Every Tuesday and Thursday a van outside the Howard County Health Department in Columbia is manned by specially trained workers who hand out fresh syringes, the opioid overdose remedy naloxone and give attention to any drug user in need.

Added recently is a “batch board” listing everything a lab found in recent samples from users’ drugs. These days, about half contain a dangerous veterinary sedative that increases the chance of overdose and causes wounds so severe they can lead to amputations.

“Xylazine, it’s our most pressing concern, " said Roe Rodgers-Bonaccorsy, director of the department’s Bureau of Behavioral Health.

Xylazine (ZY-lah-zeen), also called tranq, has emerged as such a threat, in combination with the synthetic opioid fentanyl that was the subject of a recently issued Biden administration warning.

Xylazine isn’t new to Maryland’s public health officials, however. Eight needle exchange sites began in 2021 sending samples collected from drug users to the National Institutes of Standards and Technology lab in Gaithersburg for testing.

Institute scientists found xylazine in 80% of Maryland samples within the first year of testing, according to a study recently published in the journal Forensic Chemistry. That was far more than expected. Further, the study showed the far more powerful fentanyl had all but replaced heroin.

The federal lab now tests samples from Maryland, Nevada and California, and xylazine is increasingly found in the western states. And new additives are being found in Maryland, including another veterinary sedative called medetomidine. It’s not clear if it causes similar effects in humans.

Xylazine slows breathing, which is already slowed by opioids, making drug use more life-threatening. The overdose antidote naloxone does not work on them, making warnings more urgent, officials said. Xylazine also causes skin ulcers that spread quickly and are hard to treat, sometimes leading to amputations of arms and legs once skin and muscle tissue begins to die.

Test results usually come within days to front-line nurses, counselors and peer recovery specialists. They work at harm reduction sites, like the one in Columbia, where they seek to build trust as they dole out information, services and supplies.

Officials say they lean heavily on peer recovery specialists, who themselves were once substance users, to bond with those who visit regularly or even daily.

On a recent day, several peer recovery specialists operated from the van in the parking lot in suburban Columbia, not far from the shopping mall and popular big-box stores. About a half-dozen people came by to swap used syringes, learn to administer naloxone and visit with familiar faces.

The mobile health team hopes their clients will return for more information, supplies and services that can keep them as safe and healthy as possible. Perhaps some ask about treatment.

Jack Matthews, a certified peer recovery specialist, points a visitor to the batch board. The “perc 30,” Percocet painkillers, someone bought were really fentanyl. A dose of heroin and cocaine was also fentanyl, plus the antimalarial drug quinine. Someone’s fentanyl was actually fentanyl, but also contained xylazine and an active ingredient in the cold medication Nyquil.

“They tell us where they purchased it, and we tell them what’s in it,” Matthews said.

Dillon McManus, a harm reduction and peer support supervisor, said it usually takes from four to 12 days to hear back from the federal scientists, who have tested about 70 samples from Howard in the past few months.

Recently, the lab has been finding new dangerous additives in Maryland, including medetomidine, quinine, the diuretic medication mannitol, the veterinary deworming agent levamisole, the decongestant phenylephrine and other compounds used to make fentanyl.

“We’re trying to get the word out there; this is a rapid way we can do it,” said Ed Sisco, an institute research chemist who has been testing the samples.

The lab uses high-tech equipment to test about 300 to 500 samples a month under the program that began in Maryland, called Rapid Drug Analysis and Research, or RaDAR. Scientists, relying on agency funding, hope to add more states. Sisco said he’s not aware of a similar real-time testing effort of this scale.

The scientists are looking into the best less-complex technology to place in local public and university labs where nonscientists could regularly test street drugs. This could mimic the technology used at airports to test for explosives.

Scientists also are working with Johns Hopkins University’s Bloomberg School of Public Health to assess the effectiveness of xylazine test strips, similar to fentanyl strips already in use.

“As with all these drug checking technologies, the goal is to help empower people so they are as prepared as possible to have the experience they want to have and avoid the experience they don’t want to have,” said Danielle Friedman Nestadt, an assistant scientist in Hopkins’ department of health, behavior and society.

The hope is drug users will moderate their use, avoid using drugs alone and carry naloxone, she said.

Hopkins scientists separately have been testing lab equipment as part of a study on HIV and overdose prevention.

Overdoses have been a major problem for more than a decade, and now exceed 100,000 a year nationally. In Maryland, overdoses rose from 799 in 2012 to 2,824 in 2021, with nearly 90% in the the most recent year due to opioids, according to data from the Maryland Opioid Operational Command Center.

Through November of 2022, the most recent data available, there were closer to 2,000 overdose deaths, finally putting the state on track for a decline.

But xylazine and other additives are alarming state health officials, who have formed a workgroup to assess the data. The Maryland Department of Health already has a website and flyers for distribution.

“We are working to get information directly to people that need it,” said Emily Keller, special secretary of opioid response. “Substances like xylazine pose very real health threats for people that use drugs, and we are working to share actionable information in near-real-time that can prevent harm and save lives.”

It’s a statewide effort. In Baltimore, officials are working to spread the word about xylazine and other threats. Jennifer Martin, a deputy health commissioner, also plans to order xylazine test strips, which recently became available.

The city runs 16 sites for syringe exchange and other services. They currently hand out fentanyl test strips, which Martin said are simple to use and remain in demand.

“We are focused on giving people the tools and information so they can make informed decisions on how they want to behave, including when they are injecting drugs,” Martin said.

meredith@thebaltimorebanner.com