A Review of Alpha‑2 Adrenergic Agents Implicated in Opioid Use Disorder
Audrey Hannum, Isabella Spano, Edward Ofori
TL;DR
This review discusses how alpha-2 adrenergic agents like xylazine and medetomidine are complicating opioid use disorder treatment and overdose reversal.
Contribution
The paper provides a comprehensive review of alpha-2 adrenergic agents in the context of opioid use disorder and their impact on overdose treatment.
Findings
Xylazine and medetomidine are increasingly contaminating the opioid supply, complicating overdose treatment.
Naloxone is ineffective against alpha-2 agonist overdoses, and no FDA-approved reversal agents exist.
Xylazine use is associated with severe complications like necrotic wounds.
Abstract
Opioid use disorder (OUD) has been recognized for many years as a leading public health emergency in the United States, costing almost 80,000 Americans their lives in 2023. Recently, fentanyl, the predominant synthetic opioid implicated in OUD, has begun to be adulterated with the alpha-2 adrenergic receptor (α2AR) agonists xylazine and medetomidine. This has a profound effect on the treatment of suspected overdoses, as naloxone, which reverses fentanyl overdoses, does not reverse α2 agonist overdoses, and there are no FDA-approved treatments for overdoses with an α2 agonist. Xylazine is spreading rapidly through the illicit drug supply in the United States, and to further complicate efforts to mitigate its effects, xylazine users frequently experience necrotic wounds which are difficult to treat. In this review, we comprehensively examined literature sources to compile information on…
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Taxonomy
TopicsOpioid Use Disorder Treatment · Veterinary Pharmacology and Anesthesia · Forensic Toxicology and Drug Analysis