{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T19:38:21Z","timestamp":1791920301437,"version":"4.3.4"},"reference-count":57,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T00:00:00Z","timestamp":1729814400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxics"],"abstract":"<jats:p>Introduction: Evidence suggests an increasing misuse of veterinary medicines by humans. This study aims to analyse Adverse Events (AEs) associated with selected veterinary products using the Food and Drug Administration Adverse Events Reporting System (FAERS). Methods: A descriptive pharmacovigilance analysis was conducted on AEs related to 21 drugs approved for human and\/or animal use. Results: A total of 38,756 AEs, including 9566 fatalities, were identified. The United States reported the highest number of cases (13,532), followed by Canada (2869) and the United Kingdom (1400). Among the eight drugs licenced exclusively for animals, levamisole, pentobarbital, and xylazine were most frequently reported. Reports predominantly involved males (57%) from the 18\u201364 age group, with incidents related mainly to overdose, dependence, and multi-agent toxicities. Unmasking techniques revealed \u2018intentional overdose\u2019 as the primary reaction. Polysubstance use was evident in 90% of the drugs, with benzodiazepines\/Z-drugs and opioids as common co-used classes. Conclusions: Veterinary medications are increasingly infiltrating the illicit drug market due to their pharmacological properties. This trend highlights the need for heightened vigilance and awareness to prevent further public health risks associated with the adulteration of illicit substances with veterinary products like xylazine and pentobarbital.<\/jats:p>","DOI":"10.3390\/toxics12110777","type":"journal-article","created":{"date-parts":[[2024,10,25]],"date-time":"2024-10-25T10:50:08Z","timestamp":1729853408000},"page":"777","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Exploring Human Misuse and Abuse of Veterinary Drugs: A Descriptive Pharmacovigilance Analysis Utilising the Food and Drug Administration\u2019s Adverse Events Reporting System (FAERS)"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8736-9474","authenticated-orcid":false,"given":"Josie","family":"Dunn","sequence":"first","affiliation":[{"name":"Medical School, The Grove, Swansea University, Singleton Campus, Wales SA2 8PP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4178-5401","authenticated-orcid":false,"given":"Fabrizio","family":"Schifano","sequence":"additional","affiliation":[{"name":"Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ed","family":"Dudley","sequence":"additional","affiliation":[{"name":"Medical School, The Grove, Swansea University, Singleton Campus, Wales SA2 8PP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8255-0660","authenticated-orcid":false,"given":"Amira","family":"Guirguis","sequence":"additional","affiliation":[{"name":"Medical School, The Grove, Swansea University, Singleton Campus, Wales SA2 8PP, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2970","DOI":"10.1136\/bmj.p2970","article-title":"Drug Deaths in England and Wales Rise to Highest Number on Record","volume":"383","author":"Iacobucci","year":"2023","journal-title":"BMJ"},{"key":"ref_2","unstructured":"Office for National Statistics (ONS) (2023, November 22). Deaths Related to Drug Poisoning in England and Wales\u2014Office for National Statistics, Available online: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/birthsdeathsandmarriages\/deaths\/bulletins\/deathsrelatedtodrugpoisoninginenglandandwales\/2022registrations."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s13722-019-0170-4","article-title":"Staff Perceptions of Prescription and Over-The-Counter Drug Dependence Services in England: A Qualitative Study","volume":"14","author":"Coombes","year":"2019","journal-title":"Addict. Sci. Clin. Pract."},{"key":"ref_4","unstructured":"Hughes, A., Williams, M.R., Lipari, R.N., Bose, J., Copello, E.A.P., and Kroutil, L.A. (2023, November 22). Prescription Drug Use and Misuse in the United States: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review, Available online: https:\/\/www.samhsa.gov\/data\/sites\/default\/files\/NSDUH-FFR2-2015\/NSDUH-FFR2-2015.htm."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.vaa.2023.09.004","article-title":"Electronic Survey Investigating UK Veterinarians\u2019 Perceptions of the Potential for Veterinary Prescription Medication Misuse or Abuse","volume":"51","author":"Lehnus","year":"2023","journal-title":"Vet. Anaesth. Analg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11920-020-01214-8","article-title":"Drug Misuse in the Veterinary Setting: An Under-Recognized Avenue","volume":"23","author":"Anand","year":"2021","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_7","unstructured":"Health Canada (2023, November 23). Abuse and Diversion of Controlled Substances: A Guide for Health Professionals. Government of Canada. Available online: https:\/\/publications.gc.ca\/collections\/collection_2018\/sc-hc\/H128-1-06-467-eng.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"147","DOI":"10.2460\/ajvr.21.10.0173","article-title":"Trends in the Number of Patients Linked to Potential Vet-Shopping Behavior in the United States (2014\u20132019)","volume":"83","author":"Chua","year":"2022","journal-title":"Am. J. Vet. Res."},{"key":"ref_9","unstructured":"Herzog, H. (2023, November 23). Hurting Pets to Get Attention and Drugs: A Growing Problem. Psychology Today United Kingdom. Available online: https:\/\/www.psychologytoday.com\/gb\/blog\/animals-and-us\/201808\/hurting-pets-get-attention-and-drugs-growing-problem."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"77","DOI":"10.5055\/jom.2018.0433","article-title":"Sourcing of Opioid Analgesics for Nonmedical Use: Are Veterinarians the Latest Frontier?","volume":"14","author":"Russell","year":"2018","journal-title":"J. Opioid Manag."},{"key":"ref_11","unstructured":"The Centre for Forensic Science Research and Education (CFSRE) (2023, December 11). Sentinel Snapshot: Polydrug Counterfeit Fentanyl Tablets. Available online: https:\/\/www.cfsre.org\/nps-discovery\/public-alerts\/sentinel-snapshot-polydrug-counterfeit-fentanyl-tablets."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Centers for Disease Control and Prevention (2023). Illicitly Manufactured Fentanyl\u2013Involved Overdose Deaths with Detected Xylazine\u2014United States, January 2019\u2013June 2022. MMWR Morb. Mortal. Wkly. Rep., 72, 721\u2013727. Available online: https:\/\/www.cdc.gov\/mmwr\/volumes\/72\/wr\/mm7226a4.htm.","DOI":"10.15585\/mmwr.mm7226a4"},{"key":"ref_13","unstructured":"EMCDDA (2023, December 11). Harm Reduction\u2014The Current Situation in Europe (European Drug Report 2023). Available online: https:\/\/www.emcdda.europa.eu\/publications\/european-drug-report\/2023\/harm-reduction_en."},{"key":"ref_14","unstructured":"EMCDDA (2023, December 11). Greater Diversity in Drug Supply And Use Creates New Challenges for Europe. Available online: https:\/\/www.emcdda.europa.eu\/news\/2023\/european-drug-report-2023-highlights_en."},{"key":"ref_15","unstructured":"The White House (2023, December 11). Biden-Harris Administration Designates Fentanyl Combined with Xylazine as an Emerging Threat to the United States, Available online: https:\/\/www.whitehouse.gov\/ondcp\/briefing-room\/2023\/04\/12\/biden-harris-administration-designates-fentanyl-combined-with-xylazine-as-an-emerging-threat-to-the-united-states\/."},{"key":"ref_16","unstructured":"Drug Enforcement Agency (2023, December 11). DEA Joint Intelligence Report the Growing Threat of Xylazine and Its Mixture with Illicit Drugs, Available online: https:\/\/www.dea.gov\/sites\/default\/files\/2022-12\/The%20Growing%20Threat%20of%20Xylazine%20and%20its%20Mixture%20with%20Illicit%20Drugs.pdf."},{"key":"ref_17","unstructured":"Advisory Council on the Misuse of Drugs (ACMD) (2023, December 11). A Review of the Evidence on the Use and Harms of Xylazine, Medetomidine and Detomidine; ACMD Report; 2024, Available online: https:\/\/assets.publishing.service.gov.uk\/media\/65d47b344239318339b7b944\/Xylazine+Report_17+Feb+2024.pdf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1016\/j.jemermed.2009.09.026","article-title":"Human Health Hazards of Veterinary Medications: Information for Emergency Departments","volume":"40","author":"Lust","year":"2011","journal-title":"J. Emerg. Med."},{"key":"ref_19","unstructured":"GOV.UK (2023, December 11). United Kingdom Drug Situation 2019: Focal Point Annual Report, Available online: https:\/\/www.gov.uk\/government\/publications\/united-kingdom-drug-situation-focal-point-annual-report\/united-kingdom-drug-situation-focal-point-annual-report-2019."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"026988112110215","DOI":"10.1177\/02698811211021588","article-title":"Recreational Ketamine-Related Deaths Notified to the National Programme on Substance Abuse Deaths, England, 1997\u20132019","volume":"35","author":"Corkery","year":"2021","journal-title":"J. Psychopharmacol."},{"key":"ref_21","unstructured":"EMCDDA (2023, December 11). Report on the Risk Assessment of Methyl 1-(2-Phenylethyl)-4-[phenyl(propanoyl)amino]piperidine-4-carboxylate (Carfentanil) in the Framework of the Council Decision on New Psychoactive Substances. Available online: https:\/\/www.emcdda.europa.eu\/publications\/risk-assessments\/carfentanil_en."},{"key":"ref_22","unstructured":"EMCDDA (2023, December 11). Most Recent Data from the European Syringe Collection and Analysis Project Enterprise (ESCAPE): Data Explorer, Analysis and Key Findings. Available online: https:\/\/www.emcdda.europa.eu\/publications\/data-factsheet\/syringe-residues-analysis-data-escape-project_en."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Dunn, J., Guirguis, A., Schifano, F., and Dudley, E. (Curr. Neuropharmacol., 2024). Exploring the Confluence of Animal Medicine and Its Implications for Human Health: A Systematic Literature Review, Curr. Neuropharmacol., in press.","DOI":"10.2174\/011570159X333443240822115028"},{"key":"ref_24","unstructured":"U.S. Food & Drug Association (FDA) (2023, November 22). FDA Adverse Event Reporting System (FAERS) Public Dashboard. FDA 2020, Available online: https:\/\/www.fda.gov\/drugs\/questions-and-answers-fdas-adverse-event-reporting-system-faers\/fda-adverse-event-reporting-system-faers-public-dashboard."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Chiappini, S., Vickers-Smith, R., Harris, D.R., Pelletier, G., Corkery, J., Guirguis, A., Martinotti, G., Sensi, S.L., and Schifano, F. (2023). Is There a Risk for Semaglutide Misuse? Focus on the Food and Drug Administration\u2019s FDA Adverse Events Reporting System (FAERS) Pharmacovigilance Dataset. Pharmaceuticals, 16.","DOI":"10.20944\/preprints202306.0611.v1"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1038\/clpt.2014.17","article-title":"Exploring the FDA Adverse Event Reporting System (FAERS) to Generate Hypotheses for Disease Monitoring","volume":"95","author":"Fang","year":"2024","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_27","unstructured":"(2023, December 11). Medical Dictionary for Regulatory Activities. MedDRA. Available online: https:\/\/www.meddra.org\/how-to-use\/basics\/hierarchy."},{"key":"ref_28","unstructured":"National Institute for Health and Care Excellence (2023, December 11). BNF. Available online: https:\/\/bnf.nice.org.uk."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1177\/20494637231160684","article-title":"Is England Facing an Opioid Epidemic?","volume":"17","author":"Roberts","year":"2023","journal-title":"Br. J. Pain"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.15585\/mmwr.mm6643e1","article-title":"Deaths Involving Fentanyl, Fentanyl Analogs, and U-47700\u201410 States, July\u2013December 2016","volume":"66","author":"Halpin","year":"2017","journal-title":"MMWR. Morb. Mortal. Wkly. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1111\/ajad.13365","article-title":"Characteristics of Xylazine-Related Deaths in West Virginia\u2014Xylazine-Related Deaths","volume":"32","author":"Sibbesen","year":"2022","journal-title":"Am. J. Addict."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Spadaro, A., Connor, K., Lakamana, S., Sarker, A., Wightman, R., Love, J.S., and Perrone, J. (2023). Self-Reported Xylazine Experiences: A Mixed Methods Study of Reddit Subscribers. medRxiv.","DOI":"10.1101\/2023.03.13.23287215"},{"key":"ref_33","unstructured":"Drug Enforcement Administration (DEA) (2023, December 12). 2018 National Drug Threat Assessment. US Department of Justice Drug Enforcement Administration, Available online: https:\/\/www.dea.gov\/sites\/default\/files\/2018-11\/DIR-032-18%202018%20NDTA%20%5Bfinal%5D%20low%20resolution11-20.pdf."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"E281","DOI":"10.1503\/jpn.200057","article-title":"Use of Levamisole-Adulterated Cocaine Is Associated with Increased Load of White Matter Lesions","volume":"46","author":"Conrad","year":"2021","journal-title":"J. Psychiatry Neurosci."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1016\/j.mayocp.2012.03.010","article-title":"Complications Associated with Use of Levamisole-Contaminated Cocaine: An Emerging Public Health Challenge","volume":"87","author":"Lee","year":"2012","journal-title":"Mayo Clin. Proc."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.neuint.2013.11.010","article-title":"Aminorex, a Metabolite of the Cocaine Adulterant Levamisole, Exerts Amphetamine like Actions at Monoamine Transporters","volume":"73","author":"Hofmaier","year":"2014","journal-title":"Neurochem. Int."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1007\/s13181-018-0675-3","article-title":"Deliberate Self-Poisoning with a Lethal Dose of Pentobarbital with Confirmatory Serum Drug Concentrations: Survival after Cardiac Arrest with Supportive Care","volume":"15","author":"Druda","year":"2019","journal-title":"J. Med. Toxicol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"110715","DOI":"10.1016\/j.forsciint.2021.110715","article-title":"Carfentanil\u2014From an Animal Anesthetic to a Deadly Illicit Drug","volume":"320","author":"Zawilska","year":"2021","journal-title":"Forensic Sci. Int."},{"key":"ref_39","unstructured":"World Health Organisation (WHO) (2024, May 16). WHO Recommends the Most Stringent Level of International Control for Synthetic Opioid Carfentanil. Available online: https:\/\/www.who.int\/news\/item\/13-12-2017-who-recommends-the-most-stringent-level-of-international-control-for-synthetic-opioid-carfentanil#:~:text=WHO%20has%20this%20week%20endorsed."},{"key":"ref_40","unstructured":"(2024, January 05). Randox Toxicology. Carfentanil Increases 3400% from 2022 to 2023 in Drug Tests. Available online: https:\/\/www.randoxtoxicology.com\/detection-of-carfentanil-increases-3400-from-2022-to-2023\/#:~:text=Carfentanil%20has%20been%20detected%20in,a%20Millennium%20Health%20Signals%20Alert."},{"key":"ref_41","unstructured":"The Centre for Forensic Science Research and Education (CFSRE) (2023, December 22). Colombo Plan Bulletin Worldwide Trends in Drug Markets and Toxic Adulterants. CFSRE. Available online: https:\/\/www.cfsre.org\/images\/content\/reports\/public_alerts\/ITAD_Bulletin_8_17_2023_Final.pdf."},{"key":"ref_42","unstructured":"The Centre for Forensic Science Research and Education (CFSRE) (2024, January 05). Phenylbutazone: A Toxic Adulterant Found in Illicit Street Drugs. Available online: https:\/\/www.cfsre.org\/images\/content\/reports\/public_alerts\/Phenylbutazone_Public_Health_Alert_031323_final.pdf."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"100188","DOI":"10.1016\/j.eclinm.2019.10.001","article-title":"Reported Adverse Drug Reactions in Women and Men: Aggregated Evidence from Globally Collected Individual Case Reports during Half a Century","volume":"17","author":"Watson","year":"2019","journal-title":"EClinicalMedicine"},{"key":"ref_44","unstructured":"National Institute on Drug Abuse (NIDA) (2023, December 17). Sex and Gender Differences in Substance Use, Available online: https:\/\/nida.nih.gov\/publications\/research-reports\/substance-use-in-women\/sex-gender-differences-in-substance-use."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Butelman, E.R., Huang, Y., Goldstein, R.Z., and Alia-Klein, N. (2023). Overdose Mortality Rates for Opioids or Stimulants Are Higher in Males than Females, Controlling for Rates of Drug Misuse: State-Level Data. medRxiv.","DOI":"10.1101\/2023.01.20.23284833"},{"key":"ref_46","unstructured":"Dietzen, D., Bennett, M., Wong, E., and Haymond, S. (2021). Pediatric Therapeutic Drug Monitoring, Toxicology and Pharmacogenomics. Biochemical and Molecular Basis of Pediatric Disease, Academic Press. [5th ed.]. Chapter 25."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1593","DOI":"10.1111\/add.15260","article-title":"Carfentanil and the Rise and Fall of Overdose Deaths in the United States","volume":"116","author":"Jalal","year":"2020","journal-title":"Addiction"},{"key":"ref_48","unstructured":"Cohen, J. (2024, January 15). Dangers of Humans Taking Animal Drugs and Vice Versa. Forbes. Available online: https:\/\/www.forbes.com\/sites\/joshuacohen\/2024\/04\/11\/dangers-of-humans-taking-animal-drugs-and-vice-versa\/."},{"key":"ref_49","first-page":"1548","article-title":"N-4-Substituted 1-(2-Arylethyl)-4-Piperidinyl-N-Phenylpropanamides, a Novel Series of Extremely Potent Analgesics with Unusually High Safety Margin","volume":"26","author":"Bever","year":"1976","journal-title":"Drug Res."},{"key":"ref_50","first-page":"529","article-title":"The Challenge of Polysubstance Use Overdose","volume":"09","author":"Pergolizzi","year":"2021","journal-title":"Open J. Soc. Sci."},{"key":"ref_51","unstructured":"Welsh Emerging Drugs and Identification of Novel Psychoactive Substances (WEDINOS) (2024, June 05). WEDINOS\u2014Welsh Emerging Drugs & Identification of Novel Substances Project. Available online: https:\/\/www.wedinos.org."},{"key":"ref_52","first-page":"e36864","article-title":"Xylazine in the Opioid Epidemic: A Systematic Review of Case Reports and Clinical Implications","volume":"15","author":"Ayub","year":"2023","journal-title":"Cureus"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"100155","DOI":"10.1016\/j.addicn.2024.100155","article-title":"Xylazine Is an Agonist at Kappa Opioid Receptors and Exhibits Sex-Specific Responses to Opioid Antagonism","volume":"11","author":"Bedard","year":"2024","journal-title":"Addiction Neurosci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1007\/s00213-023-06390-y","article-title":"Xylazine Effects on Opioid-Induced Brain Hypoxia","volume":"240","author":"Choi","year":"2023","journal-title":"Psychopharmacology"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"953","DOI":"10.1016\/j.sapharm.2018.06.018","article-title":"Reports of Gabapentin and Pregabalin Abuse, Misuse, Dependence, or Overdose: An Analysis of the Food and Drug Administration Adverse Events Reporting System (FAERS)","volume":"15","author":"Evoy","year":"2019","journal-title":"Res. Soc. Adm. Pharm. RSAP"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Yin, Y., Shu, Y., Zhu, J., Li, F., and Li, J. (2022). A Real-World Pharmacovigilance Study of FDA Adverse Event Reporting System (FAERS) Events for Osimertinib. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-23834-1"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.therap.2019.01.006","article-title":"Case\u2013Non-Case Studies: Principle, Methods, Bias and Interpretation","volume":"74","author":"Faillie","year":"2019","journal-title":"Therapies"}],"container-title":["Toxics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2305-6304\/12\/11\/777\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:20:42Z","timestamp":1760113242000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2305-6304\/12\/11\/777"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,25]]},"references-count":57,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["toxics12110777"],"URL":"https:\/\/doi.org\/10.3390\/toxics12110777","relation":{},"ISSN":["2305-6304"],"issn-type":[{"value":"2305-6304","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,25]]}}}