Introduction:
Xylazine is a veterinary drug used as an anesthetic, sedative, and muscle relaxant in animals like horses, cattle, and other non-human mammals. It is used as an emetic in cats.
In veterinary anesthesia, it is usually used in combination with ketamine. The routes of administration for xylazine are by mouth, inhalation, or injection (intravascular, intramuscular, or subcutaneous).
What Are the Medical Uses of Xylazine?
Xylazine is often used as a sedative, muscle relaxant, and analgesic agent in animals. Frequently, it is used in the treatment of tetanus. It is a partial alpha-2 adrenergic agonist with actions and harmful activities resembling phenothiazines and clonidine. When used as an anesthetic agent, it is usually used in conjunction with ketamine. Its action can usually be seen in 15-20 minutes, and after administering the sedative, the effect continues for 1 to 2 hours and may last up to 4 hours. Xylazine was approved by the FDA (Food and Drug Administration) for medical use in animals; now, it is approved as an animal tranquilizer (drugs are the drugs used to treat anxiety, fear, tension, and related mental disorders).
What Are the Side Effects of Xylazine?
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Xylazine is a non-opioid animal tranquilizer that is non-recommendable for human use. It is seen that xylazine is linked to a number of drug overdose cases nationwide in the evolving drug addiction and overdose crisis. Xylazine is often combined with other drugs, knowingly or unknowingly, by the population exposed to it, particularly illicit fentanyl.
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Xylazine drug usage is not suggested by the Food and Drug Administration for use in humans. Xylazine is considered a central nervous system depressant and can cause respiratory depression, slow the heart rate and cause depression issues as well. It is also seen to open skin ulcers among people who inject it. These symptoms appear to be similar to those seen in opioid overdose cases, making it difficult to distinguish opioid overdose from xylazine. However, it cannot be stated whether the side effects caused by xylazine can be reversed by naloxone or not.
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Healthcare professionals should continue the use of naloxone in opioid overdose cases and if they do not respond to naloxone, then the overdose is caused due to xylazine, and symptoms of xylazine are also present, like severe skin ulcerations. Special supportive measures are provided to the patients if they do not respond to naloxone.
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It is more common in Philadelphia. Tranq and heroin are its street names, and tranq dope is fentanyl cut with xylazine. It caused more severe deaths in Philadelphia in 2006.
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It was first noted as a more prevalent sedative in Puerto Rico. Although it was more noticed by the people who inject it as a drug and by the public health professionals as a commonplace sedative in the streets of Philadelphia. Reports released in 2019-2020 indicated xylazine as a rising overdose death-causing agent. Recent studies show a higher number of deaths due to drug overdoses in many countries. A large number of xylazine drug overdoses have become a major issue in the United States. It cannot be purchased without a veterinary license.
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By the Connecticut Office of Chief Medical Officers, a drug examination routine drug study is conducted to note the deaths caused by the overdose of different suspected drugs in which xylazine has also been included since 2013. By the office of the Chief Medical officer, antemortem and postmortem studies are conducted by collecting the specimens. Toxicology analysis conducted using liquid chromatography is done.
What Is the Risk of Exposure to Xylazine for First Responders?
While on duty, the most common method of unintentional xylazine exposure is the accidental injection of it. Other reported routes are dermal, ocular, ingestion, and inhalational. For example, a veterinarian who is exposed to xylazine by ocular means shows symptoms of bradycardia, hypotension, and a decreased level of consciousness for around two hours after the exposure. The treatment protocol includes saline irrigation of the eyes, IV fluid resuscitation, and being kept under oversedation in the hospital for almost 24 hours.
How is Xylazine Drug Abuse Managed?
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Xylazine, when combined with other opioids and other reactionary drugs, increases their toxic effects, such as potentiating sedation causing respiratory depression, Hypotension, Bradycardia, and central nervous system depression.
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Healthcare professionals should create awareness of issues related to xylazine since xylazine intoxication is unaffected by the standard dose of naloxone given in the treatment for suspected opioid intoxication.
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Xylazine intoxication usually requires additional supportive measures for the patient, such as blood pressure support, intravenous fluid support, atropine, and additional hospital observation due to cardiac effects.
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Emergency care should be provided to the patient, like endotracheal intubation, IV fluid resuscitation, Cardiopulmonary resuscitation, vasopressors, electrocardiogram (ECG) monitoring, and monitoring of blood glucose levels and electrolytes is done.
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Other effects of xylazine, when combined with fentanyl, heroin, or cocaine, still require research to identify adverse reactions and appropriate drug therapies. Aggressive treatment of Hypertension should be avoided initially as it may turn into hypotension later.
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Hypotension and bradycardia can be treated with atropine, pacing, in-vitro fertilization (IVF), and vasopressors.
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Xylazine, when reported to use with other drugs such as fentanyl and heroin, naloxone administration is still advisable for suspected intoxication involving xylazine to treat the effects of opioids.
Conclusion:
Xylazine is often used as an animal sedative and administered through the skin, inhalational, IV, and IM routes. It is not approved for human use. Its illicit use as an adulterant, commonly with cocaine and heroin combinedly, is known as a speedball. It has been used for multiple illicit purposes, such as sexual assault, accidental or intentional poisoning, and drug abuse. Routes of administration include smoking, snorting, inhalation, swallowing, or injecting. The street name for xylazine is "tranq," "tranq dope," or "sleep cut" in the United States.
Due to the lack of availability of resources and legislative actions, xylazine is underreported in its national prevalence. Xylazine is an alpha-2 adrenergic agonist. It inhibits the neurotransmitter release of dopamine and norepinephrine, resulting in depression of the central nervous system.
In animals, it provides an analgesic effect for 15 to 30 minutes and a sedation effect for one to four hours. For the treatment of xylazine, an overdose of naloxone is recommended.
