{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T13:56:17Z","timestamp":1790085377942,"version":"4.0.1"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,1,4]],"date-time":"2025-01-04T00:00:00Z","timestamp":1735948800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,1,4]],"date-time":"2025-01-04T00:00:00Z","timestamp":1735948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["DA049644"],"award-info":[{"award-number":["DA049644"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"NIMH","doi-asserted-by":"crossref","award":["MH101072"],"award-info":[{"award-number":["MH101072"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Harm Reduct J"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Xylazine is a \u03b12-adrenergic receptor agonist, used for sedation in veterinary contexts. Although it is increasingly found in overdose deaths across North America, the clinical management of xylazine-involved overdoses has not been extensively studied, especially in community-based harm reduction settings. Here we present a clinical series of xylazine-involved overdose and share the clinical approach and lessons learned by a community overdose response team in Tijuana, Mexico amidst the arrival of xylazine.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case Presentation<\/jats:title>\n                <jats:p>We present three cases describing the clinical management of patients with xylazine-involved overdoses that occurred in close proximity to the Prevencasa community harm reduction clinic. The long period of post-naloxone sedation in xylazine overdoses is a unique clinical feature. The first case is a 61-year-old man with longstanding opioid and methamphetamine use disorder found hypoxic, who received 4.0\u00a0mg of intranasal naloxone, and quickly began respirating well. He remained unconscious for 20\u00a0min, and upon awakening, experienced withdrawal symptoms, agitation and confusion, and exposed himself to considerable physical danger by entering a local roadway. The second is a 28-year-old man who primarily uses stimulants, who overdosed while trying \u201cChina White\u201d. His oxygen saturation improved from 81 to 100% with supplemental oxygen and field management, and he did not require naloxone administration. He recovered consciousness after 40\u00a0min. The third patient is a 36-year-old male who was found down, saturating at 20%, who received 0.4\u00a0mg intramuscular naloxone, was placed in recovery position, and remained unconscious for 12\u00a0min before making a complete recovery. The first and third patients provided urine and drug samples that tested positive for xylazine and fentanyl.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We describe insights about the clinical management of combined xylazine-fentanyl involved overdoses in the field, from a community harm reduction context where xylazine arrived suddenly spurring a large number of overdoses. In response to the long period of post-naloxone sedation inherent to xylazine overdoses, the clinical team learned to center oxygenation\u2014not consciousness\u2014as the key parameter of interest for the titration of naloxone, increase emphasis on field airway management, portable oxygen administration, and scene safety, and employ xylazine testing strips for urine and direct substance analysis to educate the patient population about health risks.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12954-024-01143-2","type":"journal-article","created":{"date-parts":[[2025,1,4]],"date-time":"2025-01-04T09:00:11Z","timestamp":1735981211000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Managing xylazine-involved overdoses in a community harm reduction setting: lessons from Tijuana, Mexico"],"prefix":"10.1186","volume":"22","author":[{"given":"Lilia Pacheco","family":"Bufanda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejando Gonz\u00e1lez","family":"Montoya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda Torres","family":"Carrillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana Alejandra Gonzalez","family":"Tejeda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis A.","family":"Segovia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alhel\u00ed","family":"Calder\u00f3n-Villarreal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph R.","family":"Friedman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,1,4]]},"reference":[{"key":"1143_CR1","doi-asserted-by":"publisher","first-page":"2209","DOI":"10.1056\/NEJMp2303120","volume":"388","author":"HDR Gupta Rahul","year":"2023","unstructured":"Gupta Rahul HDR, Ashburn MA. Xylazine \u2014 Medical and Public Health imperatives. N Engl J Med. 2023;388:2209\u201312.","journal-title":"N Engl J Med"},{"key":"1143_CR2","doi-asserted-by":"publisher","unstructured":"Friedman J, Castillo FM, Bourgois P, Wahbi R, Dye D, Goodman D et al. Xylazine Spreads Across the US: A Growing Component of the Increasingly Synthetic and Polysubstance Overdose Crisis [Internet]. 2021 Sep p. 2021.09.20.21263680. https:\/\/www.medrxiv.org\/content\/https:\/\/doi.org\/10.1101\/2021.09.20.21263680v1","DOI":"10.1101\/2021.09.20.21263680v1"},{"key":"1143_CR3","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1186\/s12954-023-00867-x","volume":"20","author":"DT Zhu","year":"2023","unstructured":"Zhu DT. Public health impact and harm reduction implications of xylazine-involved overdoses: a narrative review. Harm Reduct J. 2023;20:131.","journal-title":"Harm Reduct J"},{"key":"1143_CR4","doi-asserted-by":"publisher","first-page":"663","DOI":"10.3109\/15563658108990293","volume":"18","author":"AG Gallanosa","year":"1981","unstructured":"Gallanosa AG, Spyker DA, Shipe JR, Morris DL. Human xylazine overdose: a comparative review with Clonidine, Phenothiazines, and tricyclic antidepressants. Clin Toxicol. 1981;18:663\u201378.","journal-title":"Clin Toxicol"},{"key":"1143_CR5","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1007\/s11524-011-9662-6","volume":"89","author":"JC Reyes","year":"2012","unstructured":"Reyes JC, Negr\u00f3n JL, Col\u00f3n HM, Padilla AM, Mill\u00e1n MY, Matos TD, et al. The Emerging of Xylazine as a New drug of abuse and its Health consequences among drug users in Puerto Rico. J Urban Health. 2012;89:519\u201326.","journal-title":"J Urban Health"},{"key":"1143_CR6","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1186\/s12954-023-00879-7","volume":"20","author":"CM Zagorski","year":"2023","unstructured":"Zagorski CM, Hosey RA, Moraff C, Ferguson A, Figgatt M, Aronowitz S, et al. Reducing the harms of xylazine: clinical approaches, research deficits, and public health context. Harm Reduct J. 2023;20:141.","journal-title":"Harm Reduct J"},{"key":"1143_CR7","doi-asserted-by":"crossref","unstructured":"Kariisa M. Illicitly Manufactured Fentanyl\u2013Involved Overdose Deaths with Detected Xylazine \u2014 United States, January 2019\u2013June 2022. MMWR Morb Mortal Wkly Rep [Internet]. 2023 [cited 2024 Mar 11];72. https:\/\/www.cdc.gov\/mmwr\/volumes\/72\/wr\/mm7226a4.htm","DOI":"10.15585\/mmwr.mm7226a4"},{"key":"1143_CR8","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/s12954-024-00959-2","volume":"21","author":"W Bradford","year":"2024","unstructured":"Bradford W, Figgatt M, Scott KS, Marshall S, Eaton EF, Dye DW. Xylazine co-occurrence with illicit fentanyl is a growing threat in the Deep South: a retrospective study of decedent data. Harm Reduct J. 2024;21:46.","journal-title":"Harm Reduct J"},{"key":"1143_CR9","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1186\/s12954-021-00546-9","volume":"18","author":"JM Bowles","year":"2021","unstructured":"Bowles JM, McDonald K, Maghsoudi N, Thompson H, Stefan C, Beriault DR, et al. Xylazine detected in unregulated opioids and drug administration equipment in Toronto, Canada: clinical and social implications. 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Beyond Fentanyl Test Strips: Investigating Other Urine Drug Test Strips for Drug Checking Applications [Internet]. 2024 [cited 2024 Apr 16]. https:\/\/chemrxiv.org\/engage\/chemrxiv\/article-details\/660720459138d23161b43dfd","DOI":"10.26434\/chemrxiv-2024-c39kc"},{"key":"1143_CR18","doi-asserted-by":"publisher","first-page":"100209","DOI":"10.1016\/j.dadr.2023.100209","volume":"9","author":"MH Hauschild","year":"2023","unstructured":"Hauschild MH, Warp PV, Tookes HE, Yakir E, Malhotra B, Malik S, et al. Prevalence of xylazine among people who inject drugs seeking medical care at a syringe services program clinic: Miami, Florida, 2023. Drug Alcohol Depend Rep. 2023;9:100209.","journal-title":"Drug Alcohol Depend Rep"},{"key":"1143_CR19","doi-asserted-by":"publisher","first-page":"64","DOI":"10.1186\/s12954-024-00978-z","volume":"21","author":"PV Warp","year":"2024","unstructured":"Warp PV, Hauschild M, Serota DP, Ciraldo K, Cruz I, Bartholomew TS, et al. A confirmed case of xylazine-induced skin ulcers in a person who injects drugs in Miami, Florida, USA. Harm Reduct J. 2024;21:64.","journal-title":"Harm Reduct J"},{"key":"1143_CR20","doi-asserted-by":"crossref","unstructured":"Korn WR, Stone MD, Haviland KL, Toohey JM, Stickle DF. High prevalence of xylazine among fentanyl screen-positive urines from hospitalized patients, Philadelphia, 2021. Clinica Chimica Acta. 2021;521:151\u20134.","DOI":"10.1016\/j.cca.2021.07.010"},{"key":"1143_CR21","unstructured":"Zhu DT, Friedman J, Bourgois P, Montero F, Tamang S. The emerging fentanyl\u2013xylazine syndemic in the USA: challenges and future directions. The Lancet [Internet]. 2023 [cited 2023 Sep 8];0. https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(23)01686-0\/fulltext"},{"key":"1143_CR22","doi-asserted-by":"publisher","first-page":"2477","DOI":"10.1111\/add.16318","volume":"118","author":"J Friedman","year":"2023","unstructured":"Friedman J, Shover CL. Charting the fourth wave: Geographic, temporal, race\/ethnicity and demographic trends in polysubstance fentanyl overdose deaths in the United States, 2010\u20132021. Addiction. 2023;118:2477\u201385.","journal-title":"Addiction"}],"container-title":["Harm Reduction Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12954-024-01143-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12954-024-01143-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12954-024-01143-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,4]],"date-time":"2025-01-04T09:03:09Z","timestamp":1735981389000},"score":1,"resource":{"primary":{"URL":"https:\/\/harmreductionjournal.biomedcentral.com\/articles\/10.1186\/s12954-024-01143-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,4]]},"references-count":22,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["1143"],"URL":"https:\/\/doi.org\/10.1186\/s12954-024-01143-2","relation":{},"ISSN":["1477-7517"],"issn-type":[{"value":"1477-7517","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,4]]},"assertion":[{"value":"25 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 December 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 January 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics approval is not required for this case study per UCSD and Prevencasa IRB guidelines. Patients provided written consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Patients provided written consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"2"}}