Opioid and Xylazine Epidemic Flashcards
how many waves of opioid overdose deaths have there been?
3
what was the 1st wave of opioid overdose deaths?
in the 1990s
rise in prescription opioid overdose deaths
what was the 2nd wave of opioid overdose deaths?
in 2010
rise in heroin overdose deaths
what was the 3rd wave of opioid overdose deaths?
in 2013
rise in synthetic opioid overdose deaths
fentanyl is ___ times stronger than heroin and ____ times stronger than morphine
50, 100
what is a lethal dose of fentanyl?
2 mg
what is xylazine (tranq)?
a non-opioid veterinary sedative that is not approved for use in humans due CNS depression
xylazine is commonly mixed with what other drug?
fentanyl
why is xylazine often mixed with fentanyl?
bc it increases its street value and enhances the drug’s effects
is xylzine overdose reversible with Naloxone (Narcan)?
no, bc it isn’t an opioid
is fentanyl actually resistant to narcan?
no, it is actually usually laced with xylazine, which is resistant to narcan
where do xylazine wounds usually occur?
in one or both upper/lower extremities or all 4 extremities
t/f: xylazine wounds can occur regardless of how the drug is used
true
t/f: xylazine wounds are partial to full thickness wounds characterized by necrotic tissue and wound diameter >10 cm
true
what is the mechanism of xylazine wounds?
not well understood but it’s believed to be peripheral vasoconstriction resulting in poor perfusion and necrosis, small vessel disease
t/f: xylazine wounds are the progressive necrosis of skin, muscles, tendon, and bone
true
why do patients on xylazine have difficulty ambulating?
pain from the wounds
what are some complications of xylazine wounds?
bacteremia, endocarditis, sepsis, osteomyelitis, and limb amputation
what is MAP (medication-assisted treatment)?
combo Rx of meds, counseling, and behavioral therapy
what is the main Rx for opioid use disorder?
MAP
what meds are used in MAP?
Methadone, Buprinorphine, and Naltrexone
how does methadone work?
it is a weak agonist that prevents withdrawal symptoms and reduces cravings
how does Buprenorphine work?
it is a partial agonist with high affinity that blocks the effects of other opioids, prevents withdrawal symptoms, and reduces cravings
prevents fentanyl from having any effects
t/f: combo products (buprenorphine-naloxone) are preferred to monotherapy and are less likely to be diverted
true
how does naltrexone work?
it is a strong antagonist that blocks reinforcing effects of opioids, decreased reactivity to drug-conditioned cues, and reduces cravings
what is vivitrol?
a long acting IM injection naltrexone taken monthly to prevent relapse following detox
why do pts have to show stable recovery to be approved for vivitrol?
bc they have to be sure they will return monthly for the injections bc even missing by one day will increase the chances of relapse
what do PTs do with opioid use disorder?
we treat MSK conditions, chronic pain, and wound care in these overdose patients
what is the most common dx associated with an opioid prescription?
MSK conditions
if a pts answers yes to 3 or more questions on the rapid opioid dependence screen is this a concern?
yes, contact their PCP and be open and honest with the pt
