Overdoses Involving Xylazine Mixed with Fentanyl
TLDRThe transcript discusses the emerging threat of xylazine mixed with fentanyl, a tranquilizer found in drug supplies in the U.S. and Puerto Rico. Experts from the CDC and medical professionals delve into the clinical and public health implications of this mixture, noting its sedative effects, lack of respiratory depression, and the challenges in testing and treatment. They also address the concerning issue of skin wounds associated with xylazine use and emphasize the importance of naloxone in managing overdoses. The discussion highlights the need for continued research, public education, and accessible wound care for those affected.
Takeaways
- 📌 The emergence of xylazine mixed with fentanyl is a public health concern, with increasing reports of overdoses involving this combination.
- 🧬 Xylazine, initially developed as an anti-hypertensive agent in the 1960s, is now used in veterinary medicine due to its sedative, analgesic, and muscle relaxing properties.
- 🚨 The presence of xylazine in drug samples is rising, with significant increases observed in certain regions like the Northeast United States.
- 💊 Xylazine is often referred to by street names such as 'Tranq', and when combined with opioids like fentanyl, it is sometimes called 'Tranq dope'.
- 🧠 The mechanism of action of xylazine is similar to clonidine, another hypertensive drug used in humans, but xylazine is not approved for human use.
- 🩺 Clinical effects of xylazine mixed with fentanyl are not fully understood, but sedation is a commonly reported effect, and there is limited evidence of xylazine causing respiratory depression.
- 🛑 Naloxone, an opioid antagonist, does not reverse the effects of xylazine but remains the first-line treatment for overdose involving xylazine and fentanyl due to its effectiveness in reversing opioid effects.
- 🩹 There is a correlation between xylazine use and the development of skin wounds, although the exact causation is still unclear and may involve multiple factors.
- 📈 The epidemiology of xylazine mixed with fentanyl is challenging to track due to limited testing options and the fact that the presence of xylazine does not often change clinical management decisions.
- 🤝 Public health and clinical partnerships are crucial in addressing the ongoing changes in the overdose crisis, including the spread of xylazine mixed with fentanyl.
- 📚 Continued education and awareness about xylazine and fentanyl combinations are essential for healthcare providers and the public to manage and prevent overdoses effectively.
Q & A
What is the primary focus of the COCA call mentioned in the transcript?
-The primary focus of the COCA call is to discuss the clinical and public health implications of overdoses involving xylazine mixed with fentanyl.
What is the role of CDC's National Center for Injury Prevention and Control in addressing overdoses?
-The National Center for Injury Prevention and Control at CDC oversees complex responses to prevent and control overdoses, violence, suicide, and other unintentional injuries, emphasizing the importance of partnerships between public health and clinicians.
What are the historical uses of xylazine?
-Xylazine was initially developed in the 1960s as a potential anti-hypertensive agent for human use. However, due to its strong sedative properties, it was abandoned for human use and is now used in veterinary medicine for sedation, analgesia, and muscle relaxation in animals.
What are some street names for xylazine?
-Some common street names for xylazine include Tranq, Tranq dope (when combined with opioids like fentanyl), Zombie, and Anestesia de caballo.
What is the significance of the designation of xylazine mixed with fentanyl as an emerging drug threat by the Office of National Drug Control Policy?
-The designation of xylazine mixed with fentanyl as an emerging drug threat triggers a series of federal actions, including laboratory testing, epidemiology, prevention, harm reduction, treatment implementation, capacity building, source and supply information, intelligence, regulatory control, monitoring, and research.
What limitations exist in accurately describing overdoses involving xylazine mixed with fentanyl?
-Limitations include the lack of inexpensive and readily available testing options for detecting xylazine in biological fluids, the fact that the presence or absence of xylazine often does not change clinical management decisions, and the clinical presentation of overdoses involving xylazine mixed with fentanyl or other opioids typically appearing as opioid overdoses.
What are the potential reasons for the appearance of wounds in individuals exposed to xylazine mixed with fentanyl?
-Potential reasons for the appearance of wounds may include cytotoxic effects of the drug, pharmacologic effects that may induce localized vasoconstriction or subtle hypoxia, or other factors such as compression of extremities while laying on them.
How does the presence of xylazine in drug samples affect the response to naloxone?
-Naloxone, an opioid antagonist, does not reverse the effects of xylazine. However, since the primary cause of overdose is usually the opioid component (like fentanyl), naloxone remains effective in reversing the effects of the overdose. The presence of xylazine may make the overdose appear naloxone-resistant, but this is more due to the sedative effect of xylazine rather than the lethal effect.
What is the role of public health messaging in addressing the issue of xylazine mixed with fentanyl?
-Public health messaging plays a crucial role in raising awareness about the risks associated with xylazine mixed with fentanyl. It is important for the messaging to be accurate and not to cause unnecessary fear or stigma. The focus should be on harm reduction, treatment, and other aspects of care for affected individuals.
What are some of the harm reduction initiatives that can be implemented to address the issue of xylazine mixed with fentanyl?
-Harm reduction initiatives may include distributing xylazine test strips to help individuals detect the presence of xylazine in drugs, providing education on the risks and signs of xylazine mixed with fentanyl, and improving access to wound care for individuals with drug-use associated wounds.
Outlines
🌟 Introduction and Welcome
The video script begins with Captain Ibad Khan welcoming participants to the COCA call, which focuses on overdoses involving xylazine mixed with fentanyl. The call features various presenters including Captain Josh Schier, Dr. Lewis Nelson, Dr. Rachel Wightman, and Dr. Allison Arwady. The session aims to discuss the history, epidemiology, adverse health effects, and treatment strategies related to xylazine mixed with fentanyl. Participants are informed about the availability of continuing education and the disclosure of financial relationships by the CDC and presenters. The presentation is followed by a Q&A session.
🧬 Xylazine: History, Epidemiology, and Public Health Concern
Captain Josh Schier provides an overview of xylazine, its development in the 1960s, and its use in veterinary medicine. He discusses the drug's mechanism of action, similar to clonidine, and its street names such as 'Tranq.' Xylazine's emergence in drug samples and overdose cases, particularly when mixed with opioids like fentanyl, is highlighted. The potential reasons for xylazine's inclusion in the drug supply and its association with public health threats are explored, noting the lack of a clear rationale for its addition to fentanyl.
📈 Trends in Xylazine-Related Overdoses
The presentation reviews data from the CDC's State Unintentional Drug Overdose Reporting System (SUDORS) and other sources to illustrate the increasing trend of xylazine detection in overdose deaths from 2020 to 2022. The report details the monthly percentage increase of illicitly manufactured fentanyl deaths with xylazine detection. Regional variations in the prevalence of xylazine in drug samples are also discussed, with a notable increase in the Northeast U.S. Census Bureau Region. The challenges in monitoring and characterizing the epidemiology of xylazine mixed with fentanyl are addressed.
🩺 Clinical Effects and Management of Xylazine Overdose
Dr. Lewis Nelson delves into the pharmacology of xylazine, its effects on the central nervous system, and its clinical manifestations in humans based on case reports and studies. He discusses the drug's sedative properties, its lack of significant respiratory depression at conventional doses, and its rapid onset and short duration. The management of xylazine overdose, including the use of naloxone for opioid reversal and the potential need for respiratory support, is highlighted. The presentation also touches on the limited data regarding xylazine withdrawal and the emerging issue of skin wounds associated with xylazine use.
🏥 Addressing Xylazine in the Community: Testing and Harm Reduction
Dr. Rachel Wightman presents on the community management of xylazine mixed with fentanyl, discussing testing options and harm reduction initiatives. She emphasizes the importance of multidisciplinary collaboration and the need for accessible and honest messaging about xylazine. The presentation includes a case study from Rhode Island, where comprehensive drug supply testing combined with qualitative interviews provided insights into the prevalence of xylazine in the drug supply. The findings led to the development of educational materials and the implementation of harm reduction strategies, including wound care initiatives for individuals affected by drug use.
📚 Continuing Education and Future COCA Calls
The session concludes with information on continuing education opportunities for participants and updates on the CDC's transition from TCEO to CDC TRAIN for accessing educational activities. Instructions for obtaining continuing education credits for the COCA call are provided, along with details on how to access future COCA calls and subscribe to related announcements. The video script encourages participants to stay informed about emerging public health topics and thanks everyone for their participation.
Mindmap
Keywords
💡Xylazine
💡Fentanyl
💡Overdose
💡Public Health Implications
💡Naloxone
💡Harm Reduction
💡Pharmacology
💡Epidemiology
💡Continuing Education
💡Community Outreach
Highlights
Captain Ibad Khan welcomes participants to the COCA call on Overdoses Involving Xylazine mixed with Fentanyl, emphasizing the importance of continuing education and public health implications.
CDC planners, presenters, and moderators disclose no financial relationships with ineligible companies, ensuring the integrity of the educational content.
Participants are instructed on how to submit questions during the webinar, with a reminder that not all questions may be answered due to time constraints.
Captain Josh Schier provides an overview of xylazine, its history, and its emergence as a public health concern due to its presence in the illicit drug supply.
Xylazine, also known as Tranq, is increasingly found in drug samples and overdose cases, raising concerns among public health authorities.
Dr. Allison Arwady emphasizes the critical role of partnerships between public health and clinicians in addressing the evolving overdose crisis.
Xylazine's mechanism of action is similar to clonidine, and it is used in veterinary medicine for its sedative, analgesic, and muscle relaxing properties.
Dr. Lewis Nelson discusses the clinical effects of xylazine mixed with fentanyl, noting that naloxone does not reverse xylazine's effects but remains the drug of choice for overdose treatment.
Xylazine's presence in drug samples is increasing, but its specific role in overdose deaths is still not fully understood, with ongoing research needed to clarify its impact.
Dr. Rachel Wightman presents on managing xylazine mixed with fentanyl in the community, highlighting the importance of testing options and harm reduction initiatives.
A multidisciplinary team approach is essential in addressing the public health response to xylazine, including collaboration between public health officials, healthcare providers, and community organizations.
The increasing prevalence of xylazine in the drug supply has been associated with unique skin wounds, although the exact mechanism behind this is not yet fully understood.
Lieutenant Commander Julie O'Donnell discusses the transition to CDC TRAIN for continuing education, providing instructions for accessing and earning CE credits.
The COCA call concludes with information on how to access the on-demand recording, transcript, and continuing education credits for participants.
The presenters stress the importance of naloxone in the treatment of xylazine-fentanyl overdoses, despite xylazine's sedative effects not being directly reversible by naloxone.
There is a lack of understanding regarding the potential for xylazine withdrawal and tolerance development, indicating a need for further research in this area.
Transcripts
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