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Review
. 2023 Oct;176(10):1370-1376.
doi: 10.7326/M23-2001. Epub 2023 Oct 10.

Xylazine Adulteration of the Heroin-Fentanyl Drug Supply : A Narrative Review

Joseph D'Orazio  1 , Lewis Nelson  2 , Jeanmarie Perrone  3 , Rachel Wightman  4 , Rachel Haroz  1
Affiliations
Review

Xylazine Adulteration of the Heroin-Fentanyl Drug Supply : A Narrative Review

Joseph D'Orazio et al. Ann Intern Med. 2023 Oct.

Abstract

Xylazine is an animal sedative, approved by the U.S. Food and Drug Administration, that is commonly used in veterinary medicine and is not approved for human use. Since 2016, xylazine has consistently appeared in the illicitly manufactured fentanyl supply and has significantly increased in prevalence, likely due to its low cost, easy availability, and presumed synergistic psychoactive effect. Clinical experience along with the available pertinent research were used to review xylazine adulteration of the drug supply and provide guidance on the care of patients exposed to xylazine. This review discusses xylazine pharmacology, animal and human clinical effects, and what is known to date about care of patients experiencing acute overdose, xylazine-fentanyl withdrawal, and xylazine-associated wounds.

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Conflict of interest statement

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M23-2001.

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