No, xylazine is a non-narcotic drug and is not an opioid, thus, Narcan will not specifically reverse acute xylazine intoxication. However, fentanyl is the most common drug combined with xylazine. Thus, Narcan is reasonable to administer in the setting of a suspected overdose since the patient’s presentation can be due to combined use.
Xylazine, commonly known as “tranq”, is causing an emerging public health concern that is not only associated with severe respiratory and central nervous system depression but as illustrated by this case, is infamous for disfiguring and life-threatening skin ulcers. Xylazine is a non-narcotic drug mainly used for sedation, pain relief, and muscle relaxation in veterinary medicine. In more recent human use, it can be injected into muscles and veins, insufflated, ingested, or smoked. It has a large volume of distribution due to its lipophilicity and is rapidly concentrated in the CNS and kidney, with an elimination half-life of approximately 23-50 minutes.
In regard to treating resulting wounds, antibiotic coverage for secondary infection of xylazine wounds must cover MRSA and coverage for group A streptococci should also be considered.
For managing xylazine withdrawal symptoms, the Philadelphia Department of Public Health’s most recent recommendations include replacement therapy with alpha-2-adrenergic agonists such as clonidine, dexmedetomidine, tizanidine, or guanfacine paired with symptom management for pain using short-acting opioids, ketamine, gabapentin , ketorolac, acetaminophen, or NSAIDs.
