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Polysubstance Use, East-to-West Spread Observed With Xylazine in 100 Days After Emerging Threat Designation
Inclusion in polysubstance use and a spread from the eastern half of the United States to the West—similar to that of fentanyl—emerged as key observations from a report on xylazine released by Millennium Health on Thursday.
The Millennium Health Signals Report, published by the San Diego, California-based organization with more than 15 years of experience in medication monitoring and drug testing services, examined drug use trends in the 100 days following the Biden administration’s emerging drug threat designation.
Millennium Health found that more than 99% of xylazine-positive fentanyl specimens analyzed also contained fentanyl, illustrating the degree to which use of the 2 substances has been intertwined since the Biden administration declared the combo an emerging drug threat in April.
In much the same way fentanyl entered the US in the East and steadily moved west, xylazine is following a similar pattern, the organization said. While xylazine use was detected in 34 states spread across every region of the US during the 100 days following the emerging threat designation, the highest rates of xylazine detection were observed in the Mid-Atlantic and East North Central regions. The lowest rates observed were in the Pacific and Mountain regions.
A prevalence of polysubstance use was also a major theme of the report, with use of multiple substances significantly more frequent among those using fentanyl with xylazine compared to those who used fentanyl but not xylazine. Among users of fentanyl analogues, 56% of samples were also positive for both fentanyl and xylazine compared to 17% of those positive for fentanyl but not xylazine.
“If you’re using fentanyl, you’re very likely using any number of other substances,” Eric Dawson, PharmD, Millennium Health vice president of clinical affairs, told Addiction Professional. “Our own data shows that for fentanyl-positive samples, almost 85% are positive for another substance. … But what was shocking was how much more likely you are to be using another drug if you’re using fentanyl with xylazine.”
Meanwhile, more than 10% of those who used xylazine also tested positive for other sedating substances.
“A number of those other things—benzodiazepines, gabapentin, alcohol—they, like xylazine, are not opioids, so they’re going to be much less responsive to naloxone in an overdose situation,” Dr Dawson said. “Now, the last thing I would ever want to do is make someone think that Narcan is no longer our drug of choice in an overdose. Clearly, it’s lifesaving, and it may still be enough in these situations to restore breathing and save a life. But I can certainly imagine other supportive measures will be needed in the presence of xylazine and these other non-opioid sedating medications, to help that individual breathe and protect their airway.”
In addition to the development of a xylazine overdose antidote that can perform the same function as naloxone for opioid overdose, Dr Dawson also advocated for practitioners to explore ways to help patients manage xylazine withdrawals early in treatment.
“When individuals have been using xylazine for some time, they will become dependent to it. They will have withdrawal,” Dr Dawson said. “From everything I’ve read and heard, the withdrawal can be worse than heroin and worse than some opioids.
“There are a few drugs out there being used off-label right now to try to help those individuals in that early treatment phase. But we need best practices for clinicians who are dealing with xylazine on a daily basis. Even if we’re using things off-label, what are our best options? More importantly, we need additional research to find something that we can approve for use, that really is effective. Because the consequence of that withdrawal is that I think it keeps a lot of people using.”
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