Xylazine in the Illicit Drug Supply: Making Overdoses Worse and More Difficult to Manage

Xylazine is a sedative with analgesic/muscle relaxant properties that is only approved for veterinary use. It is not scheduled under the federal controlled substance act. Across the United States xylazine is emerging as a new adulterant in illicit drugs like heroin/fentanyl, cocaine, and methamphetamine. In Philadelphia in 2019 xylazine was detected in 31% of fentanyl overdose deaths. In New Jersey from 2020 to 2021 there was a 693% increase in xylazine detection in glassine bags submitted (n = 239,866) to New Jersey State Police forensic labs. The addition of xylazine to fentanyl makes the euphoria last longer like the "old days" with heroin. Overdose deaths have been reported in 25 states with 67% occurring in the Northeast United States.

Presenters will review the increasing incidence and prevalence, identifying areas of the country with an expanding presence of xylazine in their drug supply. They will discuss the significant overall detrimental effects of xylazine being used in the drug supply and present significant cases of xylazine overdoses involving fentanyl and other drugs, along with the management of xylazine withdrawal that inevitably follows xylazine-involved overdoses. With xylazine's increasing prevalence in our nation's illicit drug supply, more clinical cases like the ones presented will occur. These cases provide important information on the management of xylazine (Tranq) with fentanyl (Tranq-Dope) in significant polysubstance overdose cases followed by withdrawal. Presenters will discuss potential solutions that communities can implement to address xylazine-involved overdoses.