Xylazine-Associated Necrotic Upper-Extremity Wounds DOI
S. Arango, JOSEPH C. FLYNN, Jacob Zeitlin

et al.

Journal of Bone and Joint Surgery, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 23, 2024

Background: The rise in xylazine-adulterated heroin and fentanyl poses novel challenges to hand surgeons a rising epidemic of necrotic upper-extremity wounds. While prior case studies have focused on particularly severe complex xylazine-associated (XAN) wounds, the aim this consecutive series was characterize variability presentations (ranging from mild severe) at single institution epicenter xylazine epidemic. Methods: Patients presenting tertiary referral center for XAN wounds were retrospectively identified emergency department visits hospital admissions between January 2021 December 2023. Patient characteristics, clinical findings, treatment, hospitalization-related measures recorded. Wounds classified according depth, density, size, presence osteomyelitis. All variables quantified using descriptive statistics. Results: In total, 82 patients with 125 included study. mean age 40.3 ± 8.2 years, 57% men. Of 54% had associated osteomyelitis, 78% confluent, 47%involved more than two-thirds anatomic region. Surgery recommended performed 62%, 13% undergoing amputation. Complications rates high (77%) bacteremia (40%) death (5%). hospitalized 4.1 times discharged against medical advice 2.8 per year. Conclusions: This study presents broad perspective demographic, social, factors upper extremity. Given complexity burden public health crisis, early intervention is important prevent complications mitigate costs. Level Evidence: Therapeutic IV . See Instructions Authors complete description levels evidence.

Language: Английский

Public Xylazine Awareness and Support for Policies and Initiatives to Address the Xylazine Threat among US Adults DOI
Olivia K. Golan, Weiwei Liu, Bruce G. Taylor

et al.

Journal of Addiction Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 16, 2025

Objectives Xylazine, a nonopioid veterinary tranquilizer, is increasingly being added to the illicit opioid supply. When used by humans, xylazine can cause severe skin ulcers and extreme sedation. This study aimed examine awareness of support for policies/initiatives address threat among US adults. Methods An AmeriSpeak survey with nationally representative adults aged 18 older was administered in March 2024. Survey questions assessed potential use, drug/opioid use history, 10 (including range drug checking initiatives, wound care punitive policies, harm reduction education campaigns). We conducted weighted descriptive regression analysis data from sample 1215 Results Most respondents were not aware (88%, n = 1063). Approximately 10% (n 117) but had it, around 2% 23) possibly it. On average, participants supported only 1.52 (SD 2.41) listed threat. The number varied awareness, gender, marital status, history. Conclusions Among public, are low. Public educational campaigns may be warranted help public understand severity threat, garner associated policies/initiatives, reduce xylazine-related harms.

Language: Английский

Citations

0
Development and Validation of a High Sensitivity Rapid Xylazine Dipstick for Clinical Urine Testing DOI Open Access
Ping Wang, William J. Butler,

Niluksha Walalawela Abeykoon

et al.

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2025, Volume and Issue: unknown

Published: March 11, 2025

Abstract Background Xylazine has been increasingly linked to human overdose deaths. No antidote identified and naloxone cannot reverse the effect of xylazine. withdrawal is not alleviated by opioids. It imperative detect xylazine when treating overdoses. screening method for approved FDA. We aim develop a rapid high sensitivity test clinical urine testing. Methods Monoclonal antibodies with specificity against were developed. The leading clone was used competitive lateral flow immunoassay. analytical cutoff, performance this characterized using standards in drug-free samples. Results dipstick time 5 minutes, cutoff 10 ng/mL urine. cross reactivity other commonly drugs or endogenous metabolites observed, except 3% clonidine. In 181 mass spectrometry confirmed samples concentrations > 120 <10 ng/mL, demonstrated 100% 97%. All 4 false positives had combined 4-hydroxy-xylazine 5-10 range, additional detected spectrometry. Conclusions When demonstrates samples, compared gold standard methods. This novel potential enable informed decisions suspected

Language: Английский

Citations

0
Detecting Xylazine DOI
Katie Troike,

A. J. McShane

Clinics in Laboratory Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: March 1, 2025

Language: Английский

Citations

0
The Detection of Xylazine in Tijuana, Mexico: Triangulating Drug Checking and Clinical Urine Testing Data DOI
Joseph Friedman,

Alejando González Montoya,

Carmina Ruiz

et al.

Journal of Addiction Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: March 20, 2025

Introduction: Xylazine is a veterinary anesthetic increasingly present alongside illicit fentanyl in the United States and Canada, presenting novel health risks. Although xylazine remains less common Western US, Mexican border cities serve as key trafficking hubs may have higher prevalence of substances, but surveillance there has been limited. Methods: We examined deidentified records from Prevencasa free clinic Tijuana, describing urine paraphernalia testing patients reporting using opioids within past 24 hours. (Wisebatch Safelife brands), fentanyl, opiate, methamphetamine, amphetamine, benzodiazepine, nitazene test strips were used to samples. Paraphernalia samples also analyzed with mass spectrometry. Results: Of n=23 participants providing concurrently, 100%, 91.3%, 69.6% reported China White/fentanyl, tar heroin, respectively. The mean age was 41.7 years, 95.7% male, 65.2% unhoused, 30.4% had skin wounds currently. positivity for 2 strip types 82.6% 65.2%. For testing, 47.8%. Confirmatory by spectrometry indicated 52.2% positivity, well (73.9%), fluorofentanyl (30.4%), tramadol lidocaine (30.4%). Mass suggested triggered n=3 n=0 false positives among types. Discussion: on US-Mexico border, requiring public intervention. High complicates clinical detection via strips. Routine scenarios likely feasible, yet confirmatory studies are needed.

Language: Английский

Citations

0
Evaluating the Sensitivity, Selectivity, and Cross-Reactivity of Lateral Flow Immunoassay Xylazine Test Strips DOI

Lena Scott,

Katherine Davis, Ju Nyeong Park

et al.

The Journal of Applied Laboratory Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: March 14, 2025

The rise of xylazine-adulterated substances poses significant public health risks due to their severe side effects, creating an urgent need for reliable detection methods. Lateral flow immunoassay-based xylazine test strips (XTS) have emerged as a potential harm reduction tool quick, easy, and field-based drug checking, but effectiveness remains underexplored. Although commercial XTS from multiple vendors are available, the lack regulatory standards raises concerns regarding accuracy. This study evaluated performance commercially available 7 different investigate interproduct comparison sensitivity, precision, cross-reactivity, stability over changes in human urine pH extended storage under ambient extreme temperature conditions. All maintained reproducibility, despite urinary fluctuation temperatures 6 weeks. However, concentration-dependent false-positive results were observed when tested with drugs adulterants commonly encountered seized samples. Interfering compounds including lidocaine, levamisole, ketamine, methamphetamine, diphenhydramine, promethazine, cetirizine displayed varying degrees cross-reactivity XTS. underscores variability among XTS, highlighting implications use forensic settings. While capable detecting at low concentrations, other necessitates caution interpretation. Hence, may serve viable tool, provided that limitations thoroughly documented they incorporated part broader strategy.

Language: Английский

Citations

0
Building Multidisciplinary Consensus on Inpatient Xylazine Management through Clinical Protocols DOI

Margaret Shang,

Ilana Hull, Jane M. Liebschutz

et al.

Substance Use &amp Addiction Journal, Journal Year: 2025, Volume and Issue: unknown

Published: April 15, 2025

The evolving unregulated drug supply in the United States has led to an unprecedented rise xylazine-adulterated synthetic opioid use-related morbidity and mortality, of which Pennsylvania shoulders a disproportionate burden. People experiencing these xylazine harms who seek acute medical care require complex clinical management, multidisciplinary coordination, appropriate linkage outpatient care. We describe our experience leading hospital-wide workgroup from February June 2024 collaboratively develop time-sensitive protocols on inpatient management patients exposed xylazine. Workgroup participants were organized into three subgroups: (1) toxicology screening harm reduction; (2) withdrawal management; (3) wound summarize implementation process protocol recommendations each subgroup highlight important cross-cutting issues related changing supply, standardized patient provider educational tools, next steps.

Language: Английский

Citations

0
Performance of a Xylazine Test Strip in Urine Biospecimens DOI
Daisy Unsihuay, Ping Wang, Michael C. Milone

et al.

Journal of Addiction Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: April 28, 2025

Objective: Herein, we evaluate the performance of xylazine test strips (XTS) in urine samples. XTS is used for community drug checking (powders and liquids) but lacks regulatory approval human specimen testing. Methods: We obtained n=85 specimens from a toxicology laboratory Philadelphia, originally submitted qualitative mass spectrometry (MS) expanded analysis. Residual was tested using (BTNX Inc.), results were then compared against MS method. Synthetic spiked with standards to determine cutoff. An external quantitative method investigate potential mismatches. Results: Of n = 85 specimens, demonstrated 86% sensitivity 93% specificity cutoff 750 ng/mL established synthetic Six false negatives (14%) among 43 MS-positive samples observed, primarily due XTS’s lower sensitivity. Among 3 positives (7%) observed 42 MS-negative samples, lidocaine likely causes interference. Interestingly, some XTS-positive found have concentration than MS, suggesting cross-reactivity unknown metabolites or analogs. Conclusions: requires further refinement achieve lab-quality performance, focus on improving minimizing caused by nonspecific interactions components. Further research necessary optimize their design, establish accurate detection thresholds, supporting clinical decision-making, obtain validation.

Language: Английский

Citations

0
Assessing an ICD-10 Code Approach for Tracking Xylazine-Involved Overdose Deaths in the United States DOI Creative Commons
Joseph Friedman

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 1, 2024

Introduction The national prevalence of the veterinary sedative xylazine in US overdose deaths rose between 2018 and 2021. More updated estimates are limited, partially due to lack a dedicated ICD-10 code--a primary mechanism used specify drugs implicated US, including CDC WONDER system, which provides public data requests with 6-month lag. For other emerging substances lacking codes, over time umbrella codes have come de facto represent them, yet this has not been demonstrated for xylazine. Methods Overdose involving T42.7 ("Antiepileptic sedative-hypnotic drugs, unspecified") or T46.5 ("Other antihypertensive elsewhere classified") were compared two more specific, albeit delayed, sources: NVSS describing trends 2018-2021 SUDORS state-level 2020-2022. approach was also visualize xylazine-involved through Q1 2024 by geography, race/ethnicity, substance co-involvement, demographic categories. Results At level, concordance records previous improved after 2019 became highly similar 2021 (3,480 vs 3,468 deaths). Concordance high stratified race, age, region. state-level, across 49 state-year pairs, correlation 0.97. Xylazine-involved doubled Q1, racial inequalities widened. Discussion T46.5, together, may become de-facto coding scheme representing deaths. This up-to-date results, showing increasing worsening into 2024.

Language: Английский

Citations

2
Harm Reduction Strategies for People Who Use Drugs DOI

Ruchi R. Shah,

Joseph Shay,

Miriam Komaromy

et al.

JAMA, Journal Year: 2024, Volume and Issue: unknown

Published: Nov. 18, 2024

This JAMA Insights explores harm reduction strategies for people who use drugs and the clinicians treat them to help reduce risk of unintentional drug overdose infection.

Language: Английский

Citations

1
Overdoses with Xylazine and Fentanyl Recorded in Pennsylvania’s Overdose Information Network DOI Creative Commons
Manuel Cano, David T. Zhu, Yesenia Aponte-Meléndez

et al.

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2024, Volume and Issue: unknown

Published: Aug. 30, 2024

This study explored whether law enforcement/first responder-reported fentanyl overdose response actions (such as administration of the opioid reversal agent naloxone) differed between overdoses in which xylazine was, versus was not, suspected to be co-involved. Data were drawn from Pennsylvania State Police's Overdose Information Network (ODIN) for 11,478 fentanyl-involved overdoses, 137 reportedly co-involving xylazine, recorded across Pennsylvania, excluding Philadelphia, January 2018-January 16, 2025. We used relative frequencies, Fisher's exact tests, and binomial logistic regression compare first responders' cases Naloxone administered at scene 46.0% involving vs. 67.3% reported fentanyl-no-xylazine overdoses. Multivariable results (among ODIN, adjusting age, sex, race/ethnicity, year, county rurality, other drugs involved) indicated that co-involvement associated with 60% lower odds naloxone (Adjusted Odds Ratio, 0.40; 95% Confidence Interval, 0.28-0.57). Observed differences based on support importance equipping responders tools training recognize/manage distinct challenges xylazine-fentanyl-involved overdose.

Language: Английский

Citations

0