Xylazine Use Shows Need For Testing

Aegis provider and recent panelist, Leigh Brooks, APRN, FNP-C, has released an op-ed where she shares her firsthand experience with dangerous drugs like xylazine and how comprehensive testing and education can make an impact.

You don’t know what you don’t know. A year ago, I’d never heard of xylazine. Neither had my patients. Now, I see it weekly in my patients’ toxicology reports in combination with fentanyl — a deadly duo that the White House recently named an emerging national threat.

On paper, xylazine is a medication used by veterinarians for sedation and pain management in large animals, such as horses, cows and even elephants. It works in the central nervous system to relax an animal. So, imagine my surprise when I first started seeing xylazine in combination with fentanyl in toxicology reports in the summer of 2022.

I’m the medical director for the medication-assisted treatment program at Bluestone Health Association, in Princeton, where I treat patients with substance use disorders. I now see one or two reports weekly with this deadly combination.

My patients typically have no knowledge that they have been sold an animal sedative. Most of them are seeking fentanyl or oxycodone. Once I am aware they have consumed xylazine and I share this with them, they say, “I knew something wasn’t right with that stuff I bought.” They say they felt more drowsy, lethargic and sick.

I treat a vulnerable population. Princeton is rural, and many of my patients don’t have reliable access to transportation so they can receive care.

Knowing what’s in a patient’s body and what’s in the drug supply in your area saves lives. But treating substance abuse is difficult when it feels as though the drug supply is constantly evolving because of what we call novel psychoactive substances, or NPS.

My concern is that efforts to rid the streets of one drug will only pave the way for something stronger and more deadly. The illicit drug market is strong, organized, and profit-minded. It’s hard for me to watch the people of West Virginia — of all of Appalachia — be the lab rats or test subjects for this illicit market.

Since I started seeing xylazine in test results last year, I began educating all of my MAT patients about it. I prescribe Narcan to everyone who might be at risk of ingesting xylazine, even though Narcan won’t actually revive you from a xylazine-related overdose. But they can use it to overturn the opioid, and then use rescue breaths until EMS arrives.

I’m thankful that I began testing for xylazine when I did. I know I’m not the only MAT provider in my area with patients unknowingly ingesting it but, last year, I was the only provider with the knowledge, because I was the only one testing for it.

That’s why I rely on drug screenings that test beyond what’s standard, like the tests from Aegis Labs, which my practice contracts with. In this complicated age of NPS, a simple drug screening just isn’t sufficient. Thanks to thorough testing, I have the most up-to-date information I need to educate my patients. It is crucial that providers utilize confirmatory testing. You cannot treat or educate patients about what you do not know.

Connecting with other providers is invaluable, too. Recently, I had the opportunity to speak with colleagues on a virtual panel. We were all from different parts of the country but are seeing similar results in patient confirmatory testing and patient outcomes. The more other providers can bridge the communication gaps and actually sit down and discuss our real-world situations in practice, the more we can educate and assist each other — and ultimately provide better care to our patients.

The most important thing to remember is that we are treating people. We’re treating sons, daughters, mothers, fathers and siblings. People don’t wake up one morning and decide to become addicted to illicit drugs. Everyone deserves to understand what’s in their bodies and how to deal with it. We must prioritize treatment and destigmatize asking for help. If we don’t, this drug crisis will continue to get worse and kill more people.

Understand that we are not just in a war with illegal substances like fentanyl and xylazine. We’re in a war with mental health and the spread of disease. We’re in a war with our past ideologies of medicine.

Knowledge is the key to winning — to saving lives. And it begins with testing.

Leigh Brooks, of Princeton, is director of medication-assisted treatment at Bluestone Health Association.

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