00:11Joining us today is Dr. Rajiv Mehta, Senior Consultant Psychiatrist at Sir Gangaram Hospital.
00:19With rising concerns over zombie drug xylozyme spreading across cities like Chandigarh and
00:27Bangaluru. Today, Dr. Mehta is here with us to help us understand its dangers, its impact
00:35in India. Thank you, Dr. Mehta, for speaking with us today.
00:39Thank you for giving me that.
00:41First, I'd like to understand xylozyme started out as a veterinary sedative. So now, how and
00:50why it transitioned into a street drug in India now that we see few of the cases now also
00:56being called as a zombie drug?
00:59See, basically, xylozyme or TRANK or TRANK DOM started is basically a very cheap economical
01:07drug, not cheap, but very economical drug. And it is available without any prescription.
01:13So it is over the counter drug. It is basically, it was basically designed to sedate the animals.
01:20Yeah. They had a huge body weight and a huge energy levels. So it is a very, very robust drug
01:29to sedate.
01:34But on the other hand, it is economical also. Now the people who wish to do this term, what the
01:42drug cartel is doing is that the heroin and the fentanyl, which is again an injectable drug,
01:49they are adulterating those drugs with the help of xylozyme. So in turn, decreasing the cost.
01:58Right. So this is how that is penetrating the market. So initially, it started with the US,
02:05the drug cartel started with the US, there the fentanyl was coming from other countries and
02:10they were being adulterated. And the adulteration depends on how much the cost they had to keep.
02:16See, if they had to keep a very low cost, so they will adulterate more with xylozyme because it will
02:22again sedate and it will potentiate the impact of fentanyl, the opioids. So this is how they started
02:28mixing and it started coming into the market.
02:32Okay. So you did explain us the entire process, but from where we are seeing, there are lots of
02:41viral videos, you might have also come across those videos. There are videos from Chandigarh,
02:47there are videos from Bangalore, even Bihar for that matter, when people can be seen standing motionless for
02:53hours. So when we talk about the classic effects of xylozyme, especially when mixed with opioid,
03:01do these match with how we are seeing people reacting on streets when what we saw there in
03:08Bangalore or Chandigarh? Are these the same classic effects?
03:12Yes, definitely. See, as I told you, the xylozyme is basically a primary sedative for animals, which
03:20have huge built and huge energy levels. So it is being used as to calm them down. So when a
03:26person has
03:27injected himself or herself with xylozyme or maybe adulterated fentanyl with xylozyme, that xylozyme,
03:34what will it cause? It will cause muscle relaxation. Okay. Right. It will cause sedation. It will drop
03:41the heart rate and it will drop the respiratory rate. So definitely these are the impacts which
03:45are classically seen with xylozyme, a kind of sedative impacts. At one side, they are moving,
03:51at other side, the xylozyme is slowly taking its impact and making them sedated and sitting in a,
03:56or standing in a one posture. Okay. So what are the, like, how dangerous it is? You have,
04:04initially you did, when we started this interview, you did mention about fentanyl and heroin. So how
04:10dangerous it is? If you could just explain and give us a perspective with regards to how dangerous it
04:15is when it's mixed with fentanyl or heroin. And we have heard about nalixone. So in that case,
04:23how often we are, we do see how often it's becoming very ineffective. So how, in that case,
04:30how is it even going to affect the emergency unit of these Indian cities? So can you just help us
04:37with that perspective? Basically, you have asked so many questions. If I understand first,
04:40how dangerous it is. See, it is very, very dangerous. Number one, because the Indian doctors
04:48are not very well versed with this drug. It is a new entrant. Okay. Right. More of the veterinary
04:55doctors are well versed with this rather than the human doctors. So it is a new entrant. Right.
05:01Number one. Number two, the amount of xylozyme, nobody knows how much that it is. Okay. Number three,
05:07we don't have specific tests to decipher whether the person has consumed xylozyme or not. Like,
05:13we have many tests to know whether there is a cocaine in the body, amphetamines in the body,
05:17opioids, THC, barbiturates, benzodiazepines, alcohol, nicotine. But because it is a new entrant,
05:24we don't have any mechanism to know whether xylozyme has been consumed and how much xylozyme
05:29has been consumed. Okay. So the doctors are at their wits end. They don't know what is happening,
05:35why he is sedated. So it is basically a dangerous drug. Number two, how much dose the person has
05:41consumed? That decides the danger. Okay. Right. So if it is the fentanyl which he has taken is more
05:50adulterated, it is more dangerous. If it is less adulterated, then it is less dangerous. So that we
05:59cannot decipher. That we decipher only when the patient comes and we have to keep that person in
06:04under observation for long. Only then we will come to know whether it is becoming dangerous or not.
06:09So unknown quantity, basically, an unknown drug for the Indian sector. So it is dangerous.
06:16Now, mostly it is not used by self. It is used as an adulterant. So it acts on basically alpha
06:23receptors. Okay. And fentanyl acts on opioid receptors. So both have different mechanism of
06:30actions, but eventually resulting into same kind of action. Okay. So when we give Naloxone,
06:38it is, it debinds the opioids, that is fentanyl or heroin and washes it away. It doesn't, it doesn't
06:46work on what we say this Xylozine. Okay. So even if Naloxone has been given, only that has been washed
06:57away. The opioid, the fentanyl, Xylozine still remains. And because there is no test and otherwise
07:06also we have to manage them symptomatically. Like we have to manage the respiratory, respiration,
07:12heart rate, and everything symptomatically, the vitals we have to manage.
07:17Sir, like just, you just mentioned how Indian doctors are not very well versed with treating
07:25this, if I understood it properly. No. What I mean to say that they don't know whether
07:33this drug is there. So they will treat only symptomatically. If the heart rate is low, we
07:37will give respiratory support. If suppose there is low blood pressure, we will give that cardiovascular
07:49support. So that has to be treated symptomatically. So what I'm trying to say is the doctors have to
07:56support the patient only symptomatically. Okay. They are not aware why that is happening. Okay.
08:03So that is the only thing, but they will definitely able to support that symptomatically. But anyhow,
08:09if more of Xylozine has been taken, then eventually the patient may land up into ICU also.
08:17Okay, sir. Okay. Sir, there are multiple reports that link Xylozine with severe skin ulcers as well.
08:29Zombie effects, we are very well aware of that. Writing mortality rate has also been linked to
08:35Xylozine. You as a psychiatrist, if you could just help us understand with what you have seen,
08:42how it can damage or affect someone who consumes this physically or neurologically. And if not,
08:52what we can expect, how it can affect someone. See, if we understand the basic nature of Xylozine,
08:59what it causes to the body. Okay. Number one, it decreases the muscular power,
09:05causes muscular relaxation. It decreases your blood pressure. It decreases the respiration rate.
09:12And how it is taken. It is generally mixed with fentanyl and fentanyl is generally injected,
09:19whether it is intramuscular or intravenous. So if one is injecting time and again,
09:25and there are only very few points where a person can inject. Before that injection injury is recovered,
09:33that another injection is given. Okay. So the previous injury doesn't have the time to recover
09:40and a new injury has occurred on the same site. Okay. So that will cause, not let the wound heal
09:48properly. Okay. And therefore, there will be multiple puncture sites, multiple wounds. And because
09:56there is muscle relaxation, the pressure injuries can also be there. Okay. So these kinds of things
10:03and with sedation and with sedation, if they are doing multiple things like driving, etc, or maybe
10:10working with a machine or cooking, then there can be physical harms also. Okay. Dr. Mehta, like I mentioned,
10:21when we started out with this interview, I mentioned about viral cases, viral videos all over the social
10:27media, what we saw in Bangalore, what we saw in Chandigarh, what we saw in Bihar. Within weeks,
10:33it picked up. It was all over the internet. So now, when you see the situation on ground, how fast
10:41or
10:41rapid is the misuse of this zombie drug here in India? Generally, it is not very common right now. Okay.
10:49It is not very common. But yes, slowly and slowly, it is percolating into the system.
10:55Slowly and slowly, the drug cartel is just going into the system and soon it may cover. Like in US,
11:01it was the major drug between 2019 to 2023. Okay. Among the drug users, at least 67% had used
11:08it. Okay.
11:10So slowly and slowly, this will come over in India also. That cycle will be repeated in India also.
11:16What kind of population is most at risk when it comes to consumption of this drug?
11:21Number one, adventurous population who wishes to use more and more. Number two, the one who have
11:27been previously dependent on opioid and now they wish to have fentanyl etc. Number three, the population
11:35who wishes a cheap alternative to previous things. Okay. The economical alternatives. Number four,
11:41the adult where the drug cartel is majorly focusing. Number five, the party circuits.
11:50So these are the various populations who are at risk. So majorly every population is generally at risk
11:58who are using non-alcoholic and non-smoking drugs. When we talk about in detail with regards to what kind
12:09of
12:09treatment work best, what approaches work best to treat people who are consuming this drug.
12:17So what would you suggest? And what kind of unique challenges does this kind of consumption pose with
12:24the Indian doctors or Indian facilities here in India?
12:28See, like I told before, Indian doctors are unaware about this drug majorly.
12:33Yeah. Right. So slowly and slowly this has, they have to be taught about this. The toxicology screen
12:41have to be, have to include xylazine. That is important. And when a person is brought here,
12:50so the only way that they are knowing they are treating xylazine will be a test. And when the test
12:55is unavailable, they will not be aware that they are treating xylazine. So the only method,
13:00another method will be only an assumption that the person has consumed fentanyl or heroin injectable
13:05and still after giving Naloxone, if he is not recovering, that means the other thing is there
13:11and that is xylazine. And only symptomatic treatment can be done for xylazine. So that symptomatic
13:16treatment, that observation has to continue till the person recovers from that flaccid state and till his
13:24respiration and BP is normal.
13:27Things like this pick up very quickly. So as a psychiatrist, as someone who has treated people
13:35like that, what kind of measures or campaigns would you suggest and would you want from the
13:43authorities or for that matter, even from the normal public so that there is much awareness with
13:48regards to consumption of this kind of a drug? That's a very nice question. So basically from
13:55a government perspective, what the government can do is that this medicine can be made only available
14:03on the prescription or changing its schedule from over the counter to a schedule so that whenever there
14:11is a buying, so the person knows who's buying it. Like it has happened with benzodiazepine and other
14:16things where there is a lot of restriction now and it is unable without prescription. So number one,
14:23prescription may be mandatory. Number two, who will get the prescription because it is a veterinary drug.
14:29So only a person who's having animal. Okay, that is important. Number three, there should be a
14:39certain knowledge if it is bought in bulk. Okay. Right. So that means somebody else is buying it to mix
14:47it in a
14:47large amount of medicine. E-tracking can be done. Okay. Like in U.S. e-tracking is done where the
14:55drug is
14:55going and other things how it is being used that e-tracking can be done by the government. So these
15:00are the
15:00government measures. Now for the public, they should know that if a drug has been reduced in the price,
15:07if they're getting a cheaper alternative, that means it is mixed with something else. Everything
15:12is being inflated and a drug suddenly becomes a cheaper. That means it is adulterated with something
15:17else, which can be dangerous. And from a medical point of view, Xylazine, we should have tests to
15:26discover whether the person has taken Xylazine or not. So that test has to be there in the labs.
15:32That is important. Generally, strip tests are available. So that can be done. And accordingly,
15:37the doctor can treat that. So the doctors have to be taught regarding this. The people have to be made
15:45aware regarding this, that awareness campaign from the government can also be there. Okay. Okay.
15:50Thank you so much, doctor, for your insight on this widespread concern around this zombie drug,
15:59which is still a very alien concept, if it's the right word to use for this kind of a drug.
16:05Thank you so much for your insights. And thank you for your time, sir. Anytime, anytime.
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