Deadly, necrotizing xylazine showing up in nonopioid drugs

Aliso Viejo, Calif.-based substance use and mental health care provider Laguna Treatment Hospital said multiple kinds of illicit drugs across the state are increasingly testing positive for xylazine, a veterinary anesthetic and dangerous drug additive.

Xylazine is not an opioid, but is commonly found as a fentanyl additive because of the synergistic, elongating effect it has on fentanyl's euphoria. However, its presence is increasing in other substances including heroin, cocaine and methamphetamine. 

From 2019 to 2021, xylazine identification in the Western U.S. increased by 112 percent.

Xylazine can raise the risk of overdose death, because there is no antidote for the respiratory depression it induces. If naloxone is administered to a fentanyl overdose patient, that patient will likely recover — unless they're also suffering xylazine-induced respiratory depression.

"Gone are the days of prescription medications being the culprit," the hospital's medical director Gary Mitrevolis, MD, said. "Now, we have additions like xylazine, nitazenes and fentanyl analogs included making the use of a substance a single fatal mistake."

When injected, it can cause necrotic wounds, sores, abscesses and soft tissue infections that require amputation.

"Xylazine really has the potential to make this overdose crisis the country’s experiencing significantly worse, and unfortunately, I think that’s what might happen," Dr. Mitrevolis said.

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