Xylazine — Medical and Public Health Imperatives

Gupta, Rahul; Holtgräve, David R.; Ashburn, Michael A.

doi:10.1056/nejmp2303120

Cited by 39 publications

(59 citation statements)

References 3 publications

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“…In addition to test strips, integrating xylazine information in overdose prevention training may better prepare individuals who use drugs and other lay and professional overdose responders . The opioid reversal medication naloxone can counteract the respiratory depression caused by the opioids that commonly accompany xylazine but cannot address the effects of xylazine itself (because xylazine is not an opioid), so lay responders are often advised to not only administer naloxone but also call emergency medical services and provide rescue breathing, and medical professionals may need to provide additional interventions specific to xylazine-adulterated drugs . While arguably not directly related to overdose, wound care also represents a harm reduction priority particularly relevant for individuals who use drugs containing xylazine due to the severe skin ulcerations that may accompany use .…”

Section: Discussionmentioning

confidence: 99%

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Xylazine in Overdose Deaths and Forensic Drug Reports in US States, 2019-2022

Cano,

Daniulaityte,

Marsiglia

2024

JAMA Netw Open

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ImportanceXylazine is increasingly reported in street drugs and fatal overdoses in the US, yet state-level data are limited, hampering local public health responses.ObjectiveTo gather available state-level data on xylazine involvement in overdose deaths and in forensic drug reports.Design, Setting, and ParticipantsThis cross-sectional study was a secondary analysis of 2019 to 2022 data from the National Forensic Laboratory Information System (NFLIS), National Center for Health Statistics, and individual states' medical examiner or public health agency reports. Data were analyzed from August to October 2023.ExposureState.Main Outcomes and MeasuresYearly xylazine-related overdose deaths per 100 000 residents; xylazine NFLIS drug reports, both per 100 000 residents and as a percentage of all NFLIS drug reports (from samples of drugs seized by law enforcement and analyzed by NFLIS-participating laboratories).ResultsA total of 63 state-years were included in analyses of mortality rates, while 204 state-years were included in analyses of NFLIS reports. According to the publicly available data compiled in this study, at least 43 states reported at least 1 xylazine-related overdose death from 2019 to 2022, yet yearly totals of xylazine-related deaths were available for only 21 states. Of states with data available, xylazine-involved overdose death rates were highest in Vermont (10.5 per 100 000 residents) and Connecticut (9.8 per 100 000 residents) in 2022. In 2019, 16 states had zero xylazine reports included in NFLIS reports; in 2022, only 2 states had zero xylazine reports and all but 3 states had recorded an increase in xylazine’s representation in NFLIS reports. In 2022, xylazine represented 16.17% of all NFLIS reports in Delaware and between 5.95% and 7.00% of NFLIS reports in Connecticut, Maryland, District of Columbia, New Jersey, and Rhode Island, yet less than 1.0% of NFLIS reports in 35 different states.Conclusions and RelevanceIn this cross-sectional study of publicly available data on fatal overdoses and drugs analyzed by forensic laboratories, xylazine’s reported presence in overdose deaths and forensic reports was concentrated in the eastern US yet extended across the country to encompass nearly all states. In spite of xylazine’s geographic reach, yearly state-level numbers of xylazine-related overdose deaths were publicly available for less than half of all states.

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Section: Discussionmentioning

confidence: 99%

“…1,53 While arguablyFigure 2. Xylazine NFLIS Drug Reports as a Percentage of all NFLIS Drug Reports, US, 2019-2022…”

mentioning

confidence: 99%

Xylazine in Overdose Deaths and Forensic Drug Reports in US States, 2019-2022

Cano,

Daniulaityte,

Marsiglia

2024

JAMA Netw Open

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“…Regarding xylazine-induced wounds, there is an emergent need for clinical practice guidelines to aid treatment plans. 2 In this case, we approached treating the wounds with petroleum-impregnated gauze to keep the area moist. Petroleum-impregnated gauze is a semi-open dressing consisting of a primary layer facing the wound, a secondary layer containing the petroleum-infused absorbent gauze and padding, and a third layer of adhesive.…”

Section: Discussionmentioning

confidence: 99%

“…1 Xylazine is not approved for human use in the United States; however, it has entered the street drug supply as an additive to fentanyl, heroin, and other substances. 2 Xylazine blocks the release of norepinephrine, resulting in hypotension, bradycardia, respiratory depression, drowsiness, and amnesia. Since xylazine is not an opioid, its effects are not reversed by naloxone, making it much more challenging to treat overdose events.…”

Section: Introductionmentioning

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

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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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“…X ylazine, a veterinary sedative colloquially known as "tranq," is spreading in unregulated opioid supplies across North America. 1 Xylazine first emerged in unregulated drug supplies in Puerto Rico in the 2000s, where people who use drugs (PWUDs) and researchers noted an association between repeated xylazine exposure and a distinctive soft tissue wound. [2][3][4] More recently, clinicians in the United States have described the same phenomenon.…”

mentioning

confidence: 99%

Xylazine-associated Wounds: Clinical Experience From a Low-barrier Wound Care Clinic in Philadelphia

McFadden,

Wallace-Keeshen,

Petrillo Straub

et al. 2023

J Addict Med

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The veterinary sedative xylazine is spreading in unregulated opioid supplies across North America. Among people who use drugs with repeated exposure to xylazine, a distinct wound type has emerged. Here, we describe these wounds and share our experience treating them in a nurse-led, low-barrier wound care clinic in Philadelphia, PA. We propose a reimagining of wound treatment across settings to better serve people who use drugs, and we advocate for stronger protections against the harms of an increasingly adulterated drug supply. Our perspective from the epicenter of the xylazine crisis can inform the response of communities across the country who are starting to face harms associated with xylazine.

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Xylazine — Medical and Public Health Imperatives

Cited by 39 publications

References 3 publications

Xylazine in Overdose Deaths and Forensic Drug Reports in US States, 2019-2022

Xylazine in Overdose Deaths and Forensic Drug Reports in US States, 2019-2022

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

Xylazine-associated Wounds: Clinical Experience From a Low-barrier Wound Care Clinic in Philadelphia

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