New Overdose Risk Discovered in LA County

/

The emergence of xylazine in LA County, which was previously more common on the east coast, raises serious concerns for both healthcare professionals and the community at large. Recent warnings from the United States Food and Drug Administration (FDA) and the White House emphasize the need for heightened awareness and vigilance in identifying and managing cases involving xylazine exposure. Xylazine, often called “Tranq” on the street, is a non-opioid tranquilizer, only approved for use in large animals, such as horses. In people, Tranq added to other drugs increases the risk for overdose.

FAAX (Fentanyl Adulterated or Associated with Xylazine) was declared an emerging health threat by the US White House Office of National Drug Control Policy (ONDCP) in April 2023 (Gupta et al, 2023), following the FDA’s warning in November 2022, sounding alarms about the increasing presence of xylazine in the illicit drug supply and drug overdoses. Xylazine is now making its way to the West coast, with the drug appearing recently in Los Angeles County, after being predominantly seen only on the East coast.

Xylaxine is used as a tranquilizer for large animals, such as horses.

Xylazine: An Unwelcome Guest

Xylazine is not a newcomer to the world of medicine. It was first approved by the FDA in 1972 for use in veterinary medicine as a sedative and analgesic. Structurally similar to other substances like levamisole, clonidine, and tizanidine, xylazine shares some clinical effects with these drugs. However, it's important to note that xylazine is not approved for use in humans.

Xylazine is similar to clonidine in structure and function

The Risks of Xylazine Exposure

The FDA's warning emphasizes the grave risks associated with xylazine exposure in humans. These risks are significant and can have serious consequences:

  1. Acute Toxicity: Acute xylazine toxicity can manifest as central nervous system and respiratory depression, hypotension, bradycardia, hypothermia, miosis (constricted pupils), or high blood glucose levels. Importantly, the symptoms of xylazine toxicity can closely resemble those of opioid overdose, making it challenging to differentiate between the two. Regardless, Narcan should be administered.

  2. Naloxone Ineffectiveness: Xylazine is not reversed by naloxone. This poses a critical challenge for healthcare professionals who may be administering naloxone in overdose situations involving xylazine. While Narcan should be given for suspected overdoses, extra care should be taken to monitor blood pressure. This also makes it even more important to call 911 for emergency services after administering Narcan.

  3. Skin Ulcerations: Repeated exposure to xylazine through injection has been associated with severe, necrotic skin ulcerations. These ulcerations are distinct from other soft-tissue infections that are typically associated with injection drug use and can occur in areas of the body away from the injection site.

  4. Dependence and Withdrawal: Individuals exposed to xylazine on a recurring basis may develop dependence on the substance. Withdrawal symptoms, such as severe anxiety and agitation, can occur when they reduce or discontinue xylazine use. Unfortunately, traditional medications used to manage opioid use disorder (OUD) have not been approved for xylazine withdrawal treatment.

What should healthcare providers know about Xylazine?

1. Naloxone Awareness: Healthcare professionals need to be aware that naloxone may not be effective in cases involving xylazine. If patients do not respond as expected to naloxone, or if signs of xylazine exposure are present, xylazine exposure should be considered.

2. Testing Challenges: Routine toxicology screens do not readily detect xylazine. Therefore, healthcare providers should consider the possibility of xylazine involvement, especially when other signs or symptoms of xylazine exposure are present.

3. Skin Ulcerations: Healthcare professionals encountering patients with severe, necrotic skin ulcerations should consider the possibility of repeated xylazine exposure and provide appropriate wound management.

4. Withdrawal Management: Clinicians treating patients with OUD should be vigilant for withdrawal symptoms not typically managed by standard OUD treatments, as this may indicate xylazine withdrawal.

Healthcare professionals and residents alike should stay informed and report any adverse events related to possible xylazine exposure, as the FDA continues to monitor this troubling trend. It's a stark reminder that the opioid crisis is evolving, and new challenges continue to emerge.

References for More Information

Holt AC, Schwope DM, Le K, Schrecker JP, Heltsley R. Widespread Distribution of Xylazine Detected Throughout the United States in Healthcare Patient Samples. J Addict Med. 2023 Jul-Aug 01;17(4):468-470. doi: 10.1097/ADM.0000000000001132. Epub 2023 Jan 6. PMID: 37579111; PMCID: PMC10417214.

Xylazine Pharm Wiki: https://tmedweb.tulane.edu/pharmwiki/doku.php/xylazine

DEA Warning: https://www.dea.gov/documents/2022/2022-12/2022-12-21/growing-threat-xylazine-and-its-mixture-illicit-drugs

White House Response Plan: https://www.whitehouse.gov/ondcp/briefing-room/2023/07/11/icymi-in-continued-response-to-overdose-epidemic-the-white-house-releases-national-response-plan-to-address-the-emerging-threat-of-fentanyl-combined-with-xylazine/

Unboxing the Power of Procrastination

/
Unboxing the Power of Procrastination

Procrastination. A term often muttered with guilt, associated with the last-minute panic of unfinished tasks, and the throbbing regret of wasted time. We’re frequently told that procrastination is the thief of time, a villain we must vanquish to be successful. But is it possible that procrastination could be an effective productivity tool?

Read More