Xylazine, a Veterinary Tranquilizer, Detected in 42 Accidental Fentanyl Intoxication Deaths

Nunez, Jacqueline; DeJoseph, Maura E; Gill, James R.

doi:10.1097/paf.0000000000000622

Cited by 50 publications

(58 citation statements)

References 14 publications

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“…Xylazine, an alpha-2 receptor agonist, is used in veterinary medicine as a sedative and muscle relaxant; it is not approved for use in humans. However, reports of adulteration of illicit opioids with xylazine have been increasing in the United States ( 1 – 3 ). In humans, xylazine can cause respiratory depression, bradycardia, and hypotension ( 4 ).…”

mentioning

confidence: 99%

Notes From the Field: Xylazine-Related Deaths — Cook County, Illinois, 2017–2021

Chhabra¹,

Mir²,

Hua³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

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mentioning

confidence: 99%

Notes From the Field: Xylazine-Related Deaths — Cook County, Illinois, 2017–2021

Chhabra¹,

Mir²,

Hua³

et al. 2022

MMWR Morb. Mortal. Wkly. Rep.

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“…Xylazine is an alpha-2 adrenergic receptor agonist, similar to clonidine, and is a non-narcotic sedative used for analgesia and muscle relaxation exclusively in veterinary medicine [ 1 ]. Illicit use of xylazine among persons who inject drugs (PWID) has been reported in Puerto Rico since the early 2000s [ 2 ] and more recently in Philadelphia, Pennsylvania [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Xylazine-Induced Skin Ulcers in a Person Who Injects Drugs in Philadelphia, Pennsylvania, USA

Malayala¹,

Papudesi²,

Bobb³

et al. 2022

Cureus

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Xylazine, an alpha-2 adrenergic receptor agonist typically used as a sedative and analgesic in veterinary medicine, is being illicitly supplied to persons who inject drugs (PWID), especially in Puerto Rico and Philadelphia, Pennsylvania in the USA. There is a high prevalence (up to 78%) of xylazine in fentanyl in these areas and also a steep increase in fatalities from its overdose.In this case report, we discuss a case of xylazine-induced skin ulcers in a PWID in the city of Philadelphia. The patient is a 37-year-old female who was injecting about eight to ten "bags" of "dope" (fentanyl, which is typically mixed with xylazine in Philadelphia) every day. She typically injected into her veins on the hands and sometimes into the legs. She presented with ulcers on her lower extremities extending from the knees to ankles, associated with copious purulent drainage and a foul smell. There was extensive necrosis of the subcutaneous tissues, abscesses, and tibial osteomyelitis. This led to multiple hospitalizations with bacteremia from Strep pyogenes, methicillin-resistant Staphylococcus aureus, methicillin-sensitive S. aureus, Enterococcus faecalis, Escherichia coli, and Proteus requiring intravenous antibiotics. She required debridement of the wounds and topical care to treat them.In the areas with a high prevalence of the use of xylazine mixed with fentanyl or heroin, abscesses, and painful skin ulcers are very often reported. The mechanism is thought to be due to its direct vasoconstricting effect on local blood vessels and the resultant decreased skin perfusion. Prolonged use can lead to decreased perfusion and impaired wound healing, leading to higher chances of infection of these ulcers. In addition to the topical effect of vasoconstriction, xylazine also leads to hypotension, bradycardia, and respiratory depression.A skin ulcer in a PWID, similar to the ones reported in our case, should raise clinical suspicion for the presence of xylazine in opiates and other substances.

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“…While the concern over fentanyl in the unregulated supply is warranted, other adulterants have implications for health. The veterinary anesthetic xylazine is increasingly appearing in overdose fatalities ( 42 , 43 ) and may cause atypical ulcers beyond the injection site ( 44 , 45 ). Phenacetin, caffeine, etizolam, and synthetic cannabinoids are also increasingly used as adulterants ( 46 , 47 ).…”

Section: Two Guiding Principlesmentioning

confidence: 99%

Invited Commentary: Drug Checking for Novel Insights Into the Unregulated Drug Supply

Dasgupta

Figgatt

2021

American Journal of Epidemiology

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Tobias et al. (Am J Epidemiol. XXXX;XXX(XX):XXXX–XXXX) present a novel analysis of time trends in fentanyl concentrations in the unregulated drug supply in British Columbia, Canada. The pre-existing knowledge about unregulated drugs had previously come from law enforcement seizures and post-mortem toxicology. As both of these data sources are subject to selection bias, large scale drug checking programs are poised to be a crucial component of the public health response to the unrelenting increase in overdose in North America. As programs expand, we offer two guiding principles. First, the primary purpose of these programs is to deliver timely results to people who use drugs to mitigate health risks. Second, innovation is needed to go beyond criminal justice paradigms in laboratory analysis for a more nuanced understanding of health concerns. We provide examples of the role adulterants play in our understanding of drug harms. We also describe the applications and limitations of common laboratory assays, with implications for epidemiologic surveillance. While the research and direct service teams in British Columbia have taken groundbreaking steps, there is still a need to establish best practices for communicating results to sample donors in an approachable yet non-alarmist tone.

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Xylazine, a Veterinary Tranquilizer, Detected in 42 Accidental Fentanyl Intoxication Deaths

Cited by 50 publications

References 14 publications

Notes From the Field: Xylazine-Related Deaths — Cook County, Illinois, 2017–2021

Notes From the Field: Xylazine-Related Deaths — Cook County, Illinois, 2017–2021

Xylazine-Induced Skin Ulcers in a Person Who Injects Drugs in Philadelphia, Pennsylvania, USA

Invited Commentary: Drug Checking for Novel Insights Into the Unregulated Drug Supply

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