A street outreach team from Tapestry Health delivered what is becoming a routine warning. Xylazine is an animal sedative. It is not approved for humans, but it appears in about half of the samples of the drug Tapestry tests in the hills of western Massachusetts. It appears mainly in the illegal supply of fentanyl, but also in cocaine. In Greenfield, Tapestry Health is responding to more overdoses as more and more tests show the presence of xylazine. Several drugs have been used as supportive therapeutic interventions such as lidocaine, naloxone, thiamine, lorazepam, vecuronium, etomidate, propofol, tolazoline, yohimbine, atropine, orciprenaline, metoclopramide, ranitidine, metoprolol, enoxaparin, flucloxacillin, insulin and irrigation of both eyes with saline. [4] The effects of xylazine are also reversed by the analeptics 4-aminopyridine, doxapram and caffeine, which are physiological antagonists of central nervous system tranquilizers. [13] The combination of yohimbine and 4-aminopyridine in an effort to antagonize xylazine is superior to the individual administration of either of these drugs, as it shortens recovery time. [13] Research initiatives may be needed to normalize treatment and identify effective measures to identify chronic xylazine use and intoxication.
[3] There are limited peer-reviewed data on previous exposure to xylazine in LEO or EMS during service. As he approached a pickup truck distributing safe drug supplies in Greenfield, Massachusetts, a man named Kyle noticed a warning about xylazine. In February, the Federal Drug Enforcement Administration`s Diversion Control Division released a fact sheet on xylazine, highlighting its increasing abuse by people who also abuse opioids. Reports from active drug users indicate that xylazine, the veterinary sedative, has increased in the supply of illicit drugs in Philadelphia. To describe trends and characteristics of unintentional deaths due to heroin and/or fentanyl overdose using xylazine evidence in Philadelphia, Pennsylvania, the Philadelphia Department of Public Health analyzed data on accidental heroin and/or fentanyl overdose deaths from the Philadelphia Office of the Medical Examiner over a 10-year period (2010-2019). Xylazine was detected between 2010 and 2015 in less than 2% of fatal heroin and/or fentanyl overdoses in 262 (31%) of 858 fatal heroin and/or fentanyl overdoses in 2019. At present, information on the presence of xylazine in the continental United States is limited. The association of xylazine with adverse effects elsewhere suggests that potential health outcomes should also be monitored in the United States.
Where possible, jurisdictions should routinely test for xylazine. Xylazine is a pharmaceutical drug used for sedation, anesthesia, muscle relaxation and analgesia in animals such as horses, cattle and other non-human mammals. [1] Veterinarians also use xylazine as an emetic, especially in cats. [2] It is a clonidine analogue and an α2 agonist of the adrenergic receptor. [3] Perhaps the biggest concern is an association with more overdoses and deaths. In a study of 10 cities and states, xylazine was detected in less than 1 percent of overdose deaths in 2015, but in 6.7 percent in 2020, a year the U.S. set a new record for overdose deaths. This record was broken again in 2021 with more than 107,000 deaths. Xylazine belongs to a class of medications called alpha-2 agonists. This type of medication does not respond to Narcan® (naloxone), the widely used reversing agent for opioid overdoses. There are xylazine inversions on the market, but they are often not as readily available as Narcan. An overdose of xylazine is usually fatal in humans.
[3] Because it is used as a medicated adulterant, the symptoms caused by the drugs accompanying the administration of xylazine vary. [9] The illegal use of xylazine as an additive has been well documented in Puerto Rico since the early 2000s,5 but cases of overdose due to this mixture have increased rapidly in an increasing number of states.1,4,6 In a study that examined the incidence of xylazine in heroin and/or fentanyl overdose deaths over a ten-year period, Xylazine increased from <2% of cases between 2010 and 2015 to 31% in 2019.6 The most common concomitant drugs in xylazine overdose deaths are cocaine and fentanyl, followed by benzodiazepines, methamphetamine and heroin. Due to the lack of legislative measures and resources available to identify the drug, xylazine is likely under-reported in its national prevalence. "Repeated exposure to xylazine by injection has been associated with severe necrotic skin ulceration, which is markedly different from other soft tissue infections (e.g., cellulite, abscesses) often associated with injection drug use," he wrote in a letter sent Tuesday to health professionals across the country. "These ulcerations can develop in areas of the body outside the injection site." Yohimbine, a natural α2-adrenergic antagonist, has been shown to reverse the hypotensive effects of xylazine in dogs and elephants, but this is not approved for human use.8 Although xylazine is primarily mixed with opioids, xylazine has also been detected in stimulants such as cocaine and methamphetamine. Now you`ve heard the warnings that if you buy a bag of powder from a drug dealer, you don`t really know what`s in it. The "Just Say No" drug education classes of the 1980s warned young people that the powder they thought was cocaine could contain horrible things like rat poison and broken glass, but the adulterants commonly found in the current supply of marketed drugs like cocaine, heroin and methamphetamine are even more frightening. Fentanyl, a synthetic opioid so potent that a tiny amount can cause a fatal overdose, is the drug that receives the most advertising, but another drug appears to be on the rise. National data from Connecticut, Maryland and Pennsylvania show that at least 10 percent of overdose victims in those states had used xylazine between 2015 and 2020, usually in combination with other drugs.
Previously, xylazine abuse in Puerto Rico had been documented for more than a decade. If you`re caught buying or selling drugs, you may not know what drugs are in your possession, but you can be sure you need a Florida drug attorney. The results of this study have some limitations. This study examined the presence of certain substances detected in postmortem toxicology in overdose deaths, but we could not determine which drug or particular combination of drugs caused overdose death. In addition, we could not determine why the supply of xylazine is increasing (e.g., increased market value, increased effects) or whether the deceased intended to use xylazine alone or in combination with other drugs. Although focus groups conducted in Philadelphia suggest that some people who use drugs developed a preference for opioids in combination with xylazine, we could not determine intention from toxicological data alone. Polydrug samples seized in Pennsylvania are conducted by law enforcement and testing is conducted in accordance with court requirements. As a result, seizure data may not reflect the actual prevalence of street drugs.
The results of this study may not be generalizable outside of Philadelphia, and jurisdictions should independently assess whether xylazine is included in their illicit drug supply. Xylazine (Rompun®, Sedazine®, AnaSed®) is an FDA-approved drug for animals only. It is a non-opioid sedative and analgesic. Recent reports suggest that it is increasingly mixed with illicit drugs such as heroin to enhance the effects of euphoria. Xylazine is a potent α2-adrenergic agonist. [4] When xylazine and other α2-adrenergic receptor agonists are administered, they spread throughout the body within 30 to 40 minutes. [15] Due to the highly lipophilic nature of xylazine, xylazine directly stimulates central α2 receptors as well as peripheral α-adrenergic receptors in various tissues. [3] [4] As an agonist, xylazine causes a decrease in the neurotransmission of norepinephrine and dopamine in the central nervous system. [4] This is done by mimicking norepinephrine by binding to presynaptic surface autoreceptors, resulting in feedback inhibition of norepinephrine. [16] In dogs, sheep, horses and cattle, the half-life is very short: only 1.21 to 5.97 minutes.