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From Over-the-Counter Naloxone to the Rise of Xylazine and Conflicting Marijuana Laws, Clinicians Face New Challenges and Responsibilities

As the United States confronts a complex drug crisis, physicians are at the forefront of understanding and responding to key psychopharmacology trends. This article investigates three pivotal issues: the accessibility of Naloxone, the emergence of the dangerous street drug Xylazine, and the ongoing discord between federal and state marijuana laws.

HCN Medical Memo
Physicians must be vigilant and proactive in adapting to these evolving psychopharmacology trends. The accessibility of Naloxone presents an opportunity for community education on opioid overdose prevention, while the rise of Xylazine demands heightened awareness and reporting. The discord between state and federal marijuana laws also requires careful navigation, particularly when discussing gun ownership with patients.

Key Points

• Naloxone Availability: Naloxone is now available over-the-counter in various outlets including CVS, Walgreens, and Rite Aid. Despite its $45 price tag for two doses, efforts are underway to make it more accessible through community resource centers.
• Xylazine Surge: Known as “tranq” or “zombie drug,” Xylazine is a fast-spreading, deadly street drug. The federal government has initiated a comprehensive strategy to tackle its proliferation, which now spans at least 36 states.
• Marijuana and Gun Ownership: Despite the legalization or decriminalization of cannabis in numerous states, federal law still prohibits gun purchases by cannabis users.

“If we thought fentanyl was dangerous, fentanyl combined with xylazine is even deadlier.”
– Rahul Gupta, MD, Director of the White House Office of National Drug Control Policy

Additional Points

• In 2020, 77% of preventable drug overdose deaths involved opioids, with fentanyl-related deaths increasing by 26% in 2021.
• The death rate from Xylazine overdoses increased 35-fold from 2018 to 2021 and does not respond to Naloxone.
• The ATF has issued a notice clarifying that federal law still prohibits gun ownership for cannabis users, irrespective of state laws.

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