and Spain — plus several states in Australia.

Other jurisdictions, including several U.S. states, permit assisted suicide — in which patients take the lethal drug themselves, typically in a drink prescribed by a doctor.

The countries that allow euthanasia and assisted suicide vary in how they administer and regulate the practices, but Canada has several policies that set it apart from others. For example, AP tells us:

• Canada is the only country that allows nurse practitioners, not just doctors, to end patients’ lives. Medical authorities in its two largest provinces, Ontario and Quebec, explicitly instruct doctors not to indicate on death certificates if people died from euthanasia.
• Belgian doctors are advised to avoid mentioning euthanasia to patients since it could be misinterpreted as medical advice. The Australian state of Victoria forbids doctors from raising euthanasia with patients. There are no such restrictions in Canada. The association of Canadian health professionals who provide euthanasia tells physicians and nurses to inform patients if they might qualify to be killed, as one of their possible “clinical care options.”

In some countries, patients must be exhausted all other medical options before seeking euthanasia. There is no such requirement in Canada. 

People watch lava from the Mauna Loa volcano Thursday near Hilo, Hawaii. (AP Photo/Gregory Bull)

How native Hawaiians view Mauna Loa volcanic eruptions

You should understand that in Hawaiian culture, Mauna Loa’s eruption is not considered to be an intrusion or a threat. In fact, for many local people, this is a time of paying respects to Pele, the Hawaiian deity of volcanoes and fire. They see the volcano as a kupuna, or an ancestor. In effect, when the volcano comes back to life, it is like a family member coming to visit.

An AP story explains:

For many Native Hawaiians, an eruption of a volcano like Mauna Loa has a deep yet very personal cultural significance. For many it can be an opportunity to feel a connection with creation itself through the way lava gives birth to new land, as well as a time to reflect on their own place in the world and the people who came before them.

“A volcanic eruption is a physical manifestation of so many natural and spiritual forces for Hawaiians,” said Ilihia Gionson, a Hawaii Tourism Authority spokesperson who is Native Hawaiian and lives on the Big Island. “People who are unfamiliar with that should understand that it’s a very personal, very significant thing.”