{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:54:21Z","timestamp":1790013261005,"version":"4.0.1"},"reference-count":65,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010259","name":"American Psychiatric Association Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100010259","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["American J Addict"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Objectives<\/jats:title>\n                    <jats:p>Xylazine, an alpha\u20102\u2010adrenergic agonist, has been increasingly implicated in substance use and overdose crises. However, little is known about its effects on humans. With the growing public health crisis surrounding xylazine, it has become important to recognize and promptly manage symptoms of xylazine toxicity, withdrawal, and overdose. We conducted a systematic review to consolidate the existing literature on the topics, aiming to identify gaps and propose evidence\u2010based actions for managing patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Published literature from 1957 to 2024 was searched to identify studies focusing on the management of xylazine intoxication, withdrawal, overdose, and dependence in humans. PRISMA guidelines and JBI critical appraisal tools were used to ensure the methodological quality of the included studies and reduce bias in study selection. Thirty\u2010four studies were included in this review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Xylazine misuse was common among men aged 19\u201345 years and was more likely to be used with other substances than alone. The doses ranged from 40 to 4300\u2009mg, with no established toxic dosing. Supportive care included treatment with naloxone, alpha\u20102 agonists, and GABAergic medications. There is no antidote or evidence\u2010based treatment recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and Conclusions<\/jats:title>\n                    <jats:p>This systematic review consolidated the outcomes and proposed guidelines from xylazine management trials. It can serve as a reference for providers to promptly manage xylazine toxicity, withdrawal, and overdose symptoms to improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Scientific Significance<\/jats:title>\n                    <jats:p>Although there is currently no standardized treatment or antidote, this review will aid ongoing research to address these gaps in xylazine management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ajad.70051","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T07:03:58Z","timestamp":1749193438000},"page":"589-602","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Management of xylazine toxicity, overdose, dependence, and withdrawal: A systematic review"],"prefix":"10.1111","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2987-7872","authenticated-orcid":false,"given":"Philipa","family":"Owusu\u2010Antwi","sequence":"first","affiliation":[{"name":"Richmond University Medical Center Staten Island New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya","family":"Atodaria","sequence":"additional","affiliation":[{"name":"St. George's University School of Medicine True Blue Grenada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edmund","family":"Appiah\u2010Kubi","sequence":"additional","affiliation":[{"name":"Allegheny General Hospital Pittsburgh Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zainab","family":"Shah","sequence":"additional","affiliation":[{"name":"Richmond University Medical Center Staten Island New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elpidio Marlon","family":"Garcia","sequence":"additional","affiliation":[{"name":"Richmond University Medical Center Staten Island New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,6]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2014.03.015"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2023.2294619"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11916-024-01211-z"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/jat\/25.4.245"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-200011000-00030"},{"issue":"112","key":"e_1_2_11_7_1","article-title":"Xylazine intoxication, a case report","volume":"1","author":"Bayramoglu A","year":"2016","journal-title":"Med Rep Case Stud"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7037a4"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.46658\/JBIMES-24-06"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.3109\/15563657908989878"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3109\/15563658108990293"},{"issue":"785","key":"e_1_2_11_12_1","first-page":"714","article-title":"Potential antidote for Rompun (xylazine) in humans","volume":"98","author":"Mackintosh C","year":"1985","journal-title":"N Z Med J"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/0735-6757(86)90070-7"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.66.773.244"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1520\/JFS16155J"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006565-200112000-00012"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/00063110-200309000-00022"},{"issue":"6","key":"e_1_2_11_18_1","first-page":"324","article-title":"An unusual presentation from xylazine\u2010ketamine","volume":"46","author":"Arican FO","year":"2004","journal-title":"Vet Hum Toxicol"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2006.02.042"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650601073520"},{"key":"e_1_2_11_21_1","unstructured":"Mizerov\u00e1L Cern\u00e1O Fabianov\u00e1J et al. 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