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In Their Own Words
Fentanyl Remains the Big Driver of Overdoses so Stay Focused on Naloxone as an Antidote
LDI’s Jeanmarie Perrone Names Biggest Takeaways from NIDA’s Conference on Opioid Care
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Federal officials and caregivers have been in a race to combat a surge in overdoses from the combination of the opioid fentanyl and the animal sedative xylazine. The Biden Administration declared the combination an “emerging threat” in April 2023, marking the first time that designation has ever been used. It was given for the sharp rise in overdoses and skin wounds that the combination was causing across the nation.
In June a large group of experts met under the auspices of the National Institute on Drug Abuse to review testing, treatment and wound care for this combination, also called Tranq Dope. Then in July came the release of a National Response Plan.
LDI Senior Fellow Jeanmarie Perrone, a leading addiction expert at the University of Pennsylvania, was co-chair of the NIDA meeting. Here are some highlights she culled from the event.
- Continue to make naloxone widely available and encourage its use in suspected overdoses. Despite the rise of xylazine-fentanyl overdoses, naloxone remains the mainstay of overdose care because it reverses the effects of fentanyl, which is the primary reason that people stop breathing.
- Demystify the use of methadone in hospital settings. All patients with drug-induced withdrawal should be treated quickly with a patient-centered, approach. Most patients using xylazine-fentanyl have severe opioid dependence requiring withdrawal treatment with full opioid agonists such as methadone.
- The wounds from xylazine should be managed with more frequent wound care access. We need more low-barrier, walk-in wound care co-located with syringe services and other harm reduction and treatment services.
- Expand testing with rapid turnarounds. This will help manage wounds, withdrawal and overdoses and better track the spread of xylazine-fentanyl across regions to inform local interventions. We have no rapid testing for xylazine.
- Bring the focus back to fentanyl. Xylazine-fentanyl overdoses are concerning, but patients who overdose on xylazine-fentanyl have lower fatality rates compared to fentanyl alone. Fentanyl (and other potent opioids such as nitazines) are driving opioid overdoses.
Author
Jeanmarie Perrone, MD
Professor, Emergency Medicine, Perelman School of Medicine; Director, Penn Center for Addiction Medicine and Policy, Perelman School of Medicine
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