Fentanyl and Xylazine: What You Need To Know

Fentanyl, a potent opioid drug, is responsible for thousands of overdose deaths in the US every year.  Fentanyl has legitimate medical uses for pain and anesthesia, but fentanyl is also illicitly manufactured and sold.  This article will review some information about fentanyl and another drug, xylazine, an animal sedative often added to illicit drugs by drug dealers.

Around 2013, synthetic opioids, mainly fentanyl and related drugs, began to replace poppy-derived opioids.  Fentanyl is much more potent than morphine or heroin and is often illicitly manufactured and added to other illicit drugs.  Thus, in many fatal drug overdoses involving polysubstance use (involving multiple drugs simultaneously), fentanyl is often added to illicit methamphetamine, cocaine, ecstasy and other opioids.

The drug user may not intend to use fentanyl and due to the increased potency of fentanyl, the added fentanyl increases the likelihood of a fatal overdose.

Fentanyl Myths

A couple of myths about fentanyl should be discussed.  There is a false belief that handling fentanyl can easily result in fentanyl poisoning.  In fact, in 2016, The DEA (Drug Enforcement Administration) warned that “fentanyl can be absorbed through the skin or accidental inhalation of airborne powder can also occur…Just touching fentanyl or accidentally inhaling the substance during enforcement activity or field testing the substance can result in absorption through the skin…The onset of adverse health effects, such as disorientation, coughing, sedation, respiratory distress or cardiac arrest is very rapid and profound, usually occurring within minutes of exposure.”  DEA 2016 

This is misinformation because fentanyl is poorly absorbed from the skin and has low concentration in inhaled air. In fact, according to the Tennesse State website, “Illicit fentanyl cannot be absorbed through the skin or by touching an item or surface where it is present.  When in powder form, fentanyl and its analogs (including carfentanil and fluorofentanyl) cannot be absorbed through the skin.  Dissolving the powder in a liquid does not change this property.”

Another myth is that naloxone does not reverse fentanyl poisoning, this is categorically untrue with the Wisoncosin State website stating that “NARCAN® (generically known as naloxone) is a medication which can reverse a fentanyl overdose. NARCAN® is available at pharmacies, local public health departments, and community-based organizations throughout Wisconsin.”

What Is Xylazine?

Xylazine is an animal sedative not licensed for use in humans.  Xylazine causes three categories of toxicity: overdose, withdrawal and potentially severe soft tissue wounds.  It is added to illicit drugs, usually by local dealers, as a bulking agent to enhance the volume, perceived potency and hence profitability of the drugs.  However, xylazine causes sedation and sleepiness and not the euphoric “high” that drug users seek.  Generally, those with inadvertent xylazine use are patients with opioid use disorder.

Management of these problems must often begin in the hospital.  Wound complications are usually seen in patients who inject drugs, and the wounds may become infected.

Xylazine test strips have been introduced, which may motivate dealers not to add xylazine to drugs.  Of course, fentanyl test strips are already available. 

Regardless of which complications opioid abusers suffer, it is crucial that they address the underlying problem: the opioid addiction/abuse.  Buprenorphine and Suboxone (a combination of buprenorphine and naloxone) and effective and lifesaving drugs that dramatically improve the future for affected patients.

Anyone who has problems with opioid drugs or other drugs of abuse is urged to make an appointment as soon as possible.