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      Xylazine (veterinary sedative) use in Puerto Rico

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      Substance Abuse Treatment, Prevention, and Policy
      BioMed Central

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          Abstract

          Human xylazine use in Puerto Rico merits particular attention for its unprecedented scale and depth. Although Puerto Rican injecting drug users (IDUs) have reported using this drug since the early 2000s, little is being done in the research and service delivery sectors as it is claimed that xylazine severely impacts the health of its users. This report provides information on xylazine use and its associated harms. Data from one semi-structured interview collected in New York City (2007-2008) as part of a larger research study with migrant Puerto Rican drug users is presented as a case study. Xylazine, a veterinary sedative, is an adulterant and complement to other drugs and its chronic use is reported to be associated with physical deterioration. Because human xylazine use has been reported in other locations outside of Puerto Rico, this substance could also emerge as an adulterant in other markets to the levels currently experienced in Puerto Rico. Research and interventions are needed to provide adequate services on the island, better understand how the use of xylazine affects its users, and to reduce the possibility of increased xylazine use on the state-side.

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          GC-MS confirmation of xylazine (Rompun), a veterinary sedative, in exchanged needles.

          In order to assess the extent of xylazine (Xyz) injection in Puerto Rico, two waves of used-syringe collections were performed. In the first, syringes were gathered, anonymously and without additional information; in the second, a short interview, also anonymous, was administered. We found Xyz in 37.6% of the collected syringes; the majority of the Xyz-containing syringes came from ranching communities. Syringes containing Xyz more frequently also contained "speedball" than those without (90.6% and 66.7%, respectively). Self-reports of Xyz injection deviated markedly from actual detection: only 50% (self-described users) and 22% (self-described non-users) of the collected syringes contained the drug. With a high prevalence of skin ulcers (38.5% vs. 6.8%; p<0.001), Xyz users were more likely to be in poor health compared to non-users. Surprisingly, though a higher percentage of Xyz users than non-users had college-level educations (23.1% vs. 5.5%), they were more likely to be homeless (64.1% vs. 37%).
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            Concurrent detection of heroin, fentanyl, and xylazine in seven drug-related deaths reported from the Philadelphia Medical Examiner's Office.

            Recreational drugs, such as cocaine and heroin, are often adulterated with other pharmacological agents to either enhance or diminish the drug effects. Between April 21, 2006 and August 8, 2006, the Philadelphia Medical Examiner's Office detected xylazine (a veterinary sedative) and fentanyl (a synthetic opioid) in specimens taken from seven cases. Initial immunoassay screening was performed on urine and blood for fentanyl, opiate, cocaine, phencyclidine (PCP), and benzodiazepines. All tests reported positive were confirmed by gas chromatography-mass spectrometry. All seven xylazine positive cases tested positive for fentanyl and six cases tested positive for 6-acetylmorphine (a metabolite and definitive marker for heroin). The seventh case was positive for morphine and had a history of heroin abuse. Xylazine was present in urine in all seven cases and blood levels were detected in three cases. The blood concentrations ranged from trace to 130 ng/mL. Fentanyl was present in the blood and urine in each case and blood concentrations ranged from 4.7 to 47 ng/mL. Adulteration of illicit drugs has become an epidemic health concern for drug users. Healthcare professionals need to be aware of this issue, so the patients can be treated in an effective, timely manner.
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              Severe intoxication with the veterinary tranquilizer xylazine in humans.

              Xylazine (Rompun, Proxylaz) is a veterinary tranquilizing agent. A case of self-injection of 1.5 g xylazine by a 27-year-old farmer is reported. He subsequently became comatose, hypotensive, bradycardic, and mildly glycemic. An intensive supportive therapy including intubation and ventilation was required. The patient made a full recovery over the next 30 h. The largest concentrations measured were 4.6 mg/L in plasma, 446 mg/L in gastric fluid, and 194 mg/L in urine. The calculated plasma half-life was 4.9 h. Kinetic data correlated with clinical symptoms. Qualitative and quantitative analyses of xylazine were done by thin-layer chromatography, gas chromatography-mass spectrometry, and high-performance liquid chromatography. These methods allow the detection of small amounts substance in stomach, plasma, and urine. Liquid-liquid extraction was used for the isolation of drug. The sensitvity is high, and with these methods, a rapid analysis is possible. Xylazine intoxications in humans are rare. We describe the management of acute poisoning and present a review of xylazine toxicity in humans.
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                Author and article information

                Journal
                Subst Abuse Treat Prev Policy
                Substance Abuse Treatment, Prevention, and Policy
                BioMed Central
                1747-597X
                2011
                11 April 2011
                : 6
                : 7
                Affiliations
                [1 ]National Development and Research Institutes, Inc. (NDRI) and Public Health Solution (PHS) 71 West 23rd Street, New York, NY 10010, USA
                Article
                1747-597X-6-7
                10.1186/1747-597X-6-7
                3080818
                21481268
                1269e653-29a8-4f09-a708-ca7a1baa0e82
                Copyright ©2011 Torruella; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 October 2010
                : 11 April 2011
                Categories
                Short Report

                Health & Social care
                Health & Social care

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