Xylazine withdrawal, and how to manage it

For the past two years, emergency room doctor Kory London, also at Thomas Jefferson University, has seen many patients suffering from the painful withdrawal symptoms of xylazine and fentanyl. He recently wrote that the patients can vomit so hard and so frequently that it damages their digestive system, and that they can have prolonged panic attacks just from a conversation.

He said that patients would use drugs, so they could go to the hospital without experiencing withdrawal. The doctors would treat them, but the treatments would not address their symptoms sufficiently. The patient would then get frustrated and leave with serious untreated medical conditions like bone and heart conditions, only to end up back in the hospital with worse outcomes.

“If somebody tells you 10 times that they’re leaving, and they understand that they could die and they still want to leave, and they’re pulling out their IV that you have to put in over and over again, after a while you just say, ‘OK, please come back when you’re ready to be treated.’”

London said that after seeing this happen again and again, he and his colleagues decided to try something different.

“Before the 21st century … there was no data about patients who had used xylazine recreationally,” he said. “The fentanyl epidemic is also relatively recent and the volumes of opioids that patients use are far and away beyond anything that we’ve dealt with in … recorded human history. ”

Now he’s working with other emergency room doctors to treat these patients with short acting opioids, which doctors already use to treat pain; and a muscle relaxing drug to counter the withdrawal from xylazine.

In a recent journal article, he reported that this combination was an effective way to keep patients in the hospital so they could complete their treatment and get a chance to heal from their wounds. Canadian doctors already use short acting opioids to treat patients on opioid withdrawal.

He said this treatment is still hotly debated, even among doctors. But he added that some interested doctors in New York City and Baltimore have gotten in touch to ask about how they could adapt it for their patients.

“Ten years ago, certainly, we would have gotten laughed out of conferences and now I’m presenting at conferences about this because I think that people are starting to realize that this is a novel condition that is going to take a different approach to truly have … important patient outcomes go well.”

The challenge with this research is that the drug supply changes constantly, with new substances being mixed in, Reed said.

“What we don’t know is whether these [new] drugs are going to become entrenched in our drug supply the way that xylazine is, or if they’re going to be blips,” Reed said. “What I’m hoping to do as we go on, is to keep doing research with people who use drugs to figure out what’s happening at any given moment in time, so we can respond very rapidly and develop interventions that work in the moment.”

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