(First of five parts)
BETHLEHEM, Pa. — Heather Noonan was barely breathing when first responders found her slumped in her car.
Her eyes were open. Her head was tilted back. Her skin was blue.
She groaned, then collapsed.
“I think she didn’t want to die in her home,” her mother, Lisa Baas, said, pausing to take a deep breath.
“I think she didn’t want to die.”
Noonan died from an overdose on March 30, 2024, at Lehigh Valley Hospital-Muhlenberg.
Even naloxone, an antidote designed to rapidly reverse the effects of a life-threatening opioid emergency, couldn’t save her.
A toxicology report on Noonan showed a cocktail of drugs in her system, including a veterinary tranquilizer that Baas had never heard of.
“I knew what fentanyl was. I knew what meth was,” Baas said. “I had no clue what xylazine was.”
She's not alone.
A year before the U.S. Food and Drug Administration warned health care professionals about xylazine, an animal-grade tranquilizer, entering the illicit drug supply, it already was in the Lehigh Valley, a LehighValleyNews.com analysis shows.
That was in 2022.
Now, according to overdose death data from coroners throughout the state, OverdoseFreePA and the Pennsylvania Office of Drug Surveillance and Misuse Prevention, the drug has made its way through 26% of Pennsylvania counties.
Known on the streets as “tranq,” xylazine is a powerful veterinary sedative commonly added to fentanyl. It is said to prolong the effects or reduce withdrawal symptoms, and poses lethal health risks like low heart rate and blood pressure, and severe skin wounds.
A rapid rise
While the Biden administration designated fentanyl combined with xylazine as an "emerging crisis" in the United States in April 2023, many county coroners across the state were not yet testing for xylazine or began testing after it already entered the supply, reports show.
The National Institute on Drug Abuse, or NIDA, reported that xylazine "spread westward across the United States, with the largest impact in the Northeast."
"From 2019 to 2022, xylazine detection more than doubled in 30 states, according to data on drug seizures in those states," NIDA's webpage on xylazine says.
"The U.S. Centers for Disease Control and Prevention’s State Unintentional Drug Overdose Reporting System reported that in 20 states and the District of Columbia, the monthly percentage of fentanyl-related overdose deaths with xylazine detected increased 276% from January 2019 (2.9%) to June 2022 (10.9%)."
And, according to the CDC, Pennsylvania had the fourth-highest number of overdose deaths in the country in 2022.
The state has maintained its ranking — only ever bumping up, not down — since 2014.
In the current illicit drug market, the U.S. Drug Enforcement Administration, or DEA, acknowledges that "a number of jurisdictions across the country may not include xylazine in forensic laboratory or toxicology testing."
And an Emerging Drug Trends report published by the PA State Epidemiological Outcomes Workgroup also stated, "Not all coroners test for xylazine, and some don't report toxicology results to the PA Department of Health."
So numbers might not show the entire picture.
Still, the Drug Overdose Surveillance Interactive Data report shows that, from 2017-23, the percentage of drug overdose deaths involving xylazine increased from 0% to 24.5% in Pennsylvania.
The local surge
A similar takeover is panning out here.
The SEOW's emerging drug trends report found that nine counties "had xylazine-involved overdose death rates above the state rate" — including Lehigh County.
"When I made the move from Pittsburgh to the Lehigh Valley, xylazine was really not a drug that was used by itself," said Dr. Rachel Westover, St. Luke's University Health Network's medical director of toxicology.
"It was kind of more like, 'Oh, we find it sometimes in these samples.' And then in the last three and a half years, it's just exploded in terms of being used primarily.
"And then over the last couple of years, it's just kind of gotten worse and worse and worse as it's become more popular."
On May 15, 2024, Gov. Josh Shapiro signed House Bill 1661 into law, classifying xylazine as a Schedule III drug, which the DEA defines as "drugs with a moderate to low potential for physical and psychological dependence."
The illicit use and trafficking of Schedule III drugs in Pennsylvania carries penalties of up to 30 years in prison and $5 million in fines.
But on the streets of Philadelphia, Sarah Laurel, founder and executive director of Savage Sisters, said that just encourages those in the criminal drug market away from the scheduled drug and toward new poly-chemical substances.
Enter medetomidine, another synthetic compound used in veterinary medicine.
"So we hyper-focused on fentanyl, enter xylazine," Laurel said. "We're now hyper-focused on xylazine in certain areas, and now you're seeing medetomidine enter the supply.
"So once again, we are promoting policies and programs that support an opioid epidemic when we are in a poly-chemical substance epidemic."
'Talking about herself'
Noonan was 31 when she died.
Her mother described the Bethlehem woman as a “fiery” red-headed veterinarian technician, with a multitude of talents — playing the harp, thrifting, collecting jewelry and loving animals.
But she had her share of physical and mental trauma, Baas said.
“I believe she had a lot of heartache,” the mother said.
Baas spoke as she sat on a picnic bench in Emmaus on a calm Monday morning — a purple handkerchief in her pocket for the tears that inevitably would come as she spoke of her daughter.
Over a year after Noonan’s death, the pieces started to fall together.
“When I look back, I can see she was in fight-or-flight all the time,” Baas said.
She said she believes her daughter never recuperated from the after-effects of the COVID-19 pandemic — emotionally, physically or financially.
The mother also said genetics weren’t in her favor to fight the throes of addiction and that she still was struggling to cope with having a hysterectomy at 30 after bleeding uncontrollably for two years.
And that the medical system failed her daughter when she began to self-diagnose, the mother said.
Behavior Bass said she didn’t recognize before started to make sense — three instances immediately came to mind.
“She came in my house and was, like, ‘I’m doing my best to stay alive mom!’” Baas said. “And I sat up and was, like, ‘What does that mean?’
“One of our last conversations was, like, ‘Mom, what do you do if someone can’t change?’”
She said she thought her daughter might have been talking about a friend or her boyfriend.
“And I think in hindsight she was talking about herself,” she said.
Where did it come from?
Xylazine's mainland United States origins date to 2006, when it first was detected in Philadelphia, according to the city's Health Department.
Officials previously detected it in the early 2000s in Puerto Rico.
Philadelphia's overdose deaths involving xylazine increased from 15 in 2015 to 434 in 2021.
"It's not an opioid crisis. It's a public health crisis."Sarah Laurel, founder and executive director of Savage Sisters
"It's not an opioid crisis," Laurel said. "It's a public health crisis."
Savage Sisters is a nonprofit organization providing trauma-informed recovery housing, harm reduction services and education in Pennsylvania.
For several years, the agency has responded directly to xylazine overdoses on the streets of Philadelphia's Kensington neighborhood.
The Philadelphia Health Department forwarded alerts to county coroners throughout the state in 2022, coroners told the News Lab — a journalism lab at Penn State University that's focused on filling local and rural reporting gaps and connects student journalists to professional newsrooms.
The alerts warned xylazine would be spreading throughout the state.
While Philadelphia saw overdose deaths in 2015, data obtained by the News Lab shows that coroners began reporting xylazine in overdose deaths in 2019.
It's not clear whether coroners began testing for it in 2019 or it began showing up in toxicology reports in counties outside of Philadelphia that year.
Only seven Pennsylvania counties — Bucks, Montgomery, Westmoreland, Philadelphia, Chester, Berks and Luzerne — reported overdose deaths involving xylazine in 2019.
A year later, that grew to 14 counties, and by one more in 2021, including Northampton County.
Earliest Lehigh Valley appearance
But xylazine was in Northampton County before then. It had subtly made the news — just not the headlines — when Christopher Ferrante went to trial for the death of star wrestler Michael "Mikey" Racciato.
The veterinary sedative was found in Racciato's system after he died of an overdose in December 2020, following a blood test, which the assistant district attorney handling the case said in an email was not initially tested for by forensic examiners, because it wasn't a controlled substance at the time.
Despite that resulting test, the state's drug overdose surveillance interactive data report doesn't show an overdose death — Racciato's overdose death — with xylazine in the system in Northampton County in 2020.
In 2023, the first xylazine-related overdose deaths showed up in Lehigh County.
Of 18 counties with xylazine-related overdose deaths, Lehigh is at No. 8, with 30.1% of overdoses reportedly having xylazine in the system in 2023.
Lehigh County Coroner Dan Buglio said in June 2024 that in the previous year there were 20 drug-related deaths with xylazine present — preliminary data shows that makes up for about 17.9%.
Northampton County comes in at No. 16, with 13% of overdoses showing positive results for xylazine in 2023.
'An emerging threat'
Working at St. Luke's University Health Network, Westover said she's seen xylazine in the Lehigh Valley for a while.
"I didn't really see heavy xylazine use until I moved to the Lehigh Valley several years ago," Westover said.
"But I feel like over the last year, it has really increased exponentially in its use, especially because of our proximity to Philadelphia.
"So the xylazine itself is really prevalent in Philadelphia. And there's actually a lot of patients that will go down to Philadelphia to get their drug supply and come back, even if they live in the Lehigh Valley.
"So xylazine has definitely been more and more prominent over the last several years in Philadelphia, but this region in general."
She said she's seen more patients come in and report they're "only" using "tranq," with symptoms such as extreme withdrawal, wounds, high heart rates, tachycardia, high blood pressure, anxiety and diaphoresis.
"Those are very common symptoms that I see," Westover said.
Overdose death rates are down nationally, and decreased 9% in Pennsylvania, Westover said, citing data from the CDC.
A release from February reports a nearly 24% drop in overdose deaths nationally — which the center primarily attributes to "widespread, data-driven distribution of naloxone."
Could xylazine disrupt that success?
The White House news release from April 2023 that designated fentanyl combined with xylazine as "an emerging threat," said "xylazine is complicating efforts to reverse opioid overdoses with Naloxone and threatens progress being made to save lives and address the opioid crisis."
An accident
Noonan was resilient. Determined. Full of life.
Toward the end of that life, Baas said, she saw those qualities start to slip, but chalked it up to the stress of her daughter's newfound homeownership.
Noonan had no visible signs of usage — no injection sites or the well-known festering wounds from repeated xylazine usage.
“She was a girl that fell through the cracks,” Baas said. “She was so lovely and beautiful and vibrant, I just couldn’t tell.”
Baas said the two were supposed to dye Easter eggs with a family friend the night before she died. Baas said she called her daughter around 4:30 p.m., and she sounded groggy.
By 8:30 p.m., she texted Noonan, asking where she was — “because we’re old!” and didn’t want to be up late, she said with a chuckle. Noonan responded: “Something came up.”
“It wasn’t recreational for her… she was self-medicating,” Baas said of her daughter's drug use. “I think she probably had been medicating for a couple of months and probably got a bad batch.”
Westover said she sees patients who use xylazine regularly.
While Noonan might have been self-medicating for a few months, Westover said even long-term users don't always know what they're ingesting.
"It's kind of hard to keep up with the exact substances that patients are using, but they don't know either," Westover said.
The coroner's report on Noonan's death said xylazine was found in her system, alongside mitragynine (kratom), methamphetamine and fentanyl.
Just like the other 19 overdose deaths in Lehigh County that also had xylazine in their system, her death was ruled an accident.
EDITOR’S NOTE: Some of this reporting originated from The News Lab at Penn State from January to May 2023 and was supported by SpotlightPA during that time. LehighValleyNews.com continued the reporting in this series.
COMING TOMORROW: A look at how xylazine's rise has changed the drug landscape in Pennsylvania and what it means for users, health providers and communities.
