Xylosine 101

Overview

• Xylosine: A sedative contaminating the U.S. illicit opioid supply.
• Discovered in 1962 as an antihypertensive agent.
• Not FDA approved for human use due to side effects: sedation, hypotension, bradycardia.

Veterinary Use

• Approved for use as a tranquilizer in animals.
• Known under various names: Anised, Rompon, Xylomed, Cetazine, Chanazine.

Characteristics and Effects

• Not an opioid: Sedative with analgesic and muscle relaxant properties.
• First misuse recorded in Puerto Rico, early 2000s.
• Acts by inhibiting dopamine and norepinephrine release.
• Causes central nervous system depression.

Presence in Illicit Drugs

• Primarily found as an adulterant in fentanyl but also in other substances.
• Informal names: TRANK, SLEEP CUT, ANASTASIA DE CABAO ("horse tranquilizer").
• Can be ingested in various ways: swallowed, inhaled, smoked, snorted, injected.

Symptoms and Health Risks

• Withdrawal Symptoms: Anxiety, irritability, restlessness.
• Mimics opioid intoxication with some differences.

Harm Reduction Considerations

1. Sedation Risks: Can cause prolonged sleepiness, increasing risk of injury.
   • Ensure safe environment.
   • Avoid using alone.
2. Overdose Risks: Often mixed with opioids, increasing overdose risk.
   • Administer naloxone promptly.
   • Naloxone doesn’t reverse xylosine effects.
3. Chronic Use Effects: Can cause skin wounds.
   • Educate on wound monitoring and care.
   • Seek medical attention for atypical wounds.

Prevalence and Testing

• Rising prevalence in the illicit drug supply, significant in places like Philadelphia.
• 91% of fentanyl and heroin samples tested in Philadelphia contain xylosine.
• Detection possible in urine/blood at specialty labs or via drug sample testing at local labs.

Conclusion

• Stay informed about xylosine's increasing presence and practice harm reduction measures.
• Remain updated on latest recommendations and data.