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The Los Angeles County Department of Public Health has issued a health alert warning residents of the increased risk of overdose and death associated with xylazine, which is increasingly present within illicit drugs in California.

Both San Francisco and San Diego have detected xylazine in drug samples obtained in 2023, indicating that xylazine is now likely present within the drug supply in Los Angeles. Recently, San Francisco reported 4 overdose deaths involving both xylazine and fentanyl in 2023.

Xylazine is a sedative and muscle relaxant drug used by veterinarians to anesthetize animals. Xylazine comes in a clear liquid that is cooked down into a powder form and is mixed with illicit opioids such as heroin or fentanyl, or pressed into counterfeit pills (e.g., Norco, Percocet, Vicodin, etc.) or sedatives (Xanax) as a cheap additive to increase the effects of these drugs. When mixed with opioids and other central nervous system depressants, such as alcohol or sedatives, xylazine intensifies the effects, including sedation (drowsiness leading to unresponsiveness) and respiratory depression (slowed or stopped breathing), which can lead to a fatal overdose.

Most people who are purchasing or being given illicit drugs are not seeking xylazine and likely do not know that xylazine may be present in the drugs they are trying to obtain. Increased awareness of the risk of xylazine in illicit opioids, counterfeit pills, stimulants, and other drugs not obtained from pharmacies is necessary to support overdose prevention and harm reduction.

Recommended actions for the public:

— The safest course of action is to avoid using illicit drugs:

— The illicit drug supply has been commonly and unpredictably contaminated with lethal substances such as xylazine and fentanyl.

— There is no test to determine if illicit drugs contain xylazine.

— Avoid using pills from any sources besides an FDA-licensed pharmacy and prescribed by your healthcare provider

— If you plan to use illicit drugs:

— Start with a small amount and go slow. Xylazine is a depressant and can slow your breathing rate and heart rate and intensify the impact of fentanyl or other opioids.

— Consider smoking or snorting instead of injecting.

— If you are using in a group, stagger your use so someone is always alert.

— Be conscious of any skin infections as xylazine is associated with skin wounds, large sores and ulcers that may develop into complex infections. For this reason, xylazine has the nickname “zombie drug.”

— Recognize that the signs of a xylazine overdose are similar to an opioid overdose:

— Excessive sedation and appearing unresponsive

— Slowed breathing

— Slowed heart rate

— Low blood pressure

— Cold, clammy skin

— Avoid using substances alone

If using substances, use with a trusted person who can respond in case of an overdose. If you are using by yourself, there are resources to keep you safe.

— Never Use Alone (http://neverusealone.com) is an organization that offers phone-based support while individuals use a substance and can notify emergency services if the individual stops responding.

— The Brave App (https://www.thebraveapp.com) provides virtual overdose prevention support by contacting 911 or an emergency contact if you stop responding while using substances.

— Parents and guardians should talk about drug use with adolescents

— Parents and guardians should use direct and honest language that emphasizes their values and concerns about drug use.

— Open conversations that evoke adolescents’ understanding and experiences are more effective than lecturing and utilizing scare tactics.

— Parents and guardians should consider that not all youth immediately show changes in behaviors if they are using substances, so should initiate age-appropriate conversations with their children about substance use.

— If youth use substances, parents and guardians should explore the reasons behind substance use. For adolescents who are using substances regularly, a professional assessment may be needed, and information about substance use treatment services is listed below.

— Additional guidance for parents and families is available here and here.

— Even though there is no test readily available to the public to detect xylazine in drugs, please continue to test substances for the presence of fentanyl using fentanyl test strips before using.

Fentanyl Test Stripsidentify drugs contaminated with fentanyl and can help individuals make informed decisions about the drugs they use. Fentanyl test strips require dissolving a small amount of the drug supply in water, dipping the test strip into the liquid and waiting 15 seconds for a result.

— Fentanyl testing strips can be purchased online at:

— Team Awareness Combating Overdose (TACO) Inc: http://www.tacoinc.org/teststrips

— Dose Test: http://dosetest.com/product/fentanyl-test-strip

— Dance Safe: http://dancesafe.org/shop

— Fentanyl testing strips can be obtained through AIDS Project Los Angeles (APLA):

— http://aplahealth.org/fentanyl lists locations where to get testing strips.

— Obtain naloxone for overdose rescue: Though it is not effective against xylazine because xylazine is frequently mixed with opioids, naloxone is still recommended to reverse the opioid contribution to overdose.

— Obtain a naloxone prescription from a healthcare provider.

Healthcare providers may prescribe naloxone to patients who are at an increased risk of opioid overdose or who have household members, including children, who are at risk for accidental ingestion or opioid overdose. Ask your primary healthcare provider about being prescribed naloxone if not automatically co-prescribed to you.

— Pharmacy naloxone access

Pharmacies in California may now provide naloxone without a prescription, although availability is pharmacy and pharmacist dependent. You can find a list of participating pharmacies here.

— Community-based naloxone distribution points

Community members who are unable to access naloxone through their primary healthcare provider or via a local pharmacy can visit a community-based naloxone access point or a mail-based naloxone distributor. You can find a list of participating naloxone access points here.

— Obtain substance use disorder treatment

Find substance use treatment services and bed availability in Los Angeles using an online, filterable service locator known as the Services and Bed Availability Tool (SBAT), going to www.RecoverLA.org on their mobile devices, or by calling the Substance Abuse Service Helpline (SASH). Services include outpatient and intensive outpatient treatment, residential treatment, withdrawal management, and Opioid Treatment Programs.

— Services and Bed Availability Tool: http://sapccis.ph.lacounty.gov/sbat

— Mobile-friendly RecoverLA platform: www.RecoverLA.org

— Substance Abuse Service Helpline: 844-804-7500.

— Refer to the information sheet: Xylazine in LA County

This information sheet contains frequently asked questions, describes harm reduction steps to reduce the risk of xylazine overdose and includes information about how L.A. County residents can obtain spectroscopy testing of drugs for xylazine.

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