CLN Daily 2024
Fentanyl and xylazine drug mixtures continue to be at the forefront of the opioid crisis. In 2023 xylazine was declared an emerging threat by the White House’s Office of Drug Control and Policy.
“Seeing a nearly 1,000% increase in deaths involving any opioid is very alarming,” said Catherine Mills, PhD, a clinical chemistry fellow at the Medical University of South Carolina (MUSC). She will be hosting a roundtable on what is driving the crisis, and how laboratorians and clinicians can test and treat patients, at ADLM 2024.
A major part of the overdose epidemic right now is xylazine, a non-opioid sedative tranquilizer that has been found in the illegal U.S. drug supply and linked to overdose deaths. Xylazine can slow down the heartbeat and lower blood pressure, which is dangerous when combined with an opioid.
Between 2020 and 2021, forensic laboratory identifications of xylazine rose in all four U.S. regions in the U.S, according to the Drug Enforcement Agency. The highest increases were 193% in the south and 112% in the west. Xylazine-positive overdose deaths increased by 1,127% in the south, 750% in the west, more than 500% in the Midwest and more than 100% in the northeast.
The roundtable will review the clinical utility of incorporating fentanyl testing into routine toxicology screening, as well as xylazine reflex testing. Mills also will be discussing associated methodologies and strategies for test implementation.
“To even start to address the opioid epidemic, drug screening is critical to identify drug use, treat overdoses, and link patients with appropriate care,” Mills said.
Despite the opioid crisis continuing to stretch on, and knowing what is behind it, fentanyl is not detected in routine opioid screenings, Mills said. The adoption of fentanyl detection in routine care has been slow, with only about 20% of emergency departments testing for it. That may not be the fault of emergency departments Mills was quick to add but related to limited FDA-approved fentanyl tests.
Xylazine will also not be part of an opioid screening panel because it’s not an opioid; nor will it respond to Narcan, an overdose reversing drug, which makes identifying patients who took this combination difficult, and therefore hard to treat.
Mills will be discussing MUSC’s experience in validating two FDA-approved fentanyl assays, work that also involved Nikolina Babic, PhD, medical director of chemistry and the director of the clinical chemistry fellowship program at MUSC, and Parker Dryja, PhD, a postdoctoral researcher there. As part of the discussion, Mills will talk about that validation process, incorporating the assays into use at their academic medical center, and the outcomes so far in testing and treating potential overdose patients.
She hopes the roundtable will be attended by laboratory technicians, medical directors, and “industry professionals that are interested in fentanyl testing,” she said. “But I think this will really be useful to people working in medical centers.”
That’s critical right now as the crisis stretches on and continues to shift. It’s not easy for clinicians and healthcare workers, especially those who work in places like emergency departments and are often the first to tirage patients, to keep up with what is in the U.S. drug supply at any given moment.
“The opioid epidemic is ever evolving,” Mills said. Through this roundtable, she hopes to share the latest information of what they’re seeing right now and the best possible paths forward in testing these patients. “We're keeping up with something that's just changing so quickly, and I think that this will help people in the field,” she added.
Jen A. Miller is a freelance journalist who lives in Audubon, New Jersey. +X: @byJenAMiller.