xylazine hits those same receptors amongst other receptors how do you treat it if we were just talking about xylazine hey everybody welcome back to the channel this is Dr B Dr B addiction recovery and the topic I want to dissect today and go into briefly is again tranq dope how to manage withdrawal symptoms a related question to that that I’ve been getting a lot especially out from
Philadelphia and Nicole is why are so many people being put into precipitative withdrawals when they are attempting to manage tranquetrols let’s get started I think the best way to approach this is to give you some a little bit of background on this situation with the cranked up keep in mind tranthope usually is fentanyl a full Agonist opiate in addition to xylazine which is
an animal tranquilizer let’s start off with the fentanyl issue first and the question was why are so many people being put into precipitated withdrawals when they’re being started on probably AG antagonist therapy like Suboxone buprenorphine any of those medications why are they going into precipitated withdrawals when you are dealing with tranctope let’s take that part first and
then we’ll hit the xylazine which is quite a bit unknown at this time in general when you’re trying to start someone on Suboxone therapy full Agonist versus Agonist antagonist therapy you have to use an opiate withdrawal scale of some sort I usually use cows clinical opiate withdrawal scale and most people think that the time to start Suboxone is
wait 10 hours 12 hours 15 hours that’s wrong although it is time dependent you should start it when there is an appropriate amount of withdrawal symptoms and that’s what using some of these scales to decide when to start your medication are useful for that being said what is the issue the issue is let’s say I’m on fentanyl heroin
oxycodone and when I give you an Agonist antagonist like Suboxone what it does is knocks off all of the opiates from The receptors and the person gets a sensation of severe radical extreme withdrawals in the case of fentanyl people are already having problems in deciding when to start The Agonist antagonist therapy
like Suboxone because for some reason we don’t have the same experience as we’ve always had with Heroin opium or some of the prescription opiate medications so it’s already complicated enough and one of the things I do is let’s say the clinical opiate scale tells you that when they reach a symptom level of 10 according to that scale that’s when you should do a test dose of Suboxone with fentanyl our experience has been that
that’s already complicated as it is and we use a simple method we change the number 10 to 13 or 14. so let me repeat that to start Agonist antagonist therapy whether it’s Suboxone whether it’s buprenorphine whether it’s Subutex which whatever name you go by you have to wait until a person is at a certain level of withdrawals that means certain degree of opiates are off The receptors and now you can safely start
your medication assisted treatment why this stuff binds very strongly and rapidly to The receptors and knocks off all the opiates so if you have too many opiates on there and you put this medication on because it doesn’t give them the rush the high and it doesn’t have all the euphoric central nervous system effects they feel like there are
an extreme withdrawals so you use a validated clinical scale that’s been scientifically shown to work when they have a certain degree of withdrawals using the scale numerics you can start that medication when it comes to fentanyl for some reason everyone’s clinical experience seems so I’ve been including mine that things turn out wacky why can they turn out wacky well
sometimes there’s other medications of abuse on board whether it’s benzodiazepines whether it’s methamphetamines and whether that affects your withdrawal symptoms or not and somehow rocks the scale that you use that creates complications in this particular case we’re using fentanyl which as I just said we’ve been having some problems using the traditional
scale as it is now we’re adding xylazine we’ve already described what that is it’s an animal anesthetic it’s an animal hypnotic it’s an animal sedative it’s also causes respiratory depression it lowers your heart rate lowers your blood pressure okay now whether it’s the mixture of this medication with the fentanyl that impacts the score on the
scale or whether the mixture of this medication changes the chemical processing and Metabolism in your body of the Fentanyl I suggest that it is proceeded with more caution and you start the medication assisted treatment at some later point on the scale so if you’re thinking I’m it’s been 12 hours 15 hours and you’re just using time wrong two a person
should be using an opiate withdrawal scale of some sort and maybe they should give some cushion to that and increase the score that’s needed before you start the Suboxone by the way this is not for the regular person to use this is really should be in conjunction with your provider and you shouldn’t be doing this on your own unfortunately a lot of people are doing this on their own and trying to manage these issues on their own and I highly recommend against that and I think you should go to your
provider that’s going to start this medication that being said there’s a second question is it possible could it be some of the withdrawal symptoms or secondary or related to the xylazine here’s the answer we don’t really necessarily know in terms of clinical medicine the way we get our data is as sort of a hierarchy anecdotal medicine
is what you hear out there or what one or two cases present to you because there’s no experience with this stuff there’s no history of use and there hasn’t been data gathered to be put into scientific literature there are a couple of case reports in the case of xylazine alone by itself so let’s ask what does xylazine would draw like because now we’re talking about a drug track dope that has opiates usually
fentanyl it also has the xylazine so let’s pretend and it is often the case that people are using and abusing cytosine by itself I can’t give you any formal numbers under dosing because we don’t have gathered data that being said let’s say someone’s using straight xylazine are they going to have withdrawals what are those withdrawals like and how do you manage it we’re moving away from the Fentanyl and here’s the answer
a lot of people don’t know this and even though this stuff is prevalent ubiquitous in the animal veterinary world as an anesthetic for operation what is the mechanism of action it is exactly well it hits the same receptors for the most part and for the purpose of this discussion as the medication clonidine which many of you are familiar with what do you think of clonidine as in the substance abuse
world in the regular World it used to be used as a blood pressure medication in the substance abuse world it’s used to actually as an anti-anxiety anxiety medication as a little bit of a sedative as a calming effect and how does it do that it hits the set of receptors called Alpha II adrenergic receptors adrenaline and it hits him on the presynaptic membrane what does that all mean these
receptors are spread out through your entire nervous system in the central nervous system and in the peripheral nervous system the effects that we use for the substance abuse patient are in the central nerve nervous system in an area of the brain called Locus cellularis and what this does is it decreases what’s called a sympathetic outflow for the person what does that mean remember fight or flight remember
adrenaline remember epinephrine well it slows that outflow down what does that do in your central nervous system it has a calming effect it has a slight sedating effect and it can even be used for sleep in your cardiovascular system it decreases blood pressure it decreases heart rate and it can also decrease respiratory rate if enough is used
xylazine hits those same receptors amongst other receptors so although we don’t have robust data and humans we can think about what would be the withdrawal effects of cytosine in a human being it’s hitting the same receptor and having quite a bit of impact in the central nervous system and that’s why it’s probably cut and mixed with fentanyl besides the fact that it makes the production much cheaper what it’s
going to do if you suddenly stop this medication potentially increase your heart rate increase your blood pressure cause anxiety cause sleeplessness is it dangerous to withdraw from xylazine can you get addicted to it where there’s one or two case reports out there that show a person escalated their use of this medication over time so there’s
probably a significant abuse potential as well as escalating doses one if you suddenly stop it what can happen we don’t really know but we can infer and draw some educated guesses that the person might have increased blood pressure and if it has any impact like clonidine does you can go into What’s called the ventricular tachycardia what does that mean and eventually lead to arrhythmia that is the part of your
heart that pumps out blood and it starts to start pumping in an irregular and fast way eventually leading to a cardiac dysrhythmia which can lead to Cardiac Arrest this is speculation because I’m basically comparing it to clonidine but these are potential withdrawal side effects how do you treat it if we were just talking about xylazine well you can do
cross over tolerance with different medication there are many medications that kind of fall into this Alpha to adrenergic receptor Agonist but the one that comes to mind that a lot of you may know is Clonidine if the person is having symptoms to straight withdrawal from xylazine this would be a medication that could be potentially substituted as
controlling some of these withdrawal symptoms another one is precedex which is a short acting medication often used in hospitals you can also consider muscle relaxants and other sedatives as well now let’s take both of these medications or both of these substances with cytosine and opiates and say let’s assume a person has been using these and now we want to manage withdrawal again all of this should be under the
care of a physician potentially in the hospital because we don’t really know the potential side effects of xylazine withdrawal at this time and I know a lot of you don’t have resources to be in the appropriate situation but you need to be forewarned and you need to know that you should really do this under the care of a physician so if you’re if I was managing both of these withdrawals at the same time and I knew that the only thing I had to deal with was Fentanyl
and xylazine I would do what I know first I would attempt to use my clinical opiate withdrawal scale and weight the right appropriate amount of time until they have significant withdrawals add a little bit of time to that and let them have a little higher score and initiate the induction of Suboxone type products or buprenorphine type products and I would make sure that
I have that under some control now I have completely masked the opiate withdrawals anything left over is going to potentially be again in theory assuming there’s no methamphetamine issues there’s no benzodiazepine issues there’s no alcohol issues now I know what I have I have unmasked pure xylazine withdrawals what are we going to be looking at potentially hypertension potentially increased heart
rate potentially anxiety is there going to be seizures I don’t know and I don’t think anybody at that point knows now once I’ve unmasked that and I see some of these symptoms that I’m just describing now at this point I would probably initiate clonidine low dose 0.1 milligram 0.2 milligrams and see if I can get that under control how long are they going to be on it I don’t know I suspect not long two days
three days four days five days six days not sure but I’m gonna keep that dose very low and monitor the patient closely and eventually taper off of the clonidine or any other adjunct medication I have added in short we’re talking about withdrawal symptoms of a medication that we don’t know much about in humans we don’t know the long-term effects we don’t know the withdrawal effects we don’t know that if there’s
any potentially dangerous withdrawal effects but what I would do is basically clean up what I have in front of me first I would treat the opiate withdrawal and I would use medication assisted treatment Agonist antagonists bupren offering Suboxone whatever you want to call it I would get that under control now I have unmasked any leftover withdrawal symptoms of xylazine and I would attempt to gain control of that by replacing the xylazine with an
appropriate cross-tolerance medication I would probably pick clonidine or something of that nature and attempt to get that under control and then try to wean them off of that and proceed with the treatment and plan of care as dictated by the patient’s presentation this is a public service message I want to inform people out there that you know this is no joke this is dangerous stuff you shouldn’t do this on your own get in and get help if you can and I hope this helps you out in proceeding with your
life thank you very much see you next time peace