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Xylazine in illicit drug mixtures: a growing threat and overlooked danger

Year: 2024

Type: article

Abstract: Xylazine, classified as a nonopiate sedative, analgesic, and muscle relaxant, belongs to the drug class of α2-adrenoreceptor agonists alongside medications like clonidine, lofexidine, tizanidine, and dexmedetomidine.Originally formulated by Farbenfabriken Bayer AG in 1962 as an antihypertensive agent [1] , its development for human use was halted due to severe adverse events associated with hypotension and central nervous system (CNS) depression [2] .Despite this setback, the U.S. Food and Drug Administration (FDA) approved for veterinary use in 1972 [3] .Xylazine has emerged as a concerning factor in the ongoing drug addiction and overdose crisis, with a notable rise in overdose deaths attributed to its presence [4] .As Xylazine has been reported to have many of the same effects on users as opioids but a longer-lasting effect than fentanyl alone, it may draw customers looking for a longer high, according to a joint intelligence report released in 2022 by the Drug Enforcement Administration (DEA) and the Department of Justice [5] .The source of this statement most likely originated from epidemiological reports asserting that people are drawn to Xylazine because it 'prolong[s] the duration of fentanyl injections, in particular, overcoming 'the problem' of the 'short legs' of the ordinarily euphoric effects of fentanyl manufactured illegally' [4] .Individuals, whether knowingly or unknowingly, frequently combine Xylazine with other substances, notably illicit fentanyl, to extend the euphoric effects [4,[6][7][8] .Illicit opioids, including fentanyl, are often adulterated with Xylazine to enhance their impact [6] .Investigations into overdose cases involving Xylazine and fentanyl have revealed the concurrent use of additional substances such as cocaine, heroin, benzodiazepines, alcohol, gabapentin [6] , methadone, and prescription opioids [2] .In the Friedman et al. [4] study, 98.4% of overdose deaths involving Xylazine contained illicitly made fentanyls, indicating a strong ecological association.Beyond its association with overdose deaths, Xylazine has been misused for various purposes, ranging from a horse doping agent to a substance of abuse and even as a tool for attempted sexual assault.Incidents of accidental or intentional poisoning have also been reported [9] .In Philadelphia, Xylazine is colloquially known as 'tranq', and the term 'tranq dope' refers to heroin and fentanyl mixed with Xylazine on the street.

Source: Annals of Medicine and Surgery

DOI: 10.1097/ms9.0000000000002190

Authors: Ashna Habib, Tooba Ali, Laveeza Fatima, Zainab Nazir, Aaliya Imtiyaj Hafiz, Md Ariful Haque