A new adulterant: Xylazine

 https://www.myamericannurse.com/infiltration-of-xylazine-in-illicit-fentanyl/

A new adulterant: Xylazine

Bowles and associates reported an increasing involvement of xylazine, a highly dangerous, novel emergent adulterant, in drug overdose mortality and morbidity across North America. According to Reed and associates, xyla­zine has most severely affected populations in the eastern United States, Puerto Rico, and Canada. In a mixed-method study, Friedman and colleagues identified xylazine as a factor in national overdose deaths five times higher in 2020 than in 2015.

Xylazine, developed in 1962 by the Bayer Corporation, is a clonidine analog used for large animal sedation and anesthesia; it’s not approved for human use and requires a veterinary license for purchase. Its misuse was first detected in the early 2000s in Puerto Rico where it was called anestesia de caballo (horse anesthesia), according to findings reported by Reed and colleagues. In 2007, it was detected in Philadelphia under the street name tranq (or trank). Other street names include sleep-cut, zombie drug, and Philly dope. Data collected by Knopf reveal that an alarming 38 states have reported the presence of xylazine in overdoses. The DEA Joint Intelligence Report documents the identification of xylazine in all U.S. regions, which indicates increased use.

As an illicit drug for humans, xylazine is easily available for purchase on internet sites that aren’t associated with veterinarian use. Regulation efforts by government agencies aim to classify the drug as a controlled substance.

Xylazine effects

Xylazine prolongs the effects of fentanyl, costs less than fentanyl, and serves as a bulking additive to increase the supply of illicit drugs. It depresses the central nervous system, increasing the likelihood of unintentional overdose. Xylazine causes hypotension, bradycardia, hyperglycemia, hypothermia, profound sedation, coma, dysrhythmia, and respiratory depression. These dramatic physiologic effects ultimately place the individual at high risk for morbidity due to cardio-respiratory events and injuries sustained during periods of stupor or unresponsiveness. In addition, prolonged and profound unresponsiveness increases the risk for violence-related harm.

Xylazine can be taken orally, but I.V. use is most common, which has resulted in the increasing incidence of severe wound infections. These necrotizing wounds present as much worse than the cellulitis or abscesses frequently seen with other illicit I.V. drug use, and they occur not only at injection sites. Reports indicate higher amputation rates among those injecting drugs adulterated with xylazine than those without. Similar to burns, these severe infections form eschar, which when observed in combination with prolonged unresponsiveness (even after administration of naloxone), indicate possible xylazine toxicity.

Nursing implications

When encountering an individual with a suspected overdose of fentanyl or heroin that contains xylazine, remember that naloxone has no effect. The patient may remain unresponsive and in a state of stupor with continued respiratory depression, even after receiving naloxone. Kariisa and colleagues recommend immediate respiratory and cardiovascular supportive care.