Protocols for first responders and harm reduction workers should be reviewed and updated to account for the increased presence of the animal tranquilizer xylazine in the illicit street drug supply, according to a new study led by researchers at the Yale School of Public Health.
Known in street lingo as “tranq,” xylazine is increasingly being used as an adulterant in fentanyl. As a result, presence of xylazine in fentanyl involved overdose deaths in Connecticut rose 5.5-fold between 2019 and 2021 and the drug has been labeled an emerging public health threat.
Xylazine’s powerful sedative properties complicate emergency response to overdose, the researchers said. The standard response to a suspected drug overdose is the administration of naloxone, which reverses depressed opioid-induced respiration. However, the extreme sedative properties of xylazine slow the recovery of consciousness, disguise the effect of a single dose of naloxone, and promote multiple doses of naloxone, which can lead to severe and unnecessary withdrawal, the researchers said.
After reviewing Connecticut medical examiner records, surveying people who use drugs, and interviewing harm reduction workers and first responders in Philadelphia and Connecticut where xylazine emerged as a serious problem earlier than in the rest of the U.S. – the researchers identified several areas that warrant further exploration and possible adoption to improve emergency response to xylazine-suspected drug overdose. They are:
- Easily accessible test strips for the detection of xylazine in a drug sample.
- If any respiration is restored following an overdose, blood oxygen levels should be closely monitored using an oximeter. Supplemental oxygen can also be provided through rescue breathing or portable oxygen canisters until normal oxygen levels are achieved.
- As xylazine use is associated with severe skin lesions, normal injection site wound care is insufficient, and xylazine-specific wound care kits should be created and disseminated to frontline health workers.
- Persistent exposure to xylazine can produce dependence and may require management of withdrawal symptoms that appear similar to those produced by cessation of benzodiazepines like Xanax and Valium.
Thomas Quijano, Jason Crowell, Kathryn Eggert, Katie Clark, Marcus Alexander, Lauretta Grau, Robert Heimer, Xylazine in the drug supply: emerging threats and lessons learned in areas with high levels of adulteration. International Journal of Drug Policy, August 11, 2023.