Background: Xylazine is an alpha-2 adrenergic agonist commonly used as a large animal anesthetic. It is used as an adulterant in illicit opioids, and it is now well established that its synergistic effect with opioids increases lethality. The amount of xylazine adulterating illicit opioids is growing at an alarming rate, present in almost one-third of opioid overdose deaths reported in Philadelphia in 2019. Despite this, there are no reports considering the management of patients using xylazine chronically. In particular, there are no reported cases detailing the management of xylazine withdrawal or exploring the potential for ongoing treatment for those in recovery from xylazine use.
Case Summary: We present the case of a 29 year old female with opioid use disorder and chronic xylazine use, admitted to the intensive care unit for treatment of chronic lower extremity wounds thought to be due to xylazine injection. Her xylazine withdrawal was managed with a combination of dexmedetomidine infusion, phenobarbital and tizanidine, later transitioned to clonidine. By hospital day 4 she was no longer experiencing withdrawal symptoms. She was transitioned from full-agonist opioids for pain to buprenorphine via a buprenorphine "micro-induction" and was ultimately discharged on buprenorphine, clonidine, and gabapentin on day 19 of admission.
Clinical Significance: This case illustrates a potential treatment pathway that allows for safe and comfortable xylazine withdrawal in hospitalized patients. It also provides an introduction into several medical concerns affecting this patient population specifically, including xylazine-mediated soft tissue wounds.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/ADM.0000000000000955 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Managing xylazine-involved overdoses in a community harm reduction setting: lessons from Tijuana, Mexico.
Harm Reduct J
January 2025
Asociación Bajacaliforniana de Salud Pública A.C, Tijuana, Baja California, Mexico.
Background: Xylazine is a α2-adrenergic receptor agonist, used for sedation in veterinary contexts. Although it is increasingly found in overdose deaths across North America, the clinical management of xylazine-involved overdoses has not been extensively studied, especially in community-based harm reduction settings. Here we present a clinical series of xylazine-involved overdose and share the clinical approach and lessons learned by a community overdose response team in Tijuana, Mexico amidst the arrival of xylazine.
View Article and Find Full Text PDFObjective: To describe indications for and demonstrate the technique to perform a transtracheal aspirate in horses. Transtracheal aspirate is indicated to collect samples for cytology and bacteriologic culture in cases of suspected pneumonia or other lower respiratory tract disease.
Animals: 1 healthy university-owned horse was used for demonstration purposes.
A response to: Tranq dope: Characterization of an ED cohort treated with a novel opioid withdrawal protocol in the era of Fentanyl/Xylazine: Some concerns.
Am J Emerg Med
December 2024
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Emergency department treatment of fentanyl and xylazine withdrawal: Some concerns.
Am J Emerg Med
December 2024
Division of Medical Toxicology, Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Withdrawal Signs and Symptoms Among Patients Positive for Fentanyl With and Without Xylazine.
J Addict Med
December 2024
From the Division of Substance Use Disorder Programming, McNabb Center, Knoxville, TN (RA); Department of Internal Medicine, Graduate School of Medicine, University of Tennessee, Knoxville, TN (RA); Department of Internal Medicine, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN (RA, CA); Tennessee Department of Health, Nashville, TN (CW); and Aegis Sciences Corporation, Nashville, TN (JS, AH, RH).
Background: Xylazine is not approved for human use, yet it has emerged as a common adulterant of illicit fentanyl. It is currently unclear whether there is a withdrawal syndrome associated with xylazine and the potential impact of fentanyl coexposure.
Methods: A retrospective cohort study of patients with opioid use disorder admitted to an inpatient medically monitored withdrawal facility was performed.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!