Xylazine intoxication in humans and its importance as an emerging adulterant in abused drugs: A comprehensive review of the literature.
Xylazine is not a controlled substance; it is marketed as a veterinary drug and used as a sedative, analgesic and muscle relaxant. In humans, it could cause central nervous system depression, respiratory depression, bradycardia, hypotension, and even death. There have been publications of 43 cases of xylazine intoxication in humans, in which 21 (49%) were non-fatal scenarios and 22 (51%) resulted in fatalities. Most of the non-fatal cases required medical intervention. Over recent years xylazine has emerged as an adulterant in recreational drugs, such as heroin or speedball (a cocaine and heroin mixture). From the 43 reported cases, 17 (40%) were associated with the use of xylazine as an adulterant of drugs of abuse. Its chronic use is reported to be associated with physical deterioration and skin ulceration. Literature shows some similar pharmacologic effects between xylazine and heroin in humans. These similar pharmacologic effects may create synergistic toxic effects in humans. Therefore, fatalities among drug users may increase due to the use of xylazine as an adulterant. Xylazine alone has proven harmful to humans and even more when it is combined with drugs of abuse. A comprehensive review of the literature of non-fatal and fatal xylazine intoxication cases including those in which the substance was used as adulterant is presented, in order to increase the awareness in the forensic community, law enforcement, and public health agencies.
Puerto Rico Institute of Forensic Sciences, P.O. Box 11878 Caparra Heights Station, San Juan 00922-1878, Puerto Rico. Electronic address: Kazandra80@yahoo.com.
Kazandra
K
Ruiz-Colón
Puerto Rico Institute of Forensic Sciences, P.O. Box 11878 Caparra Heights Station, San Juan 00922-1878, Puerto Rico. Electronic address: cachave@hotmail.com.
Carlos
C
Chavez-Arias
Puerto Rico Poison Center, P.O. Box 367212, San Juan, Puerto Rico. Electronic address: toxicdiaz@gmail.com.
José Eric
JE
Díaz-Alcalá
Instituto Nacional de Toxicología y C. Forenses, Ministerio de Justicia, Las Rozas de Madrid, C/ José Echegaray, 4, 28232 Las Rozas de Madrid, Madrid, Spain. Electronic address: mariaantonia.martinez@justicia.es.
María A
MA
Martínez
D001919:Bradycardia / Q000139:chemically induced; D002845:Chromatography; D004340:Drug Contamination; D053593:Forensic Toxicology; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced; D006993:Hypnotics and Sedatives / Q000009:adverse effects* / Q000737:chemistry / Q000506:poisoning*; D007022:Hypotension / Q000139:chemically induced; D015877:Miosis / Q000139:chemically induced; D015394:Molecular Structure; D012131:Respiratory Insufficiency / Q000139:chemically induced; D019966:Substance-Related Disorders / Q000150:complications*; D014991:Xylazine / Q000009:adverse effects* / Q000737:chemistry / Q000506:poisoning*
D006993:Hypnotics and Sedatives; D014991:Xylazine
Adulterant; Cocaine; Heroin; Speedball; Xylazine