Reducing the harms of xylazine: clinical approaches, research deficits, and public health context.
Drug injection
Harm reduction
Wounds
Xylazine
Journal
Harm reduction journal
ISSN: 1477-7517
Titre abrégé: Harm Reduct J
Pays: England
ID NLM: 101153624
Informations de publication
Date de publication:
30 09 2023
30 09 2023
Historique:
received:
16
05
2023
accepted:
27
09
2023
medline:
2
10
2023
pubmed:
1
10
2023
entrez:
30
9
2023
Statut:
epublish
Résumé
Xylazine has emerged as a consistent part of the unregulated drug supply in recent months. We discuss major domains of xylazine's harm, current knowledge deficits, clinical and harm reduction strategies for minimizing harm, and xylazine's public health and policy context. As an interdisciplinary team from across the USA, we have pooled our knowledge to provide an overview of xylazine's current and emerging contexts. To inform this essay, the pertinent literature was reviewed, clinical knowledge and protocols were shared by multiple clinicians with direct expertise, and policy and public health context were added by expert authors. We describe xylazine's major harm domains-acute poisoning, extended sedation, and wounds, along with anemia and hyperglycemia, which have been reported anecdotally but lack as clear of a connection to xylazine. Current successful practices for xylazine wound care are detailed. Understanding xylazine's epidemiology will also require greater investment in drug checking and surveillance. Finally, approaches to community-based wound care are discussed, along with an orientation to the larger policy and public health context. Addressing the harms of xylazine requires interdisciplinary participation, investment in community-based harm reduction strategies, and improved drug supply surveillance. The relatively unique context of xylazine demands buy-in from public health professionals, harm reduction professionals, clinicians, basic science researchers, policymakers and more.
Identifiants
pubmed: 37777769
doi: 10.1186/s12954-023-00879-7
pii: 10.1186/s12954-023-00879-7
pmc: PMC10544173
doi:
Substances chimiques
Xylazine
2KFG9TP5V8
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
141Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Greene SA, Thurmon JC. Xylazine—a review of its pharmacology and use in veterinary medicine. J Vet Pharmacol Ther. 1988;11(4):295–313. https://doi.org/10.1111/j.1365-2885.1988.tb00189.x .
doi: 10.1111/j.1365-2885.1988.tb00189.x
pubmed: 3062194
Kitano T, Kobayashi T, Yamaguchi S, Otsuguro K. The alpha(2A) -adrenoceptor subtype plays a key role in the analgesic and sedative effects of xylazine. J Vet Pharmacol Ther. 2019;42(2):243–7. https://doi.org/10.1111/jvp.12724 .
doi: 10.1111/jvp.12724
pubmed: 30417462
Bedard M, Murray J, et al. Xylazine is an agonist at kappa opioid receptors and exhibits sex-specific responses to naloxone administration. Preprint. Posted September 9, 2023. https://doi.org/10.1101/2023.09.08.556914
Ruiz-Colon K, Chavez-Arias C, Diaz-Alcala JE, Martinez MA. Xylazine intoxication in humans and its importance as an emerging adulterant in abused drugs: a comprehensive review of the literature. Forensic Sci Int. 2014;240:1–8. https://doi.org/10.1016/j.forsciint.2014.03.015 .
doi: 10.1016/j.forsciint.2014.03.015
pubmed: 24769343
Reyes JC, Negron JL, Colon HM, et al. The emerging of xylazine as a new drug of abuse and its health consequences among drug users in Puerto Rico. J Urban Health. 2012;89(3):519–26. https://doi.org/10.1007/s11524-011-9662-6 .
doi: 10.1007/s11524-011-9662-6
pubmed: 22391983
pmcid: 3368046
Rodriguez N, Vargas Vidot J, Panelli J, Colon H, Ritchie B, Yamamura Y. GC-MS confirmation of xylazine (Rompun), a veterinary sedative, in exchanged needles. Drug Alcohol Depend.2008;96(3):290–3. https://doi.org/10.1016/j.drugalcdep.2008.03.005
Alexander RS, Canver BR, Sue KL, Morford KL. Xylazine and overdoses: trends, concerns, and recommendations. Am J Public Health. 2022;112(8):1212–6. https://doi.org/10.2105/AJPH.2022.306881 .
doi: 10.2105/AJPH.2022.306881
pubmed: 35830662
Moraff C. "“Tranq Dope”—The Heroin Combo That’s Been Putting Philly to Sleep." Filter Magazine. 2 April 2019. Online. https://filtermag.org/tranq-dope-the-heroin-combo-thats-been-putting-philly-to-sleep/
Krishnan M. A Horrifying Drug Called ‘Tranq Dope’ Is Spreading in the US. Vice News. Nov 15, 2022. https://www.vice.com/en/article/akeqje/tranq-dope-in-united-states
Montero F, Bourgois P, Friedman J. Potency-enhancing synthetics in the drug overdose epidemic: Xylazine (“Tranq”), fentanyl, methamphetamine, and the displacement of heroin in Philadelphia and Tijuana. J Illicit Econ Dev. 2022;4(2):204–222. https://doi.org/10.31389/jied.122
Lambdin BH, Bluthenthal RN, Zibbell JE, Wenger L, Simpson K, Kral AH. Associations between perceived illicit fentanyl use and infectious disease risks among people who inject drugs. Int J Drug Policy. 2019;74:299–304. https://doi.org/10.1016/j.drugpo.2019.10.004 .
Ahern J, Stuber J, Galea S. Stigma, discrimination and the health of illicit drug users. Drug Alcohol Depend. 2007;88(2–3):188–96. https://doi.org/10.1016/j.drugalcdep.2006.10.014 .
doi: 10.1016/j.drugalcdep.2006.10.014
pubmed: 17118578
Figgatt MC, Salazar ZR, Vincent L, et al. Treatment experiences for skin and soft tissue infections among participants of syringe service programs in North Carolina. Harm Reduct J. 2021;18:80. https://doi.org/10.1186/s12954-021-00528-x .
doi: 10.1186/s12954-021-00528-x
pubmed: 34330297
pmcid: 8324443
Ball NS, Knable BM, Relich TA, Smathers AN, Gionfriddo MR, Nemecek BD, Montepara CA, Guarascio AJ, Covvey JR, Zimmerman DE. Xylazine poisoning: a systematic review. Clin Toxicol. 2022;60(8):892–901. https://doi.org/10.1080/15563650.2022.2063135 .
doi: 10.1080/15563650.2022.2063135
Friedman J, Montero F, Bourgois P, Wahbi R, Dye D, Goodman-Meza D, Shover C. Xylazine spreads across the US: a growing component of the increasingly synthetic and polysubstance overdose crisis. Drug Alcohol Depend. 2022;233: 109380. https://doi.org/10.1016/j.drugalcdep.2022.109380 .
doi: 10.1016/j.drugalcdep.2022.109380
pubmed: 35247724
pmcid: 9128597
Sivilotti ML. Flumazenil, naloxone and the “coma cocktail.” Br J Clin Pharmacol. 2016;81(3):428–36. https://doi.org/10.1111/bcp.12731 .
doi: 10.1111/bcp.12731
pubmed: 26469689
Giovannitti JA, Thoms SM, Crawford JJ. Alpha-2 adrenergic receptor agonists: A review of current clinical applications. Anesth Prog. 2015;62(1):31–8. https://doi.org/10.2344/0003-3006-62.1.31 .
doi: 10.2344/0003-3006-62.1.31
pubmed: 25849473
pmcid: 4389556
Ehrman-Dupre R, Kaigh C, Salzman M, Haroz R, Peterson LK, Schmidt R. Management of Xylazine withdrawal in a hospitalized patient: a case report. J Addict Med. 2022;16(5):595–598. https://doi.org/10.1097/ADM.0000000000000955
Lyder CH, Ayello EA. Pressure ulcers: a patient safety issue. In: Hughes RG, editor. Patient safety and quality: an evidence-based handbook for nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 12. https://www.ncbi.nlm.nih.gov/books/NBK2650/
Mitchell A. Adult pressure area care: Preventing pressure ulcers. Br J Nurs 2018;27(18), 1050–1052. https://doi.org/10.12968/bjon.2018.27.18.1050
Ramondou P, Hersant J, Bernardeau E, Moumneh T, Feuilloy M, Henni S, Abraham P. Kneeling-induced calf ischemia: a pilot study in apparently healthy European young subjects. Eur J Appl Physiol. 2021;121(11):3031–40. https://doi.org/10.1007/s00421-021-04764-8 .
doi: 10.1007/s00421-021-04764-8
pubmed: 34254181
Clarke D, Mullings S, Franklin S, Jones K. Well leg compartment syndrome. Trauma Case Rep. 2017;11:5–7. https://doi.org/10.1016/j.tcr.2017.09.002 .
doi: 10.1016/j.tcr.2017.09.002
pubmed: 29644268
pmcid: 5887056
Abbey A, Zawacki T, Buck PO, Clinton AM, McAuslan P. Alcohol and sexual assault. Alcohol Res Health. 2001;25(1):43–51.
pubmed: 11496965
pmcid: 4484576
Chambers HF. Skin and soft tissue infections in persons who inject drugs. Infect Dis Clin N Am. 2021;35(1):169–81. https://doi.org/10.1016/j.idc.2020.10.006 .
doi: 10.1016/j.idc.2020.10.006
Biancarelli DL, Biello KB, Childs E, Drainoni M, Salhaney P, Edeza A, Bazzi AR. Strategies used by people who inject drugs to avoid stigma in healthcare settings. Drug Alcohol Depend. 2019;198:80–6.
doi: 10.1016/j.drugalcdep.2019.01.037
pubmed: 30884432
pmcid: 6521691
Powers J, Higham C, Broussard K, Phillips TJ. Wound healing and treating wounds. J Am Acad Dermatol. 2016;74(4):607–25. https://doi.org/10.1016/j.jaad.2015.08.070 .
doi: 10.1016/j.jaad.2015.08.070
pubmed: 26979353
Wilkins RG, Unverdorben M. Wound cleaning and wound healing: a concise review. Adv Skin Wound Care. 2013;26(4):160–3. https://doi.org/10.1097/01.ASW.0000428861.26671.41 .
doi: 10.1097/01.ASW.0000428861.26671.41
pubmed: 23507692
Brown G. Wound documentation: managing risk. Adv Skin Wound Care. 2006;19(3):155–65.
doi: 10.1097/00129334-200604000-00011
pubmed: 16639222
Majtan J. Honey: an immunomodulator in wound healing. Wound Repair Regen. 2014;22(2):187–92.
doi: 10.1111/wrr.12117
pubmed: 24612472
Bryant RA, Nix DP. Chapter 17: wound debridement. In Acute & chronic wounds: current management concepts (pp. 295–305). 2017. Elsevier.
Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, Chambers HF. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin infect Dis. 2011;52(3):e18–55.
doi: 10.1093/cid/ciq146
pubmed: 21208910
Smith+Nephew. How to apply Collagenase SANTYL◊ Ointment. Accessed 12 April 2023. https://santyl.com/how-to-apply
Mackenzie AR, Laing RB, Douglas JG, Greaves M, Smith CC. High prevalence of iliofemoral venous thrombosis with severe groin infection among injecting drug users in North East Scotland: successful use of low molecular weight heparin with antibiotics. Postgrad Med J. 2000;76(899):561–5. https://doi.org/10.1136/pmj.76.899.561 .
doi: 10.1136/pmj.76.899.561
pubmed: 10964121
pmcid: 1741719
Hoda Z, Kerr T, Li K, Montaner JS, Wood E. Prevalence and correlates of jugular injections among injection drug users. Drug Alcohol Rev. 2008;27(4):442–6. https://doi.org/10.1080/09595230802089701 .
doi: 10.1080/09595230802089701
pubmed: 18584397
Ambrosio AM, Keila Kazue IDA, Souto MTDMR, Claudio L, da Silva LC, Soares PB, Marcelo T. Significant hematocrit decrease in healthy horses during clinical anesthesia. Braz J Vet Res Anim Sci. 2012;49(2):139–45.
Xiao YF, Wang B, Wang X, Du F, Benzinou M, Wang YX. Xylazine-induced reduction of tissue sensitivity to insulin leads to acute hyperglycemia in diabetic and normoglycemic monkeys. BMC Anesthesiol. 2013;13(1):33. https://doi.org/10.1186/1471-2253-13-33 .
doi: 10.1186/1471-2253-13-33
pubmed: 24138083
pmcid: 4016475
Sanchez DP, Tookes H, Pastar I, Lev-Tov H. Wounds and skin and soft tissue infections in people who inject drugs and the utility of syringe service programs in their management. Adv Wound Care (New Rochelle). 2021;10(10):571–82. https://doi.org/10.1089/wound.2020.1243 .
doi: 10.1089/wound.2020.1243
pubmed: 33913781
Kolla G, Strike C. Practices of care among people who buy, use, and sell drugs in community settings. Harm Reduct J. 2020;17(1):27. https://doi.org/10.1186/s12954-020-00372-5 .
doi: 10.1186/s12954-020-00372-5
pubmed: 32381011
pmcid: 7206732
Dasgupta N, Figgatt MC. Invited commentary: drug checking for novel insights into the unregulated drug supply. Am J Epidemiol. 2022;191(2):248–52. https://doi.org/10.1093/aje/kwab233 .
doi: 10.1093/aje/kwab233
pubmed: 34528056
03—Standards and schedules. The Florida Senate. Accessed 12 April 2023. https://www.flsenate.gov/laws/statutes/2018/893.03
Drug Enforcement Administration. The Growing Threat of Xylazine and its Mixture with Illicit Drugs. DEA Joint Intelligence Report. October 2022. https://www.dea.gov/sites/default/files/2022-12/The%20Growing%20Threat%20of%20Xylazine%20and%20its%20Mixture%20with%20Illicit%20Drugs.pdf
Beletsky L, Davis CS. Today’s fentanyl crisis: prohibition’s iron law, revisited. Int J Drug Policy. 2017;46:156–9. https://doi.org/10.1016/j.drugpo.2017.05.050 .
doi: 10.1016/j.drugpo.2017.05.050
pubmed: 28735773