An emerging poisoning threat: the surge in illicit use of horse sedative xylazine
For Poison Prevention Week, we spotlight the vital need for accurate toxicology data to aid poison control specialists in managing overdose emergencies effectively.
Every year, poison control centers around the world receive millions of calls seeking medical help for exposures and poisonings. Close to 3 million calls are made every year to the U.S. poison control centers alone.1 In the UK, there are 350,000 hospital presentations per year due to poisoning, including overdose,2 and in Canada, poisoning is a leading cause of injury-related death.3
A serious public health threat
A key contributor to these poisoning incidents is drug overdose, with opioid overdoses reaching unprecedented levels.4 Recently, there has been a sharp increase in the powerful veterinary sedative xylazine being mixed with the opioid fentanyl for illicit use. Last year, the U.S. Office of National Drug Control Policy (ONDCP) designated fentanyl adulterated or associated with xylazine as an emerging threat to the United States,5 due to the impact of xylazine on the opioid crisis, and its growing role in overdose deaths.
Xylazine is a non-opioid tranquilizer approved by the Food and Drug Administration (FDA) for veterinary use but not human use. Nevertheless, xylazine-involved overdose rates have been rapidly rising in recent years in the U.S. and Canada, representing a serious public health epidemic. Illicit use of xylazine is now also penetrating Europe, with a reported death in the UK6 and syringe residue analysis in Riga, Latvia, detecting the drug in 13% of syringes analysed.7
A unique clinical risk
An important consideration that creates additional risk is that xylazine is not an opioid, so it does not respond to the overdose reversal drug naloxone, an opioid antagonist medication that is indicated for reversing opioid-induced respiratory depression during overdose.8 However, naloxone should be administered to treat opioid effects, if present or suspected in combination with xylazine.9
Specialists need the latest toxicology data
With emerging threats from poisoning causing a serious risk to public health, it is essential that poison information specialists have accurate information at their fingertips to make fast decisions for their patients.
Micromedex is committed to providing accurate content to support poison control centers, and ensuring it is continually updated. The editorial team behind the toxicology content in Micromedex regularly reviews over 400 articles each week and consistently adds to and updates the database of nearly half a million products and substances.
Clear recommendations for panicked callers
The “patient disposition” toxicology content in Micromedex is a crucial information set, containing key details to help poison control specialists make a recommendation when they receive an emergency phone call. The patient disposition content includes recommendations, based on the exposure or poisoning, for whether a patient should be seen immediately or can be managed at home. Micromedex contains toxicology management information for approximately 2,000 poisoning substances, including xylazine. The content is designed to be concise and actionable to support poison control specialists to make fast, accurate decisions under pressure.
“When we get a panicked caller, the first thing we do is turn to Micromedex. We trust the quality of the product, that it will have the current information available to guide us through their care. It’s a mainstay, integral to what we do.”
– Julie A. Weber, RPh, CSPI, Director, Missouri Poison Center, USA
“Micromedex is an accurate tool that is critical in supporting toxicology management, due to the quality of its clinical and pharmacology content, and therapeutic approaches for poisoned patients.”
– Dr. José Luis Conejo Menor, Head of the Toxicological Information Service, National Institute of Toxicology and Forensic Sciences, Spain
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References
- https://www.poison.org/poison-statistics-national
- https://www.npis.org/Download/NPIS%20report%202022-23.pdf
- https://infopoison.ca/wp-content/uploads/2024/01/Poison-Centres_2021-Annual-Report.pdf
- https://www.cdc.gov/drugoverdose/deaths/index.html
- https://www.whitehouse.gov/ondcp/briefing-room/2023/04/12/biden-harris-administration-designates-fentanyl-combined-with-xylazine-as-an-emerging-threat-to-the-united-states/
- https://www.sciencedirect.com/science/article/pii/S1752928X23000604
- https://www.emcdda.europa.eu/publications/european-drug-report/2023/injecting-drug-use_en
- https://www.micromedexsolutions.com/micromedex2/librarian/PFDefaultActionId/evidencexpert.DoIntegratedSearch?navitem=topHome&isToolPage=true#
- https://www.micromedexsolutions.com/micromedex2/librarian/ssl/true/CS/E34B38/ND_PR/evidencexpert/ND_P/evidencexpert/DUPLICATIONSHIELDSYNC/F1A5E8/ND_PG/evidencexpert/ND_B/evidencexpert/ND_AppProduct/evidencexpert/ND_T/evidencexpert/PFActionId/evidencexpert.IntermediateToDocumentLink?docId=441&contentSetId=51#