Identification of the veterinary sedative medetomidine in combination with opioids and xylazine in Maryland

Sisco, Edward; Appley, Meghan G

doi:10.1111/1556-4029.15242

Cited by 8 publications

(2 citation statements)

References 21 publications

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“…In April 2023, the White House Office of National Drug Control Policy designated fentanyl adulterated with xylazine an emerging threat****; some jurisdictions have scheduled or are trying to schedule xylazine as a controlled substance. † † † † Because replacement by similar substances or analogs has previously followed scheduling of certain substances (7), monitoring xylazine trends and other sedatives such as medetomidine (8) that have recently appeared in the drug supply is important.…”

Section: Discussionmentioning

confidence: 99%

Illicitly Manufactured Fentanyl–Involved Overdose Deaths with Detected Xylazine — United States, January 2019–June 2022

Kariisa¹,

O’Donnell²,

Kumar³

et al. 2023

MMWR Morb. Mortal. Wkly. Rep.

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In 2022, provisional data indicated that more than two thirds (68%) of the reported 107,081 drug overdose deaths in the United States involved synthetic opioids other than methadone, principally illicitly manufactured fentanyls (IMFs) (1). Xylazine, a nonopioid sedative not approved for human use and with no known antidote, has been increasingly detected in IMF products in the U.S. drug supply* and in IMF-involved overdose deaths (2). Limited studies suggest xylazine can cause central nervous system depression, respiratory depression, bradycardia, and hypotension in humans (3,4); chronic use might lead to severe withdrawal symptoms † as well as skin ulcerations (4). This report uses data from CDC's State Unintentional Drug Overdose Reporting System (SUDORS) to describe IMF-involved § overdose deaths with and without xylazine detected that occurred during January 2019-June 2022. Among 21 jurisdictions, which included 20 states and the District of Columbia, the monthly percentage of IMFinvolved deaths with xylazine detected increased 276%, from 2.9% to 10.9%. Among IMF-involved deaths during January 2021-June 2022 in 32 jurisdictions, xylazine was detected in a higher percentage of jurisdictions in the Northeast U.S. Census Bureau region; listing detected xylazine as a cause of death varied across jurisdictions. Expanded postmortem and illicit drug product testing for xylazine is needed to clarify prevalence in drug supplies; further investigation of xylazine's effects on humans is necessary to characterize morbidity and overdose risk. It is important for overdose prevention and response messages to highlight the potential presence of xylazine in IMF products and emphasize the need for respiratory and cardiovascular support to address the sedative effects of xylazine.Jurisdictions entered information on drug overdose deaths that were unintentional or of undetermined intent into SUDORS using death certificates, medical examiner and * https://www.dea.gov/sites/default/files/2022-12/The%20Growing%20 Threat%20of%20Xylazine%20and%20its%20Mixture%20with%20Illicit%20 Drugs.pdf † https://hip.phila.gov/document/2524/PDPH-HAN_Aler t_1_ Xylazine_03.16.2022.pdf § A drug was considered involved or co-involved if it was listed as a cause of death on the death certificate or in the medical examiner or coroner report. Fentanyl was classified as likely illicitly manufactured using toxicology, scene, and witness evidence. For the 8% of deaths involving fentanyl that had insufficient evidence for classification as illicit or prescription, fentanyl was classified as illicit because the vast majority of fentanyl overdose deaths involve illicit fentanyl. All fentanyl analogs except alfentanil, remifentanil, and sufentanil, which have legitimate human medical use, were included as IMFs.

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Section: Discussionmentioning

confidence: 99%

Illicitly Manufactured Fentanyl–Involved Overdose Deaths with Detected Xylazine — United States, January 2019–June 2022

Kariisa¹,

O’Donnell²,

Kumar³

et al. 2023

MMWR Morb. Mortal. Wkly. Rep.

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show abstract

“…The final articles are on forensic pathology and forensic toxicology [13][14][15][16][17][18][19]. There is a Case Report [20] that serves as a path forward in the detection of "fentanyls," other novel synthetic opioids (NSO), and novel psychoactive substances (NPS).…”

Section: Included In Thismentioning

confidence: 99%

Introduction to the JFS Special Section on Fentanyl and its Analogs in Forensic Science

Peat

2023

Journal of Forensic Sciences

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Tranq Dope: Characterization of an ED cohort treated with a novel opioid withdrawal protocol in the era of fentanyl/xylazine

London,

Li,

Kahoud

et al. 2024

The American Journal of Emergency Medicine

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Identification of the veterinary sedative medetomidine in combination with opioids and xylazine in Maryland

Cited by 8 publications

References 21 publications

Illicitly Manufactured Fentanyl–Involved Overdose Deaths with Detected Xylazine — United States, January 2019–June 2022

Illicitly Manufactured Fentanyl–Involved Overdose Deaths with Detected Xylazine — United States, January 2019–June 2022

Introduction to the JFS Special Section on Fentanyl and its Analogs in Forensic Science

Tranq Dope: Characterization of an ED cohort treated with a novel opioid withdrawal protocol in the era of fentanyl/xylazine

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