Perspectives of people in Philadelphia who use fentanyl/heroin adulterated with the animal tranquilizer xylazine; Making a case for xylazine test strips

Reed, Megan; Imperato, Nicholas S.; Bowles, Jeanette M.; Salcedo, Venise J.; Guth, Amanda; Rising, Kristin L.

doi:10.1016/j.dadr.2022.100074

Cited by 40 publications

(32 citation statements)

References 25 publications

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“…Evidence suggests a favorable attitude of PWID toward XTS; in a recent study, 100% of PWID interviewed about xylazine in Philadelphia were interested in hypothetical XTS. 14 The acceptability and utility of fentanyl test strips supports widespread dissemination of XTS to PWID, as fentanyl test strips have been reported to change drug use behavior and improve perceived overdose safety. 16 Harm reduction programs, such as the IDEA SSP, play an important role in linking PWID to healthcare services.…”

Section: Discussionmentioning

confidence: 94%

“…While there have been reports of intentional xylazine use, 13 with patients reporting that xylazine "extends the high'' and "gives the [fentanyl] more of a heroin effect," recent studies emphasize PWID's overwhelming concern about the adulterated fentanyl supply. 14 Xylazine's sedating effects leave unhoused PWID vulnerable to robbery and assault, and one study stated that xylazine-induced wounds are a primary concern among PWID. 3 The rising prevalence of xylazine-adulterated fentanyl is a concerning trend that may be changing the risk pro le of substance use, altering substance use patterns, and affecting the treatment response of individuals with suspected overdose events.…”

Section: Discussionmentioning

confidence: 99%

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A Confirmed Case of Xylazine-Induced Skin Ulcers in a Person Who Injects Drugs in Miami, Florida, USA

Warp

Hauschild

Tookes

et al. 2023

Preprint

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Background Xylazine is an alpha-2 adrenergic receptor agonist that has emerged as a contaminant in the street drug supply of fentanyl. Xylazine use may be suspected in naloxone-resistant overdoses and atypical, chronic wounds in people who inject drugs (PWID). This case is unique because it is the first case to our knowledge describing wound care for a xylazine-induced wound with a confirmatory xylazine test strip (XTS) in the setting of a syringe services program (SSP) and in the state of Florida.Case Presentation A 43-year-old woman with a past medical history of severe opioid use disorder and stimulant use disorder presented to a student-run clinic at the IDEA Miami SSP for wound care. She had multiple ulcerations diffusely over her bilateral forearms with surrounding erythema and warmth. Seven weeks later, she presented to clinic again for wound care because her wounds had progressed. At this visit, a XTS was used to confirm the presence of xylazine in her urine. Wound care management and harm reduction strategies employed at both visits are discussed below. Wound outcomes are unknown as the patient has not returned to clinic.Conclusions Many PWID at highest risk for acute and chronic health consequences of xylazine-adulterated fentanyl do not have access to healthcare outside of low barrier clinics and SSPs due to lack of insurance or mistrust of the traditional healthcare system. There is an urgent need for access to XTS for PWID and clinical practice guidelines for the treatment of xylazine-related wounds in outpatient clinics.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

A Confirmed Case of Xylazine-Induced Skin Ulcers in a Person Who Injects Drugs in Miami, Florida, USA

Warp

Hauschild

Tookes

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…It is still too early to know if the presence of medetomidine in the drug supply will grow or subside, given the increasing awareness of xylazine in the drug supply, especially as new drugs containing this compound are released into the market [20]. The detection of other veterinary sedatives also brings into question whether or not calls to develop xylazine immunoassay test strips [21] should be expanded to include additional compounds, even if they have yet to be seen on a large-scale. The presence of medetomidine in used drug samples, ultimately, highlights the increasing need for monitoring and early detection of the drug supply from multiple sample sources including public health, law enforcement, and forensics.…”

Section: Discussionmentioning

confidence: 99%

Identification of the Veterinary Sedative Medetomidine in Combination with Opioids and Xylazine in Maryland

Sisco

Appley

2023

Preprint

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Public health, public safety, and forensic science personnel continue to face the emergence of new compounds into the drug market. While focus is often put on the detection of new analogs of known illicit drugs, monitoring the changes in cutting agents and other compounds can be equally as important. Over the last year, near real-time monitoring of the drug supply in Maryland has been completed through a public health – public safety partnership whereby residue from suspected drug packaging or used paraphernalia is collected and analyzed. Through this project, we have recently detected the presence of the veterinary sedative medetomidine in a small number of samples. The presence of medetomidine has been identified in both public health and law enforcement samples and in the presence of fentanyl and xylazine – another veterinary sedative that has been widely observed over the last year. While the rate at which medetomidine has been detected remains low, it is concerning and worthy of continued monitoring.

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“…It is still too early to know whether the presence of medetomidine in the drug supply will grow or subside and whether the increased awareness of xylazine in the drug supply will effect this [22]. The detection of other veterinary sedatives also brings into question whether or not calls to develop xylazine immunoassay test strips [23] should be expanded to include additional compounds, even if they have yet to be seen on a large scale. The presence of medetomidine in used drug samples, ultimately, highlights the increasing need for monitoring and early detection of the drug supply from multiple sample sources including public health, law enforcement, and forensics.…”

Section: Con Clus Ionmentioning

confidence: 99%

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

Sisco

Appley

2023

Journal of Forensic Sciences

View full text Add to dashboard Cite

Public health, public safety, and forensic science personnel continue to face the emergence of new compounds into the drug market. While focus is often put on the detection of new analogs of known illicit drugs, monitoring the changes in cutting agents and other compounds can be equally as important. Over the last year, near real‐time monitoring of the drug supply in Maryland has been completed through a public health–public safety partnership whereby residue from suspected drug packaging or used paraphernalia is collected and analyzed. Through this project, we have recently detected the presence of the veterinary sedative medetomidine in a small number of samples. The presence of medetomidine has been identified in both public health and law enforcement samples and in the presence of fentanyl and xylazine—another veterinary sedative that has been widely observed over the last year. While the rate at which medetomidine has been detected remains low, it is concerning and worthy of continued monitoring.

show abstract

Perspectives of people in Philadelphia who use fentanyl/heroin adulterated with the animal tranquilizer xylazine; Making a case for xylazine test strips

Cited by 40 publications

References 25 publications

A Confirmed Case of Xylazine-Induced Skin Ulcers in a Person Who Injects Drugs in Miami, Florida, USA

A Confirmed Case of Xylazine-Induced Skin Ulcers in a Person Who Injects Drugs in Miami, Florida, USA

Identification of the Veterinary Sedative Medetomidine in Combination with Opioids and Xylazine in Maryland

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

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