Xylazine in Overdose Patient Encounters

 Xylazine in Overdose Patient Encounters

A very potent sedative medication called Xylazine has been detected in the illicit drug supply in Maryland. Xylazine, also known as “tranq,” is a veterinary tranquilizer that produces serious and life-threatening effects in humans. Although it is not an opioid, xylazine is being added to fentanyl or heroin in order to extend the effects of these drugs. The prevalence of xylazine in the illicit drug supply has been increasing sharply over the past three years. It was implicated in 19.3% of overdose deaths in Maryland in 2021, compared with 4.3% of fatal overdoses in 2019. Xylazine can cause respiratory depression, hypotension, bradycardia and miosis. It can render a person unconscious for extended periods of time. Clearly, it can be difficult to distinguish opioid overdoses from xylazine exposure, as their effects are very similar. For xylazine and opioid overdoses, the first priority is to support the patient’s ventilation. Of note, xylazine will not respond to naloxone because it is not an opioid. However, EMS clinicians should continue to administer naloxone for suspected opioid overdose patients, because xylazine is frequently combined with opioids. Currently, there is not a known reversal agent for xylazine that is safe or effective for humans.

Xylazine exposure can also lead to severe, necrotic skin ulcerations, which are difficult to treat. Withdrawal symptoms such as agitation or severe anxiety may occur when the drug is discontinued. Commonly used medications for opioid withdrawal, such as buprenorphine or methadone, are ineffective for xylazine withdrawal. Further information may be found on the following websites:

 Maryland Opioid Operational Command Center: https://beforeitstoolate.maryland.gov/xylazine/

 U.S. FDA: https://www.fda.gov/drugs/drug-safety-and-availability/fda-alerts-health-care-

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