Current situation:

 Increasing overdose deaths associated with xylazine are occurring in every region of the United States. Locally, xylazine has been confirmed in Santa Cruz, San Luis Obispo, and Monterey Counties. Xylazine is often added to illicit opioids, including fentanyl, as it lengthens the effects of the drug, staving off withdrawal symptoms. Most overdose deaths linked to both xylazine and fentanyl also involved additional substances, including cocaine, heroin, benzodiazepines, alcohol, gabapentin, methadone, and prescription opioids.* Xylazine is an emerging issue in California and poses a greater risk for overdose and serious skin infections. People using xylazine often develop skin and sofy tissue infections/injuries that become necrotic and can result in amputation.

It is important to know how to screen for xylazine and communicate with patients utilizing harm reduction strategies.

Recommendations for medical providers

1. Consider xylazine exposure in patients who use drugs, regardless of the drug they are intending to use, and regardless of route of use (smoking, injection, snorting, ingestion, etc.)
2. Screen for skin/soft tissue infections as people who are using xylazine have a higher prevalence of skin abscesses, ulcers, and infections which are not typically seen at/near the injection site and can rapidly become severe and necrotic.
3. Educate about wound care — provide gloves and hand sanitizer for those unable to regularly access hand-washing as well as individual saline, gauze, wraps, and ointment when possible. Reinforce the importance of seeking urgent medical evaluation for signs/symptoms of severe or worsening infection.
4. Educate patients and their loved ones that naloxone should still be used in case of suspected overdose as xylazine is most commonly used with fentanyl. Even though naloxone is not effective in treating xylazine, it does reverse the effects of fentanyl and other opioids
5. Educate that it is critical to call 911 for any suspected overdose as further medical treatment will likely be necessary.
6. Counsel patients who use illicit drugs on how to stay safe
   • Never use alone or behind a locked door (Never Use Alone hotline — (800) 484-3731) 
   • Go slow, use less 
   • Carry and know how to use naloxone
   • Call 911 if an overdose is suspected. The Good Samaritan Law protects those who call for help during a suspected overdose. You will not be charged with drug possession or use crimes if you act in good faith and seek medical assistance/emergency medical services for another person experiencing a drug-related overdose.

    

   *Biden-Harris Administration Designates Fentanyl Combined with Xylazine as an Emerging Threat to the United States | ONDCP | The White House

   For helpful resources and to learn more, visit www.montagehealth.org/prescribesafei