Zaki Mark, Dillon Cynthia, Patel Anjali, Gracious Barbara
HCA Florida Orange Park Hospital, Orange Park, FL.
Edward Via College of Osteopathic Medicine, Blacksburg, VA.
HCA Healthc J Med. 2024 Dec 1;5(6):713-719. doi: 10.36518/2689-0216.1695. eCollection 2024.
As illicit drug manufacturers find new ways to market their products and increase their profit margins, multiple contaminants have found their way into the illicit drug supply. The newest addition, xylazine, also known as "tranq," has spread through the city of Philadelphia and has recently been gaining ground across the United States, including in the state of Florida.
This case describes a 37-year-old male with a significant past psychiatric history of severe polysubstance intravenous (IV) use, including fentanyl and methamphetamine. He was comorbid with other mental and physical conditions and presented to the emergency department with acute psychosis and worsening multi-digit ulcerations. The patient reported that the ulcerations started and progressed since he began injecting fentanyl cut with tranq. The patient was hospitalized for over 30 days due to his complex psychiatric illness as well as complications related to his ulcerations. Over the course of the hospitalization, the ulcerations began to heal, which was likely due to stopping IV drug use and receiving IV antibiotics in a restricted setting.
Continued use of IV drugs that are contaminated with xylazine or other dangerous additives can lead to increased morbidity and mortality. Suspicion of xylazine contamination should be prompt in patients with a history of IV drug use, skin ulcerations, and suspected opiate overdose that is unresponsive to naloxone. Further research on and awareness of the presence of xylazine in illicit drug supplies across the country is crucial to the prevention and early detection of xylazine-related complications.
随着非法毒品制造商寻找新的产品营销方式并提高利润率，多种污染物进入了非法毒品供应渠道。最新出现的赛拉嗪，也被称为“tranq”，已经在费城蔓延，最近在美国各地，包括佛罗里达州，也越来越常见。
本病例描述了一名37岁男性，有严重的多种物质静脉注射使用史，包括芬太尼和甲基苯丙胺，有显著的既往精神病史。他还患有其他精神和身体疾病，因急性精神病和多趾溃疡恶化而就诊于急诊科。患者报告说，自从他开始注射掺有赛拉嗪的芬太尼后，溃疡就开始出现并恶化。由于其复杂的精神疾病以及与溃疡相关的并发症，患者住院超过30天。在住院期间，溃疡开始愈合，这可能是由于停止静脉吸毒并在受限环境中接受静脉抗生素治疗。
持续使用被赛拉嗪或其他危险添加剂污染 的静脉注射毒品会导致发病率和死亡率上升。对于有静脉吸毒史、皮肤溃疡且疑似对纳洛酮无反应的阿片类药物过量的患者，应及时怀疑赛拉嗪污染。对全国非法毒品供应中赛拉嗪存在情况的进一步研究和认识对于预防和早期发现与赛拉嗪相关的并发症至关重要。
