ACP InternistGuidance Offered for Treating Patients Exposed to Xylazine

The Rising Prevalence of Xylazine in Illegally Manufactured Fentanyl

The increasing prevalence of xylazine, an animal sedative, in illegally manufactured fentanyl is a growing concern. This substance, approved only for veterinary use, has been appearing in fentanyl since 2016 and its presence has been escalating in recent years. The implications of this trend are far-reaching, impacting not only those exposed to the drug but also the healthcare professionals tasked with their care.

HCN Medical Memo
The findings from this study underscore the need for healthcare professionals to be aware of the increasing prevalence of xylazine in illegally manufactured fentanyl. This knowledge is crucial for accurate diagnosis and effective treatment. It also highlights the importance of comprehensive surveillance and education about the likelihood of xylazine exposure. This information could significantly impact their practice and patient care by informing treatment strategies and harm-reduction efforts.

Key Points

• Xylazine has been consistently found in illegally manufactured fentanyl since 2016.
• Exposure to xylazine-fentanyl typically results in sedation but does not require airway intervention.
• It is unclear whether xylazine contributes to acute overdose in patients taking xylazine-fentanyl or whether xylazine-fentanyl withdrawal is distinct from opioid withdrawal.
• Use of xylazine has been associated with open skin ulcerations and chronic wounds.
• The authors recommend educating clinicians on how the presence of xylazine affects recognition, acknowledgment, prophylaxis, and treatment of fentanyl use.
• They also suggest conducting more research to investigate the pharmacology, toxicology, adverse effects, withdrawal syndrome, and treatment strategies related to xylazine-fentanyl use.
• The authors propose expanding screening to include xylazine in standard urine drug testing and further defining test characteristics regarding timing and parameters.
• They advocate for intensifying harm-reduction efforts, including increased surveillance of the drug supply and xylazine test strip distribution.
• They recommend expanding access to low-barrier treatment settings that offer co-located treatment for substance use disorder and wound care.

According to the National Institute on Drug Abuse, more than 70% of people misusing opioids are using them without a prescription.

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