Bufanda Lilia Pacheco, Montoya Alejando González, Carrillo Brenda Torres, Tejeda Mariana Alejandra Gonzalez, Segovia Luis A, Calderón-Villarreal Alhelí, Friedman Joseph R
Prevencasa A.C. Harm Reduction Clinic, Tijuana, Baja California, Mexico.
Xochicalco University, Tijuana, Baja California, Mexico.
Harm Reduct J. 2025 Jan 4;22(1):2. doi: 10.1186/s12954-024-01143-2.
Xylazine is a α2-adrenergic receptor agonist, used for sedation in veterinary contexts. Although it is increasingly found in overdose deaths across North America, the clinical management of xylazine-involved overdoses has not been extensively studied, especially in community-based harm reduction settings. Here we present a clinical series of xylazine-involved overdose and share the clinical approach and lessons learned by a community overdose response team in Tijuana, Mexico amidst the arrival of xylazine.
We present three cases describing the clinical management of patients with xylazine-involved overdoses that occurred in close proximity to the Prevencasa community harm reduction clinic. The long period of post-naloxone sedation in xylazine overdoses is a unique clinical feature. The first case is a 61-year-old man with longstanding opioid and methamphetamine use disorder found hypoxic, who received 4.0 mg of intranasal naloxone, and quickly began respirating well. He remained unconscious for 20 min, and upon awakening, experienced withdrawal symptoms, agitation and confusion, and exposed himself to considerable physical danger by entering a local roadway. The second is a 28-year-old man who primarily uses stimulants, who overdosed while trying "China White". His oxygen saturation improved from 81 to 100% with supplemental oxygen and field management, and he did not require naloxone administration. He recovered consciousness after 40 min. The third patient is a 36-year-old male who was found down, saturating at 20%, who received 0.4 mg intramuscular naloxone, was placed in recovery position, and remained unconscious for 12 min before making a complete recovery. The first and third patients provided urine and drug samples that tested positive for xylazine and fentanyl.
We describe insights about the clinical management of combined xylazine-fentanyl involved overdoses in the field, from a community harm reduction context where xylazine arrived suddenly spurring a large number of overdoses. In response to the long period of post-naloxone sedation inherent to xylazine overdoses, the clinical team learned to center oxygenation-not consciousness-as the key parameter of interest for the titration of naloxone, increase emphasis on field airway management, portable oxygen administration, and scene safety, and employ xylazine testing strips for urine and direct substance analysis to educate the patient population about health risks.
赛拉嗪是一种α2肾上腺素能受体激动剂，用于兽医领域的镇静。尽管在北美，因过量使用赛拉嗪导致死亡的案例越来越多，但对于涉及赛拉嗪过量的临床管理尚未进行广泛研究，尤其是在社区减少伤害的环境中。在此，我们介绍一系列涉及赛拉嗪过量的临床案例，并分享墨西哥蒂华纳一个社区过量用药应对小组在赛拉嗪出现期间的临床处理方法和经验教训。
我们呈现三例发生在Prevencasa社区减少伤害诊所附近的涉及赛拉嗪过量患者的临床管理案例。赛拉嗪过量后纳洛酮镇静时间长是一个独特的临床特征。第一例是一名61岁男性，长期患有阿片类药物和甲基苯丙胺使用障碍，被发现时处于低氧状态，接受了4.0毫克鼻内纳洛酮治疗，很快呼吸恢复正常。他昏迷了20分钟，醒来后出现戒断症状、躁动和困惑，还进入当地道路，使自己面临相当大的身体危险。第二例是一名28岁男性，主要使用兴奋剂，在尝试“中国白”时过量用药。通过补充氧气和现场处理，他的血氧饱和度从81%提高到100%，不需要使用纳洛酮。40分钟后他恢复意识。第三例患者是一名36岁男性，被发现时情况不佳，血氧饱和度为20%，接受了0.4毫克肌肉注射纳洛酮，被置于恢复体位，昏迷12分钟后完全康复。第一例和第三例患者提供的尿液和药物样本经检测，赛拉嗪和芬太尼呈阳性。
我们描述了在社区减少伤害环境中，赛拉嗪突然出现引发大量过量用药情况下，现场对赛拉嗪 - 芬太尼联合过量用药的临床管理见解。针对赛拉嗪过量后纳洛酮镇静时间长的情况，临床团队学会将氧合而非意识作为纳洛酮滴定的关键关注参数，更加重视现场气道管理、便携式氧气供应和现场安全，并使用赛拉嗪尿液检测试纸和直接物质分析来向患者群体宣传健康风险。
