Manifestations of potential xylazine withdrawal: A retrospective cohort study with nested case series

IF 3.9 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2025-04-30 DOI:10.1016/j.drugalcdep.2025.112681

Ashish P. Thakrar , Samantha J. Zwiebel , Paul J. Christine , Anthony Spadaro , M.Holliday Davis , Ranvir Bhatia , Natasa Rohacs , Lin Xu , Jeanmarie Perrone , Margaret Lowenstein

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引用次数: 0

Abstract

Purpose

The alpha₂-agonist xylazine is an increasingly common adulterant of illicitly manufactured fentanyl. A potential xylazine withdrawal syndrome (XWS) is poorly characterized. We assessed for XWS.

Methods

We conducted a retrospective cohort study of all hospitalized patients with urine GC-MS xylazine testing performed at three academic hospitals in Philadelphia, PA from 3/2022–2/2023. We used linear and logistic regression to compare peak systolic blood pressure, peak heart rate, and intensive care unit (ICU) admissions for patients with vs. without xylazine detected. Additionally, addiction specialist physicians assessed for candidate signs and symptoms of XWS (otherwise unexplained agitation, elevated blood pressure or heart rate, diaphoresis, tremor) using chart review.

Results

Of 121 xylazine tests, each among unique patients (mean age 44.6 years, 33.1 % female), 73 (60 %) were positive. Xylazine detection was not associated with differences in peak systolic blood pressure or heart rate, but was associated with lower odds of ICU admission (aOR 0.24, 95 % CI 0.09–0.60). Among 73 patients with xylazine detected, chart review determined 54 (74.0 %) did not have candidate signs of XWS, 12 (16.4 %) were indeterminate, and 5 (6.8 %) were excluded due to severe critical illness. Two patients (2.7 %) had otherwise unexplained blood pressure and heart rate elevation consistent with possible XWS. Co-occurring opioid, benzodiazepine, and alcohol withdrawal were common.

Conclusions

In a cohort of hospitalized patients, there was no association between xylazine detection and vital sign instability, xylazine detection was associated with lower ICU admission rate, and chart review did not detect distinct signs or symptoms of XWS.

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潜在的噻嗪戒断表现：一项嵌套病例系列的回顾性队列研究

目的α 2激动剂噻嗪是一种越来越常见的非法制造芬太尼的掺假剂。潜在的噻嗪戒断综合征（XWS）的特征很差。我们评估了XWS。方法对2022年3月至2023年2月在宾夕法尼亚州费城三所学术医院进行尿GC-MS检测的所有住院患者进行回顾性队列研究。我们使用线性和逻辑回归比较了检测到与未检测到噻嗪的患者的收缩压峰值、心率峰值和重症监护病房（ICU）入院情况。此外，成瘾专家医师使用图表评估XWS的候选体征和症状（其他原因不明的躁动、血压或心率升高、出汗、震颤）。结果121例异位患者（平均年龄44.6岁，女性33.1%）中，73例（60%）阳性。检测Xylazine与收缩压峰值或心率差异无相关性，但与较低的ICU入院几率相关（aOR 0.24, 95% CI 0.09-0.60）。在检测到xylazine的73例患者中，图表复习确定54例（74.0%）没有XWS候选体征，12例（16.4%）不确定，5例（6.8%）因严重危重症而被排除。2例患者（2.7%）有其他原因不明的血压和心率升高，与可能的XWS一致。同时出现阿片类药物、苯二氮卓类药物和酒精戒断是常见的。结论在一组住院患者中，木嗪检测与生命体征不稳定无相关性，木嗪检测与较低的ICU入院率相关，图表复习未发现明显的XWS体征或症状。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Drug and alcohol dependence 医学-精神病学

CiteScore

7.40

自引率

7.10%

发文量

409

审稿时长

41 days

期刊介绍： Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.