The Dangers of Xylazine Mixed with Non-Pharmaceutical Fentanyl (NPF)

Introduction.Xylazine hydrochloride and non-pharmaceutical fentanyl (NPF) are addictive illicit drugs of abuse, whose abuse in combination has gained popularity in last few years.Xylazine has gone from a drug that was hardly seen in U.S. drug markets in 2018, to one of the commonly abused additive drugs.Xylazine added to these drugs is thought to increase their duration of action, potentially leading to the increased popularity of the mixture.This is of concern due to its increasing involvement of xylazine mixed fentanyl in drug overdose deaths.This case highlights a case of lack of patient knowledge while using xylazine. Methods.A retrospective chart review of the patient's presentation, workup, treatment, and follow up was conducted. Results.A 43-year-old male presents for methadone clinic for the third time in his life.At the age of 23 he started to use illicit opiates and heroin.His recently began using a new drug he reports as "carfentanil."He describes it as a powerful sedative and that he uses it as the same dose as he uses fentanyl.Considering that carfentanil has a potency that is 100 times that of fentanyl, the patient would have noticed if he had been taking actual carfentanil.Thus, it was determined that the patient incorrectly named the xylazine mixed fentanyl as "carfentanil."Conclusions.Xylazine mixed fentanyl is an increasingly popular drug combination that is finding its way across the country with potential for fatal consequences.