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Xylazine Adulteration of the Illicit Heroin–Fentanyl Drug Supply

“Xylazine pharmacology, animal and human clinical effects, and what is known to date about care of patients experiencing acute overdose, xylazine–fentanyl withdrawal, and xylazine-associated wounds” are summarized in a narrative review.

“Xylazine is an animal sedative, approved by the U.S. Food and Drug Administration, that is commonly used in veterinary medicine and is not approved for human use,” the authors write. “Since 2016, xylazine has consistently appeared in the illicitly manufactured fentanyl supply and has significantly increased in prevalence, likely due to its low cost, easy availability, and presumed synergistic psychoactive effect. Clinical experience along with the available pertinent research were used to review xylazine adulteration of the drug supply and provide guidance on the care of patients exposed to xylazine.”

Editorial: “We do not currently know how widespread the xylazine problem is,” editorialists write. “For now, we must rely on sorting out pieces of data and attempt to obtain a clear picture of this rapidly evolving phenomenon. The addition of xylazine to the opioid crisis has not only further complicated public health response, it has also complicated our surveillance efforts. Collaboration between disciplines is needed to better monitor the situation—with fewer blind spots.”

Source: Annals of Internal Medicine