August 2021: Adulterant in Fentanyl Complicates OD

​A 38-year-old woman with opioid use disorder presented to the emergency department after an unintentional overdose. EMS said the patient was found with decreased respirations, and she was given 2 mg intranasal naloxone. She was awake, alert, and oriented x 3 in the emergency department.She reported that she used one bundle of fentanyl/heroin a day intravenously and that she had recently been hospitalized for four weeks for a wound infection. She stated that she used her usual dosage of fentanyl/heroin on discharge, not realizing how much her tolerance had decreased.She also said the fentanyl contained “tranq" (xylazine), and it made her feel like she was “dipping out" but was more sedating than the typical heroin high that she would get. Her vital signs were normal, and her physical exam revealed track marks in her arms, an old, well-healed wound to her left upper arm, and some sores in different stages of healing. Her rapid glucose was 114 mg/dL.SymptomsXylazine is a nonnarcotic sedative used exclusively in veterinary medicine for analgesia and muscle relaxation, and it is now increasingly found as an adulterant in fentanyl. Xylazine was first reported as an adulterant in Puerto Rico in the early 2000s, and it is known as anestesia de caballo (horse anesthetic). Xylazine is not a scheduled medication.Xylazine's chemical structure is similar to clonidine and phenothiazines, and it acts as a central alpha-2 agonist. Alpha-2 agonism decreases the release of nor...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs