Elsevier

Drug and Alcohol Dependence

Volume 96, Issue 3, 1 August 2008, Pages 290-293
Drug and Alcohol Dependence

Short communication
GC–MS confirmation of xylazine (Rompun), a veterinary sedative, in exchanged needles

https://doi.org/10.1016/j.drugalcdep.2008.03.005Get rights and content

Abstract

In order to assess the extent of xylazine (Xyz) injection in Puerto Rico, two waves of used-syringe collections were performed. In the first, syringes were gathered, anonymously and without additional information; in the second, a short interview, also anonymous, was administered. We found Xyz in 37.6% of the collected syringes; the majority of the Xyz-containing syringes came from ranching communities. Syringes containing Xyz more frequently also contained “speedball” than those without (90.6% and 66.7%, respectively). Self-reports of Xyz injection deviated markedly from actual detection: only 50% (self-described users) and 22% (self-described non-users) of the collected syringes contained the drug. With a high prevalence of skin ulcers (38.5% vs. 6.8%; p < 0.001), Xyz users were more likely to be in poor health compared to non-users. Surprisingly, though a higher percentage of Xyz users than non-users had college-level educations (23.1% vs. 5.5%), they were more likely to be homeless (64.1% vs. 37%).

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.

Section snippets

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

References (21)

  • M. Alegria et al.

    Understanding hard-core drug use among urban Puerto Rican women in high-risk neighborhoods

    Addict. Behav.

    (2004)
  • J. Micallef et al.

    Effects of a subanaesthetic dose of ketamine on emotional and behavioral state in healthy subjects

    Neurophysiol. Clin.

    (2003)
  • D.G. Spoerke et al.

    Human overdose with veterinary tranquilizer xylazine

    Am. J. Emerg. Med.

    (1986)
  • F.O. Arican et al.

    An unusual presentation from xylazine–ketamine

    Vet. Hum. Toxicol.

    (2004)
  • A.J. Capraro et al.

    Severe intoxication from xylazine inhalation

    Pediatr. Emerg. Care

    (2001)
  • http://www.clearhavencenter.com/substance-abuse-treatment-resources/signs-of-Ketamine-use.php, (accessed on July 20,...
  • H. Colón et al.

    Between-city variation in frequency of injection among Puerto Rican injection drug users: East Harlem, New York, and Bayamon, Puerto Rico

    J. Acquir. Immune Defic. Syndr.

    (2001)
  • H. Colón et al.

    A comparative study among Puerto Rican injection drug users in East Harlem, New York, and Bayamon, Puerto Rico

    J. Urban Health

    (2006)
  • J.I. Elejalde et al.

    Drug abuse with inhaled xylazine

    Eur. J. Emerg. Med.

    (2003)
  • H. Finlinson et al.

    Injecting shared drugs: an observational study of the process of drug acquisition, preparation, and injection by Puerto Rican drug users

    J. Psychoactive Drugs

    (2005)
There are more references available in the full text version of this article.

Cited by (38)

View all citing articles on Scopus
View full text