“Animal Sedative Xylazine in Fentanyl: A Dangerous Combination Causing Wounds and Hindering Overdose Prevention Efforts”

# Powerful Animal Sedative Complicates US Response to Opioid Crisis

A potent animal sedative called xylazine is causing complications in the US response to the opioid crisis. The drug is being added to fentanyl, the synthetic opioid responsible for most overdose deaths, and is scrambling longstanding methods for reversing overdoses and treating addiction. Xylazine can cause severe skin wounds, but whether it is leading to more deaths is not yet clear. Early data suggests the drug may inadvertently be diluting the effects of fentanyl. However, there is broad agreement that much more information is needed to understand xylazine’s impact, to disrupt illegal supplies, and to develop medicines to reverse its effects.

## Xylazine’s Impact

* Xylazine is being added to fentanyl, giving a longer-lasting high, more like heroin.
* The drug is often cheaper and easier to get than fentanyl, making it a preferred cutting agent for dealers.
* Xylazine can cause severe skin wounds, which can lead to infections, rotting tissue, and amputations.
* The drug can be addictive, and patients who stop taking it report severe withdrawal symptoms, including anxiety and distress.
* Fatal overdoses involving xylazine increased more than 1,200% between 2018 and 2021.

## Challenges in Philadelphia

* Naloxone, a medication used to revive people who have stopped breathing, doesn’t reverse the effects of xylazine.
* The drug’s introduction has created a host of new challenges in Philadelphia, including skin wounds that can make it harder to get people into addiction treatment programs.
* With no approved reversal drug for xylazine, outreach groups are carrying oxygen tanks to help revive people.
* A roaming van staffed by local health workers and city staffers aims to treat the skin wounds before they require hospitalization.

## Possible Upside of Xylazine

* People who overdosed on a combination of fentanyl and xylazine had “significantly less severe” outcomes than those taking fentanyl alone.
* Xylazine’s ability to extend users’ high may be a factor in why it’s showing up less than expected in fatal overdoses.
* Xylazine’s impact is far from clear, and more research is needed into its long-term effects.

The Biden administration and Congress are considering changes to try to limit xylazine prescribing and distribution. However, past restrictions didn’t solve the problem, and a shifting mix of opioids, stimulants, and sedatives has come to define the US drug epidemic, making it harder to manage a crisis that now claims more than 100,000 lives a year.

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