SUMMARY AND ACTIONS:

Xylazine-involved overdoses and deaths are increasing in Illinois.

Healthcare providers should:

• Consider xylazine in human poly drug use, especially when standard doses of naloxone are ineffective.

• Be aware of evolving treatment recommendations.

• Educate patients who use illicit drugs about the risks of xylazine exposure in fentanyl, heroin, cocaine, and ‘tranq’ use.

Harm Reduction programs should:

• Prepare for potentially larger naloxone distribution and use needs.

• Deliver appropriate wound care.

• Educate patients who use illicit drugs about the risks of xylazine exposure in fentanyl, heroin, cocaine, and ‘tranq’ use.

A veterinary non-opioid tranquilizer named Xylazine is increasingly involved in drug overdose deaths in Illinois, increasing from two reported deaths in 2018 to 45 in 2020 and (provisional data) 155 deaths in 2021. Per the Illinois Poison Control Center, “The drug has a similar mechanism of action of other prescription medications such as Clonidine (used to treat hypertension), Guanfacine (used to treat ADHD) and Tizanidine (used as a muscle relaxant to treat pain). Overdose will cause coma, slow heart rate and at first hypertension followed by hypotension. It does not respond to naloxone. There is no bedside, real-time clinical test to see if this is an agent on board at the time of emergency/hospital stabilization and care.”

Presentation at the Texas Substance Use Symposium from staff (Claire Zagorski, MSc, LP) working a cluster of xylazine-involved overdoses in Austin, Texas in March 2022 informed providers that “patients who use drugs (especially heroin/fentanyl) and present with symptoms like fatigue, sedation, sudden incontinence, extended immobility, bradycardia and hypotension should be considered as potentially xylazine exposed”. The Austin/Travis County MES system medical advisory released on March 5, 2022, urged EMS staff to be prepared to suction patient airways and position patients to avoid aspiration due to the large emetic properties and to consider use of calcium chloride and sodium bicarbonate administration in cardiac arrest secondary to overdose.

Please see the attachments for more information.

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