What Now: Relevance of Xylazine in the Age of Opioid Use Disorder - Guidance for OUD Treatment Providers On-Demand-Presentation

Video Transcription

Video Summary

The webinar, hosted by the Providers Clinical Support System Medication for Opioid Use Disorder (PCSS MOUD) Project and the National Council for Mental Well-Being, featured Dr. Daniel Rosa, senior medical director at Acacia Network and ER physician, discussing the emerging issue of xylazine (referred to as "xylosine" in the talk) in the context of opioid use disorder (OUD). Xylazine, a veterinary sedative not responsive to naloxone, has increasingly been found adulterating illicit fentanyl across many U.S. states, notably in the Northeast and Puerto Rico, contributing to complex overdoses that may not fully respond to naloxone. The drug’s sedative properties, acting via alpha-2 receptors, complicate overdose rescue and extend withdrawal durations and severity, though data remain limited due to lack of diagnostic codes and research. <br /><br />Dr. Rosa emphasized that treating xylazine exposure involves addressing the co-occurring opioid use disorder primarily through medications for opioid use disorder (MOUD) such as methadone and buprenorphine along with naloxone distribution, supportive care, and addressing social determinants. Unique challenges include managing prolonged sedation and associated necrotic skin lesions (so-called “zombie drug” wounds), which can occur beyond injection sites and may not always require surgical intervention. The panel discussed practical care approaches, including wound management and symptomatic treatments such as clonidine for withdrawal symptoms. <br /><br />The talk highlighted the urgent need for increased awareness, testing (including xylazine test strips), and integration of care practices for this growing public health threat. It concluded with discussion of treatment strategies, knowledge gaps, and future research directions to support clinical care for patients affected by xylazine-adulterated opioids.

Keywords

Xylazine

Opioid Use Disorder

PCSS MOUD

Naloxone

Fentanyl Adulteration

Overdose Rescue

Alpha-2 Receptors

Methadone

Buprenorphine

Necrotic Skin Lesions