Strategies to mitigate xylazine-involved fentanyl overdoses: Lessons from Tijuana, Mexico

A recent study published in the Harm Reduction Journal documents the arrival of xylazine to the San Diego-Tijuana border region, and shows the efforts of local physicians to address this emerging challenge in the nation’s overdose crisis.

Xylazine, a veterinary sedative—often referred to as “tranq”—has increasingly appeared as an additive in illicit fentanyl, complicating overdose interventions due to its prolonged sedative effects. This has prompted the Biden Administration to label xylazine-fentanyl an emerging threat in the United States.

The study, conducted as a collaboration between University of California San Diego researchers and physicians at the Prevencasa community harm reduction clinic in Tijuana, Mexico, discusses how to improve the clinical responses to xylazine-involved fentanyl overdoses, proposing strategies tailored to field settings.

Through case studies of three patients at the Prevencasa clinic, the research highlights unique challenges presented by xylazine-involved fentanyl overdoses, such as prolonged unconsciousness despite naloxone administration and heightened risks of post-overdose confusion and injury.

Patients who experience xylazine-involved fentanyl overdose often require careful oxygenation management, including the use of portable oxygen tanks and airway positioning, rather than aggressive naloxone titration.

The clinic’s approach emphasizes harm-reduction practices, including using xylazine testing strips to inform patients about drug contents and reduce risks. Strips can be given to participants to directly test their own drug supply before consumption.

Additionally, community education and scene safety measures, such as relocating patients to secure environments, are critical components of the response to ensure patients do not place themselves in harmful scenarios.

This approach not only enhances immediate overdose management but also empowers patients with knowledge and tools to make safer decisions.