Illinois Xylazine Best Practices for Health Care Providers

Illinois Xylazine Best Practices for Health Care Providers

On August 2023, IDPH released a SIREN, in collaboration with IDHS, regarding Illinois Xylazine Best Practices for Health Care Providers. The full document can be accessed at State of Illinois Siren upon registering. It is also available on our website, Xylazine: Best Practices for Health Care Providers.

Xylazine Background

Xylazine, a non-opioid sedative commonly used in veterinary medicine, has become increasingly prevalent in the unregulated drug supply in the United States. While the presence of xylazine use is underreported likely both in its geographic distribution and in its contribution to overdose deaths, available data indicate xylazine use is widespread and impacting overdose mortality throughout the country. Xylazine was detected in 45 Illinois overdose deaths in 2020 and has been detected in more than 200 overdose deaths in the state in 2022 (Illinois Department of Public Health, Vital Records). Xylazine's presence in the unregulated drug supply and its contribution to overdose deaths is widespread and increasing.

Xylazine Best-Practices- Clinical Recognition & Supportive Care

Depending on the route of administration, xylazine takes effect in 1-2 minutes and the duration of effect lasts between 3 and 4 hours, on average, but can last up to eight hours. While there are no current evidence-based recommendations for the management of xylazine withdrawal syndrome, it is important to recognize and sufficiently treat xylazine withdrawal symptoms. Xylazine withdrawal symptoms include non-specific anxiety (primary symptom), hypertension, tachycardia, diaphoresis, restlessness, agitation, and irritability. The Illinois Xylazine Best Practices for Health Care Providers provides information on how to manage withdrawal symptoms as well as on how to prevent, recognize, and address xylazine-related skin wounds.

Xylazine-Involved Overdose Recognition and Response

Because xylazine is often found mixed with fentanyl (an opioid) in the unregulated drug supply, when responding to an overdose, assume an opioid is involved and administer naloxone. Once administered, the responder should wait two minutes before giving an additional naloxone dose. However, if an individual is not responding to 1-2 doses of naloxone, suspect that it is a polysubstance overdose with possible xylazine involvement. If responding to a known or suspected xylazine-involved overdose, the response should include placing the person in the recovery position, ensuring an open airway, and rescue breathing if possible.

In addition to checking for breathing, check for a pulse. If there is no pulse, the recommendation is to perform chest compressions or full cardiopulmonary resuscitation (CPR), if trained to do so. If not trained to perform CPR, assure 911 was activated in the initial phase of the response or immediately.

Harm Reduction Strategies for Xylazine

As xylazine is increasing in the unregulated drug supply, it is critical to discuss harm reduction strategies with patients. Information to share with patients "Have someone with you when using or use the Never Use Alone Hotline (800-484-3731). Start low and go slow. Try to avoid mixing substances. Test your substances using fentanyl and xylazine test strips. Use it in a safe location, with belongings securely stored and try to be in a comfortable seated position since sedation can last up to eight hours. Ask whomever you are using with to move (repositioned) you every two hours. If helping someone else how is using, they may be very deeply sedated, move them every 2 hours. When the person awakens, exercise the limbs to improve the circulation and prevent blood clots. Keep naloxone nearby so someone can administer it to you, or you can administer it if an overdose occurs."

Additional Information, References, and Resources