Learn how IDEXX is enhancing the lives of animals, people, and the planet.

IDEXX: Contributing to something bigger

As a veterinarian, you may know xylazine as Rompun, Sedazine or AnaSed. Known for its long-acting sedative effects, xylazine is frequently used in veterinary medicine as a tranquilizer and often in combination with ketamine for anesthesia as well as sedation, muscle relaxation, and analgesia.

On the streets, however, xylazine is known by a variety of other names. These nicknames include “Tranq”, “Tranq Dope”, “Sleep Cut”, and “Anestesia De Caballo” (Horse Anesthesia) as well as “Zombie Drug”.

A drive through the Kensington neighborhood in Philadelphia shows how much xylazine-laced opioid addiction has taken over. Addicted individuals can be seen lying unresponsive on the ground and others nodding off or walking around aimlessly uncoordinated and out of step.

According to a December 2022 health update released by the Philadelphia Department of Public Health, xylazine is now the most common adulterant in the Philadelphia illicit drug supply chain.

 In addition, data released by the DEAreported that, in 2021, xylazine was found in more than 90% of heroin and fentanyl samples in Philadelphia.

And it’s not just Philadelphia. Drug Enforcement Administration (DEA) laboratory data also revealed xylazine to be the most commonly found substance in “polydrug” mixtures with fentanyl.According to the CDC and state and local officials now tracking the threat, other mid-Atlantic cities, including New York City, are experiencing the same horrors. Findings from DEA’s laboratory system between 2020 and 2021 indicate the influx of xylazine in all 4 US census regions. Although the northeast has the highest total (some of the hardest hit states being Connecticut, Maryland, Massachusetts, Rhode Island, and Vermont), each of the 4 regions has seen an increase in identifications of xylazine, with the south reflecting the most significant increase (193% increase in xylazine instances over the 2-year period), followed by the West with an almost 112% increase.

wherein DEA Administrator Ann Milgram stated, “Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier.” Milgram also noted that the agency “has seized xylazine and fentanyl mixtures in 48 of 50 States.” The DEA Laboratory System is reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.”

As a long-acting sedative, xylazine can be mixed with opioids like fentanyl to lengthen its euphoric effects. As an unscheduled substance, xylazine is also more easily accessible than other adulterants used as a cutting agent and is less likely to lead to scrutiny from law enforcement agencies. At a cost of $6-$20 per kilogram, readily available for purchase online, the use of xylazine as an opioid adulterant increases the volume of product that can be produced in a polydrug mixture; reducing the amount of fentanyl or heroin being used while also increasing net profit for illicit drug traffickers.

As a drug, xylazine’s main effect is heavy sedation, which can last up to 6 hours. Blackouts induced by xylazine use can leave individuals in a zombie-like unconscious state for hours, with dangerously low blood pressure levels and heart rates. When xylazine users “come to”, the opioid high has long since faded and they immediately crave more. Xylazine users have been reportedly compelled to begin searching for their next “hit” while still under the influence demonstrating aggressive behavior and uncoordinated movements…hence the “zombie effect”.

But, perhaps the most compelling reason xylazine has earned the name “zombie drug” is because of the wounds it creates. Human use of xylazine—whether injecting, snorting, smoking, or swallowing the drug—leads to the development of severe skin, muscle, nerve, and soft tissue wounds known as eschars. Unlike scabs made up of dried blood cells and fluids that sit on top of the skin, eschars are a collection of dead tissue within a wound that are flush within the skin surface, highly persistent, and easily infected. Eschar patches of rotting tissue may form anywhere and when left untreated can lead to necrosis, amputation, and other serious life-threatening conditions.

Unlike the opioids it is commonly used as an adulterant in so-called polydrug mixtures with, xylazine is a sedative. Xylazine also has no approved antidote for human use and is resistant to typical opioid overdose reversal agents such as naloxone. This makes overdoses associated with xylazine more difficult to identify as they appear similar to opioid overdoses and are often not included in routine drug screening tests. Consequently, the presence of xylazine may render naloxone noneffective or less effective.

A count of xylazine-positive overdose deaths in the US is not currently possible, as not all jurisdictions routinely conduct testing for xylazine in postmortem toxicology. Testing procedures can vary even within the same state. Additionally, it is not currently included with the CDC reporting of national statistics on fatal overdoses. As a result, it is highly likely the prevalence of xylazine is widely underestimated.

Point of care testing for xylazine is not yet available. Therefore, individuals who use substances may not be aware that they have been exposed to xylazine. If an individual does not respond to naloxone, overdose responders should continue to provide supportive care, such as airway management and supplemental oxygen, to patients with prolonged sedation in the presence of normal respirations.

On February 28, 2023, the FDA announced that it was taking action to restrict the unlawful entry of xylazine active pharmaceutical ingredients and finished dosage form drug products into the United States.

 This agency’s action was taken in response to the growing public health concern that xylazine has created and aims to prevent xylazine from further entering the US market for illicit purposes, while still maintaining availability for legitimate uses in animals.

As part of the newly enacted actions, the FDA will halt and review xylazine shipments to ensure they're headed toward state-licensed pharmacies, agency-approved manufacturing facilities, or veterinarians, who use the drug for licit purposes. Although not a total fix, it’s a start.

Beyond federal controls, certain states are enacting their own controls on xylazine. In New York, Xylazine has been a schedule III-controlled substance depressant since 2017.

 On January 11, 2023, the Indiana General Assembly proposed a bill8 for toxicology screening at the time of a person’s death. This bill proposed that if a coroner reasonably suspects the cause of the person's death to be overdose of an opioid or if the person was administered an overdose intervention drug prior to death and was unresponsive to the overdose intervention drug, the coroner shall test certain bodily fluids to determine whether the they contain any amount of xylazine.

On February 9, 2023, Illinois’ State Senate introduced a billseeking to amend the Illinois Controlled Substance Act and make xylazine a schedule I controlled substance.

 Additionally, on February 17, 2023, Illinois’ State House proposed a bill to further make Xylazine’s isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, a schedule II-controlled substance.

With congressional lawmakers considering scheduling xylazine through legislation, concerns have been raised regarding how moving this drug to a federally scheduled controlled substance list will impact the industry and the use of it as a therapy in veterinary medicine. On the flip side, concerns are being raised about the impact on human health and addiction if xylazine remains an unregulated and unmonitored substance.

It is unlikely that the illicit use of xylazine will ever completely go away or be eliminated. By becoming educated about the problem, aware about how to handle it, and proactive in approach, we have the ability to not only survive but also do our part to prevent new threats like xylazine from taking over. Veterinarians and their teams must be aware of the issues discussed above and recognize that they can help keep the xylazine-induced zombie apocalypse from taking over.

About the author: Kelley Detweiler is a DEA regulatory compliance expert who provides controlled-substance risk-management solutions to veterinarians through her partnership with Dr Peter Weinstein in Simple Solutions 4 Vets Inc. Kelley has spoken on international platforms including the United Nations and is the coauthor of "

" published by the American Animal Hospital Association. Contact: kelley@simplesolutionsforvets.com.

Cheryl Bettigole, MD, MPH, ANDREW BEST, DPA, LCSW, DANIEL TEIXEIRA DA SILVA MD, MSHP. Xylazine (Tranq) Exposure Among People Who Use Substances in Philadelphia. Philadelphia Department of Public Health. Published December 8, 2022. Accessed March 10, 2023. 

https://hip.phila.gov/document/3154/PDPH-HAN_Update_13_Xylazine_12.08.2022.pdf/

DEA Joint Intelligence Report. The Growing Threat of Xylazine and its Mixture with Illicit Drugs. Drug Enforcement Administration. Published October 2022. Accessed March 8, 2023. 

https://www.dea.gov/sites/default/files/2022-12/The%20Growing%20Threat%20of%20Xylazine%20and%20its%20Mixture%20with%20Illicit%20Drugs.pdf

Public Safety Alert: DEA Reports Widespread Threat of Fentanyl Mixed with Xylazine. Drug Enforcement Administration. Published March 20, 2023. Accessed March 20, 2023. 

https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine

FDA Takes Action to Restrict Unlawful Import of Xylazine. FDA. Published February 28, 2023. Accessed March 10, 2023. 

https://www.fda.gov/news-events/press-announcements/fda-takes-action-restrict-unlawful-import-xylazine

Sen. Terrence Murphy. Senate Bill S7397. New York State Senate website. 

https://www.nysenate.gov/legislation/bills/2015/S7397

. Published April 27, 2016. Accessed March 10, 2023.

Meltzer, Lauer, Vermilion, Garcia Wilburn. HB1286. Indiana General Assembly. Updated February 14, 2023. Accessed March 8, 2023. 

https://in-proxy.openstates.org/2023/bills/HB1286/versions/HB1286.02.COMH

Sen. Patrick J. Joyce. SB2089. Illinois General Assembly. Updated March 10, 2023. Accessed March 10, 2023. 

https://ilga.gov/legislation/BillStatus.asp?DocTypeID=SB&DocNum=2089&GAID=17&SessionID=112&LegID=146962

Rep. Jackie Haas. HB3873. Illinois General Assembly. Published February 17, 2023. Accessed March 8, 2023. 

https://www.ilga.gov/legislation/BillStatus.asp?DocNum=3873&GAID=17&DocTypeID=HB&SessionID=112&GA=103

Articles

Permitted for use as a veterinary tranquilizer, the drug is illicitly being consumed by individuals with substance addiction

Xylazine moves from the stables to the streets

The DEA is warning the American public of a sharp increase in the trafficking of fentanyl mixed with xylazine. Xylazine, also known as “Tranq,” is a powerful sedative that the FDA has approved for veterinary use.

“Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” said Administrator Milgram, in the public safety report.

 “DEA has seized xylazine and fentanyl mixtures in 48 of 50 States. The DEA Laboratory System is reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.”

Xylazine and fentanyl drug mixtures place users at a higher risk of suffering a fatal drug poisoning. Because xylazine is not an opioid, naloxone (Narcan) does not reverse its effects. Still, experts always recommend administering naloxone if someone might be suffering a drug poisoning. People who inject drug mixtures containing xylazine also can develop severe wounds, including necrosis—the rotting of human tissue—that may lead to amputation.

According to the CDC, 107,735 Americans died between August 2021 and August 2022 from drug poisonings, with 66% of those deaths involving synthetic opioids like fentanyl. The Sinaloa Cartel and Jalisco Cartel in Mexico, using chemicals largely sourced from China, are primarily responsible for most of the fentanyl that is being trafficked in communities across the United States.

FDA recently communicated to health care providers about the risks to patients exposed to xylazine in illicit drugs. A copy of that communication can be found 

DEA reports widespread threat of fentanyl mixed with xylazine. News release. The U.S. Drug Enforcement Administration. Accessed March 21, 2023. https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine

DEA issues warning for the trafficking of fentanyl mixed with FDA-approved sedative xylazine

DEA reports widespread threat of fentanyl mixed with xylazine

An oleander flower, which is poisonous to many animals and even humans (Photo: hayden / stock.adobe.com). 

The third week in March is dedicated to National Poison Prevention Week. To recognize the occasion, we have selected 3 case studies displaying how different animals were treated after toxin exposure. 

From a hamster ingesting a human drug to a dog swallowing a Fitbit—there's something for everyone. Happy reading! 

Hamster ingests potentially fatal antidepressant

: Professor Sweetcheeks got his paws on something that wasn't so sweet—sertraline, the active ingredient in Zoloft.

: Fortunately, Lily the donkey's veterinarian suspected poisoning, and she was immediately sent to the Large Animal Clinic at UC Davis for treatment. 

Dog ingests Fitbit that continues to monitor movement

: During surgery, the veterinary team also noticed Harley the dog had a rock in her intestine that may have caused further damage if left unchecked. 

3 articles to raise awareness of dangers to animals 

3 Must-reads for National Poison Prevention Week

UC Davis School of Veterinary Medicine professors, Karen Vernau (left) and David Maggs (center) mentor student Hikaru (Ray) Shiraishi (right) on the proper techniques of examining a kitten's eyes. (Photo courtesy of UC Davis)

 from UC Davis School of Veterinary Medicine, over the past 20 years, the eye disease symblepharon has only been studied in 5 published papers covering 20 kittens. This condition can be blinding to the car and occurs when the conjunctiva—the pink tissue surrounding the eye—fuses with other nearby surface structures of the eye or eyelid soon after birth, likely secondary to a feline herpesvirus infection on the ocular surface. Symblepharon is commonly seen in feline medicine practice, yet veterinary academic literature has been limited and inconclusive.

UC Davis recently published its own study

 on symblepharon using 40 kittens (in a total of 54 eyes) on February 6, 2023, to retrospectively evaluate the signalment, treatment, surgical technique, and outcomes for feline symblepharon.

“There is a misconception that this disease is not treatable or that it has a high rate of recurrence,” said David Maggs, BVSc (hons), DACVO, a professor of ophthalmology at UC Davis, said in the release. “We were able to separate out that smaller percentage of cases that do recur from those that respond much better to therapy, and to determine that this is not one homogenous disease. Many of these cases were previously being referred for enucleation (removal of eye), but we discovered that almost all these kittens have visual, comfortable eyes that can be saved.”

The study began with kittens that had a clinical diagnosis of symblepharon between January 1, 2002, and May 31, 2022, identified through a digital search of electronic medical records from the University of California Davis Veterinary Medical Teaching Hospital. All the kittens that participated were less than 1 year of age at the time of initial diagnosis.

There were 5 types of symblepharon found in various combinations: eyelid deformation (24 kittens; 32 eyes); ankyloblepharon (4 kittens; 4 eyes); conjunctiva-to-conjunctiva (11 kittens; 12 eyes); third eyelid-to-conjunctiva (24 kittens; 29 eyes); and corneoconjunctival adhesions (14 kittens; 16 eyes). At initial presentation, 23 (43%) eyes were affected by 1 type of symblepharon, 25 (46%) eyes by 2 types, and 6 (11%) eyes by 3 types.

Surgery was performed under general anesthesia/sedation (30 occasions) or topical anesthesia (21 occasions) on 30 (56%) eyes of 22 kittens; 12 eyes (40%) underwent multiple surgeries. There were 4 surgical techniques used, including: separation of conjunctival-to-conjunctival adhesions ± eyelid margins (14 eyes); resection of third eyelid adhesions ± temporary tacking of the third eyelid (modified Arlt’s pterygium technique; 18 eyes); en bloc resection of the third eyelid (2 eyes); and separation of corneoconjunctival adhesions (14 eyes).

From there, the researchers concluded that some forms of the disease were more amenable to surgical treatment than others and the surgery needed was relatively simple in some cases. The study also introduced a new surgical technique for managing this disease.

“By carefully identifying which type of symblepharon a kitten may have, the surgery to correct two of the types could be performed by a general practitioner. This could allow shelter veterinarians to correct the condition at the time of neutering. In fact, many of the surgeries documented in this study were performed by our Community Surgery Service,” said Karen Vernau, DVM, MAS, DACVIM (Neurology), a clinical professor of neurology/neurosurgery who works with many shelters and rescue groups through the Access to Care Program at UC Davis.

UC Davis undergraduate student, Hikaru (Ray) Shiraishi, took the lead on this study and became acquainted with the Ophthalmology Service through his work with the Vet Aide Club, a student organization that allows undergraduates to gain practical, hands-on experience in a variety of animal care fields. Shiraishi was offered a student position as an animal technician with the Ophthalmology Service and was ultimately recommended by the ophthalmology faculty to take on this research project.

Study shows complexity and treatability of eye disease in kittens. News release. UC Davis School of Veterinary Medicine. Published March 17, 2023. Accessed March 20, 2023. 

https://www.vetmed.ucdavis.edu/index.php/news/study-shows-complexity-and-treatability-eye-disease-kittens

Shiraishi H, Vernau KM, Kim S, et al. Symblepharon in kittens: a retrospective study of 40 kittens and 54 eyes (2002-2022). 

. 2023;25(2):1098612X221150160. doi:10.1177/1098612X221150160

Study shows a complex, but treatable disease with 40 patients

UC Davis study on eye diseases in kittens

The American College of Veterinary Ophthalmologists (ACVO) has opened registration for the 14

 anniversary of the National Service Animal Eye Exam Event, sponsored by Epicur Pharma. It will take place throughout May, with over 260 board-certified ACVO Diplomates throughout nearly 200 cities in the US, Canada, Puerto Rico, and Hong Kong, offering free eye exams to service and working animals. 

 appointments are limited and must be made by service and working animal handlers during the registration period from April 1, 2023 to April 30, 2023. The event is making its debut again after a hiatus due to COVID-19.

"Over 550 ACVO Diplomates have volunteered their time and resources to provide free exams to all types of service and working animals, in hopes of catching potential health concerns earlier," stated Stacee Daniel, executive director of ACVO, in the release.

 "The event has provided free examinations to approximately 76,000 service and working animals since it was founded in 2008, and we're proud to be back at full capacity this year."

"During our annual National Service Animal Eye Exam Event, other ophthalmologists and I have found eye problems that left untreated could shorten the service life of these valuable animals," added Bill Miller, DVM, DACVO, and creator of the Service Animal event. "I have been so fortunate to participate in the event and help different types of service animals, including search and rescue dogs, diabetic detection dogs, cadaver dogs, guide dogs, and PTSD support dogs, just to name a few."

ACVO Diplomates around the globe look forward to giving back during the annual National Service Animal Eye Exam Event by helping the service and working animals that help us. "Vision is so important for the normal function of service and therapy dogs," shared Nancy Bromberg, VMD, MS, DACVO, in the release. "The handlers of the animals are always so thankful for the services we offer, and in return, I feel good knowing I've given back to my community."

Before registering for the 2023 event, see participating locations at acvoeyeexam.org/participating-cities. To register, visit acvoeyeexam.org/qualifications-expectations. Once registration is confirmed, the owner/handler will receive a link to a list of participating clinics and their contact information to schedule an appointment. The owner/handler must provide the registration number to the clinic when making an appointment. Appointments are not confirmed until the owner/handler has contacted the clinic directly. Appointments will be held during May 2023, and dates and times may differ based on the availability of exams. 

 to qualify for a free eye exam, animals must be active, working formally trained service, working or formally trained therapy animals with written proof of training (and/or active registration for therapy only). Those currently enrolled in a formal service or working animal training program may also qualify for an exam based on clinic availability. Qualification paperwork for the training and current working status of either the service animal or therapy animal must be provided to the clinic at the time of the exam, along with the registration number provided in the confirmation email. 

Go here to learn what to expect during the exam: acvoeyeexam.org/qualifications-expectations.

Service and working animals receive free eye exams during 14th annual event. News release. American College of Veterinary Ophthalmologists. March 20, 2023. Accessed March 21, 2023. https://www.prnewswire.com/news-releases/service-and-working-animals-receive-free-eye-exams-during-14th-annual-event-301776248.html

ACVO with Epicur Pharma to hold 14th annual National Service Animal Eye Exam Event this May

American College of Veterinary Ophthalmologists to offer service and working animals free eye exams

 interview, Fetch Charlotte faculty member Natalie Marks, DVM, CVJ, president at Marks DVM Consulting, exclaims she is looking forward to sharing the stage with Adam Christman, DVM, MBA, 

chief veterinary officer. The duo will discuss key insight to know when using insulin therapy for diabetic patients.

The following is a partial transcript of the video.

: We'll be going through some specific examples of how to get the most use out of your insulin case selection, understanding the nuances between dogs and cats. And little drumroll, there'll be a sneak peek of something new that's out for cats that may not even be insulin to treat diabetes, which is mind blowing.

 Charlotte Conference taking place this week, from March 24-26, 2023.

Videos

In this interview, faculty member Dr Natalie Marks previews this must-attend session that will take place at the Fetch Charlotte Conference

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