Alexander Ryan, Agwuncha Chinelo, Wilson Christopher, Schrecker Joshua, Holt Andrew, Heltsley Rebecca
From the Division of Substance Use Disorder Programming, McNabb Center, Knoxville, TN (RA); Department of Internal Medicine, Graduate School of Medicine, University of Tennessee, Knoxville, TN (RA); Department of Internal Medicine, DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Knoxville, TN (RA, CA); Tennessee Department of Health, Nashville, TN (CW); and Aegis Sciences Corporation, Nashville, TN (JS, AH, RH).
J Addict Med. 2025;19(2):202-207. doi: 10.1097/ADM.0000000000001423. Epub 2024 Dec 4.
Xylazine is not approved for human use, yet it has emerged as a common adulterant of illicit fentanyl. It is currently unclear whether there is a withdrawal syndrome associated with xylazine and the potential impact of fentanyl coexposure.
A retrospective cohort study of patients with opioid use disorder admitted to an inpatient medically monitored withdrawal facility was performed. Patients positive for fentanyl were compared to patients copositive for fentanyl and xylazine. Outcomes were self-directed discharge and completion of treatment. Independent variables included Clinical Opioid Withdrawal Scale (COWS) scores, heart rate, and blood pressure. Associations between individuals with or without xylazine were measured.
Among 71 patients admitted for opioid withdrawal management positive for fentanyl, 51.4% were copositive with xylazine. There was no difference detected in average COWS scores ( P = 0.12-0.78) or average heart rate ( P = 0.33-0.80) between groups. Xylazine copositive patients had higher average systolic blood pressure on days 1 (129.0 vs 123.0, P = 0.01) and 2 (127.9 vs 116.3, P = 0.04) although unclear if clinically meaningful. Individuals copositive for xylazine were less likely to complete treatment (43.2% vs 55.9%, P = 0.23) and more likely to have self-directed discharge (67.6% vs 44.1%; OR, 2.64; 95% CI, 1.0-6.9) although not statistically significant.
Among 71 patients admitted for medically monitored withdrawal, individuals who were copositive for xylazine at the time of admission had higher average blood pressure and were more likely to have a self-directed discharge. Additional research is needed to determine the impact of xylazine on withdrawal.
赛拉嗪未被批准用于人类，但它已成为非法芬太尼的常见掺杂剂。目前尚不清楚是否存在与赛拉嗪相关的戒断综合征以及芬太尼共同暴露的潜在影响。
对入住住院医疗监测戒断设施的阿片类物质使用障碍患者进行了一项回顾性队列研究。将芬太尼检测呈阳性的患者与芬太尼和赛拉嗪检测均呈阳性的患者进行比较。结局指标为自行出院和完成治疗。自变量包括临床阿片类物质戒断量表（COWS）评分、心率和血压。测量了有无赛拉嗪的个体之间的关联。
在71名因阿片类物质戒断管理入院且芬太尼检测呈阳性的患者中，51.4%同时赛拉嗪检测也呈阳性。两组之间的平均COWS评分（P = 0.12 - 0.78）或平均心率（P = 0.33 - 0.80）没有差异。赛拉嗪检测呈阳性的患者在第1天（129.0对123.0，P = 0.01）和第2天（127.9对116.3，P = 0.04）的平均收缩压较高，不过尚不清楚这是否具有临床意义。赛拉嗪检测呈阳性的个体完成治疗的可能性较小（43.2%对55.9%，P = 0.23），且更有可能自行出院（67.6%对44.1%；比值比，2.64；95%置信区间，1.0 - 6.9），尽管差异无统计学意义。
在71名接受医疗监测戒断的患者中，入院时赛拉嗪检测呈阳性的个体平均血压较高，且更有可能自行出院。需要进一步研究以确定赛拉嗪对戒断的影响。
