Following is some important information shared by Al Barber:

In her AARP* 2023 presentation “Xylazine: A New Deadly Threat to Public Health”, Dr. Katie Liveoak, PharmD, BCPP from Aegis Sciences Corporation brought attention to the growing prevalence and detection of this veterinary tranquilizer adulterant in the illicit drug supply in the US.

*American Association o Psychiatric Pharmacists

Highlights:

– Xylazine added to fentanyl, heroin, cocaine to increase their euphoric effects and to especially lengthen fentanyl’s short duration of effects.

– Has a 3-day urine detection window, not detected in routine urine drug screens, thus requiring targeted testing methods like gas or liquid chromatography/mass spectrometry (GC/MS),

– Illicitly manufactured #fentanyl was present in 98.4% of #xylazine present-overdose-deaths.

– Not reversed by #naloxone.

– Repeated exposure leads to dependence, severe withdrawal symptoms, and necrotic wound ulcerations/abscesses.

– Multimodal treatment approach has been used to stabilize patients: hydromorphone IV, phenobarbital, dexmedetomidine, tizanidine, clonidine, buprenorphine, gabapentin, ketamine, naloxone with atropine, activated charcoal, lidocaine, vasopressors, metoprolol succinate.

Takeaways:
– Continue administering naloxone for opioid overdoses and consider xylazine if no response.
– Provide appropriate supportive measures to patients, including wound care.
– Consider appropriate testing methods when clinically appropriate and in high-risk patient populations.