Corrections_Today_Spring_2025_Vol.87_No.1

HEALTHCARE COMMITTEE

like fentanyl and heroin and other illicitly manufactured drugs to boost their depressive effects on the cen tral nervous system (Rubin, 2022; U.S. Department of Justice & Drug Enforcement Administration, 2022; Weixel, 2023). Xylazine is in a class of medi cations called alpha-2 adrenergic agonists and is a non-narcotic agent that was formulated by the Bayer company in 1962 (Drug Enforce ment Administration, 2022). While not an opioid, it is chemically like other sedative-type medications that decrease central nervous system ac tivity and have calming effects, such as clonidine which is approved for human use as an anti-hypertensive agent (Drug Enforcement Admin istration, 2022). Xylazine has been studied for human use, however it was disapproved after clinical trials due to induction of central nervous system depressant effects and severe hypotension (Drug Enforcement Administration, 2022; Papudesi et al., 2023). Thus, xylazine was relegated to veterinary use only, for a variety of animal species (U.S. Department of Justice & Drug En forcement Administration, 2022). Xylazine use and treatment considerations Xylazine can be swallowed, in haled, smoked, snorted, or injected into the muscle or veins. There is little information available on the impact of vaping. It has a rapid onset within minutes and can last up to 8 hours or longer depending on the dose, method of consump tion, and whether it was mixed with an opioid or other drug. Xylazine’s

sedating effect allows illicit drug manufacturers to decrease the amount of fentanyl and heroin in drug mixtures while still producing similar effects, making it a profit able addition (Papudesi et al., 2023). Some users intentionally seek out xylazine-laced fentanyl or heroin as they believe xylazine increases the duration of action for fentanyl and heroin, although this belief is anec dotal (Weixel, 2023).

the drug is very frequently mixed with opioids like fentanyl (Centers for Disease Control and Prevention, n.d.). Treatment after a xylazine overdose primarily involves main taining respiratory function and blood pressure. In case of significant intoxication, fluid infusion, atro pine and hospital observation are recommended. Xylazine is emerging as a com mon adulterant in illicit drug mixtures resulting in overdose deaths in numerous states across the United States. Since not all jurisdictions have adopted test ing for the presence of xylazine in postmortem toxicology, and it is not currently required by the CDC in reporting on fatal overdoses, it is likely that the presence of xylazine in the illicit drug supply is vastly underestimated (U.S. Department of Justice & Drug Enforcement Administration, 2022). The city of Philadelphia has had the high est prevalence of xylazine-related deaths in a concentrated area, fol lowed by the states of Maryland and Connecticut (Johnson et al., 2021). In Philadelphia, xylazine went from being detected in < 2% of cases of fatal heroin and/or fentanyl over dose between 2010 and 2015 to 31% in 2019 (Johnson et al., 2021). The DEA, FDA, CDC, and state health departments have issued warnings about xylazine given its serious impact on opioid overdose deaths. Xylazine is still legal in the United States for veterinary purposes, but the FDA has taken steps to prevent the drug from being imported into the U.S. market for illicit purposes (U.S. Food & Drug Administra tion, 2023). The FDA has warned

Since xylazine is not an opioid, it cannot be neutralized by naloxone (Narcan).

Xylazine’s use has been linked to an increase in overdose deaths and medical sequelae such as skin ulcers, abscesses, lesions, drowsiness, amnesia, hypotension, bradycardia, and bradypnea, making it a seri ous public health concern (Drug Enforcement Administration, 2022; Friedman et al., 2022; Rubin, 2022). Police departments across the nation are bolstering their efforts to combat the xylazine threat by preparing for wound care needs, overdose response, and creating educational materials for communi ties (Barndollar, 2024). Opioid overdose involving xylazine is much more challenging to reverse and consequently more le thal. Since xylazine is not an opioid, it cannot be neutralized by naloxone (Narcan). Experts still recommend administering Narcan during sus pected xylazine overdose because

Spring 2025 | Corrections Today

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