Sober Synthesis

Communication

Xylazine – An Emerging Threat

The recent edition of the CDC Morbidity and Mortality Weekly Report (MMWR) Weekly / June 30, 2023 / 72(26);721–727 contained the communication: Illicitly Manufactured Fentanyl–Involved Overdose Deaths with Detected Xylazine — United States, January 2019–June 2022

https://www.cdc.gov/mmwr/volumes/72/wr/mm7226a4.htm?s_cid=mm7226a4_w

Xylazine, often known as “tranq” or  “tranq dope” has been declared an “emerging threat” by the federal government.  It is most often found mixed with fentanyl although it has also been found in street cocaine, methamphetamine, and benzodiazepines.  The drug is most often added to give a “booster” effect to another drug. It is cheap and readily available thus making it a profitable additive for the illicit drug trade.

In a few short years it now has been associated with between 9% to 23% of fentanyl overdose deaths. The CDC estimates that 10.9% of  illicitly manufactured fentanyl deaths involved xylazine in the time period studied.  When injected it can produce severe necrotic non healing skin lesions.

Xylazine is used an an animal anesthetic often in combination with ketamine.  It has no approved use in humans, thus it is not a scheduled drug.  It is considered too dangerous for human use.  The pharmacology is akin to a cluster bomb, affecting multiple transmitter systems.  Because of its primary actions on the adrenergic system it produces depressed heart rate, blood pressure, and respiration.  It produces strong physical withdrawal symptoms.

Xylazine is not an opiate, thus naloxone does not reverse the effects.  Because it most often is taken with fentanyl, rescue naloxone should be administered with overdose.  There is no known specific antidote and treatment is supportive of vital functions.

The epidemiology is limited at this time as toxicology tests are not widely available or known.  The CDC data is based on their SUDORS reporting system and only for confirmed cases, thus limiting.  It is based on only 21 reporting jurisdictions for 18 months.

CDC fact sheet with suggested harm reduction strategies for individuals and communities.

https://www.cdc.gov/drugoverdose/deaths/other-drugs/xylazine/faq.html

More information about Xylazine from drugs.com 

https://www.drugs.com/illicit/xylazine.html

A very good short article with comments from a medical toxicologist

https://theconversation.com/what-is-xylazine-a-medical-toxicologist-explains-how-it-increases-overdose-risk-and-why-narcan-can-still-save-a-life-199482

Another informative article

https://medicalxpress.com/news/2023-07-soaring-misuse-horse-tranquilizer-xylazine.html

Thank you for your consideration in reviewing this brief article.

For information and educational purposes only.  No commercial or institutional interests.  This post should not be considered professional or medical advice.

Comments and feedback are always welcome.