Short communicationGC–MS confirmation of xylazine (Rompun), a veterinary sedative, in exchanged needles
Introduction
Injection drug use is widespread in Puerto Rico (PR) and has been associated with a number of social, economic, criminal, and health problems, with “speedball”, a cocaine/heroin mixture, being the drug of choice (Hansen et al., 2004, Finlinson et al., 2005, Perez et al., 2005, Colón et al., 2006). The use and consequences of speedball are well documented (Colón et al., 2001, Alegria et al., 2004, Finlinson et al., 2006), but the extent to which it is co-injected with other drugs is not.
Employees of a local health-risk reduction program visiting a shooting gallery observed that several injecting drug users (IDUs) were disoriented and had trouble standing; many had open skin ulcers. As part of an existing needle-exchange program (NEP), syringes were collected from the IDUs. Analyzing the contents of the syringes by gas chromatography/mass spectroscopy (GC/MS) revealed the presence of heroin, cocaine, and xylazine (Xyz), a veterinary analgesic, sedative, and muscle relaxant.
In order to assess the extent of Xyz use in PR, two waves of syringe collections were performed and the contents of the syringes analyzed. The results reveal varying degrees of Xyz/speedball abuse in different parts of PR.
Though there are reports on acute toxicity induced by Xyz injection or inhalation (Spoerke et al., 1986, Mittleman et al., 1998, Capraro et al., 2001, Hoffmann et al., 2001), and a single case report of Xyz–ketamine abuse (Arican et al., 2004), no information exists regarding the prevalence of chronic Xyz abuse and its resulting health consequences, particularly when co-used with speedball.
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Used-syringe collection
Used syringes were collected in two waves from IDUs at 29 sites located in 11 municipalities (Arecibo, 1 site; Cidra, 1; Coamo, 3; Guayama, 2; Guánica, 2; Juana Díaz, 1; Loiza, 1; Mayagüez, 1; Ponce, 6; San Juan, 8; and Yauco, 3). Two NEPs managed the collection procedures: the PR Community Research Initiative and Proyecto Amor que Sana. The first wave ran from October to November 2005; the second, March to April 2007.
After the first wave, 22 sealed containers containing exchanged syringes
The presence of Xyz in syringes
No drugs were detected in 2/260 of the first wave samples and 5/117 pairs of syringes collected in the second wave; these samples were excluded. Xyz was found in 100/258 (38.7%) of the first and in 39/112 pairs (34.8%) of the second-wave samples. ANOVA revealed consistent patterns of drug use from one collection wave to the next. No significant between-site differences were found except in San Juan, which was subdivided into two sectors based on the frequency of Xyz use: 12/35 (34%) in four
Discussion
Xyz, a veterinary analgesic, sedative, and muscle relaxant, is used on large animals such as horses and cattle. A recent survey (Hewson et al., 2007) revealed Canadian veterinarians’ widespread use of Xyz for pain reduction and for improving the well-being of large animals after surgery, as it induces a sleep-like state characterized by decreased respiratory and heart rates.
An anecdotal case report of (human) Xyz use describes a patient who experienced attacks of fatigue, faintness, and blurred
Conflict of interest
None.
Acknowledgements
Assistance in statistical analyses was provided by Ms. Silka Abreu of the RCMI Epidemiology-Biostatistics Core. The authors are also grateful for the unselfish contributions that were made by all of the health-risk-reduction workers from both the PR Community Research Initiative, Inc. (San Juan, PR) and Proyecto Amor que Sana, Inc. (Ponce, PR) who participated in this study.
Role of funding sources: Infrastructure support for this study was provided by NCRR RCMI grant G12 RR003050 and CCHD grant
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