A recent publication in the Canadian Medical Association Journal (CMAJ) highlights critical information regarding xylazine, a veterinary drug increasingly found in the illicit opioid market. The article, accessible via CMAJ, emphasizes the challenges and dangers associated with xylazine contamination in opioids, particularly given the lack of an effective antidote.

Key Points:

• Xylazine, primarily used in veterinary medicine, is now frequently detected in illicit drugs, especially those containing fentanyl. Opioid users are often unaware of its presence. Note: most experts suggest that street forms of Xylazine are not veterinary sourced drug.

• The substance is known to enhance the feeling of euphoria but can lead to side effects like sedation, low blood pressure, and a slowed heart rate. Notably, these symptoms may continue even after administering naloxone, a standard treatment for opioid overdose.

• In cases of opioid overdose, the immediate focus should still be on treating respiratory issues with naloxone and ensuring proper airway management, regardless of potential xylazine contamination.

• Xylazine has been linked to severe, ulcerative skin wounds, which are different from those typically associated with intravenous drug use.

• Prolonged xylazine use can lead to withdrawal symptoms. Treatment of these symptoms may require additional medications to alleviate discomfort, irritability, and low blood pressure.

Dr. Peter Wu, an internist at the University Health Network and the University of Toronto, along with Dr. Emily Austin of the Hospital for Sick Children (SickKids) in Toronto, Ontario, notes, "Xylazine is not included in standard urine drug screening tests, and no specific treatments or reversal agents exist, other than supportive care."

They stress the importance of specialized addiction care to effectively address the root causes of substance use disorders involving such adulterants