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U. expert explains new DEA warning about xylazine, fentanyl combination

A combination of xylazine and fentanyl can have lethal consequences, according to a public safety alert from the Drug Enforcement Administration (DEA). – Photo by @cbschicago / Twitter

In a recent public safety alert, the Drug Enforcement Administration (DEA) warned the public about the lethal combination of fentanyl and xylazine. Xylazine, colloquially referred to as "Tranq," is a medicinal sedative approved for veterinary care.

Lewis Nelson, the chair of the Department of Emergency Medicine and chief of the Division of Medical Toxicology at Rutgers New Jersey Medical School, discussed xyalizine's dangers and implications.

He said the drug is mainly found in Southern New Jersey rather than Northern New Jersey. Across the country, the drug likely has the highest prevalence in the New York, New Jersey and Philadelphia regions, Nelson said.

"We started seeing it in earnest in the illicit drug supply probably around 2020, and it has exploded in prevalence over the past 18 months to (approximately) a third of all samples analyzed," he said.

Nelson said the drug is relatively safe for humans, but xylazine combined with other sedatives like opioids can have additive effects, where the effects of both drugs combine to create a larger impact on the individual.

He said xylazine is often added to 1 to 2 milligrams of fentanyl in order to increase the potency and weight of the drug combination. Nelson also mentioned the misunderstandings surrounding the causality associated with fentanyl and its negative effects.

"Xylazine may protect against, and not enhance, the lethal effects of fentanyl, but it may make it appear harder to reverse an opioid overdose with naloxone because the xylazine component of the drugs does not reverse," he said.

Nelson said efforts to curb the improper usage of xylazine include disrupting its distribution and importation. He said much of this drug is being made overseas and purchased from illegitimate pharmaceutical companies.

Nelson also mentioned spreading awareness of the drug and its effects.

"Messaging to the public is generally worthwhile to increase awareness but is of limited value and can have unintended effects," he said. "Although of unproven and likely low value, testing strips to check for the presence of xylazine in the sample immediately prior to use are available."

Nelson added that while these strips can detect xylazine, they largely depend on the individual, and the test results may not always be reliable. Xylazine is not found in routine toxicology tests, and as such, additional tests may be needed to detect its presence.

"Until we know more, it is best to message the risks, but we should be honest in our knowledge limitations," Nelson said.

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