Opioid and Xylazine Epidemic

Question 1

how many waves of opioid overdose deaths have there been?

Answer 1

3

Question 2

what was the 1st wave of opioid overdose deaths?

Answer 2

in the 1990s

rise in prescription opioid overdose deaths

Question 3

what was the 2nd wave of opioid overdose deaths?

Answer 3

in 2010

rise in heroin overdose deaths

Question 4

what was the 3rd wave of opioid overdose deaths?

Answer 4

in 2013

rise in synthetic opioid overdose deaths

Question 5

fentanyl is ___ times stronger than heroin and ____ times stronger than morphine

Answer 5

50, 100

Question 6

what is a lethal dose of fentanyl?

Answer 6

2 mg

Question 7

what is xylazine (tranq)?

Answer 7

a non-opioid veterinary sedative that is not approved for use in humans due CNS depression

Question 8

xylazine is commonly mixed with what other drug?

Answer 8

fentanyl

Question 9

why is xylazine often mixed with fentanyl?

Answer 9

bc it increases its street value and enhances the drug’s effects

Question 10

is xylzine overdose reversible with Naloxone (Narcan)?

Answer 10

no, bc it isn’t an opioid

Question 11

is fentanyl actually resistant to narcan?

Answer 11

no, it is actually usually laced with xylazine, which is resistant to narcan

Question 12

where do xylazine wounds usually occur?

Answer 12

in one or both upper/lower extremities or all 4 extremities

Question 13

t/f: xylazine wounds can occur regardless of how the drug is used

Answer 13

true

Question 14

t/f: xylazine wounds are partial to full thickness wounds characterized by necrotic tissue and wound diameter >10 cm

Answer 14

true

Question 15

what is the mechanism of xylazine wounds?

Answer 15

not well understood but it’s believed to be peripheral vasoconstriction resulting in poor perfusion and necrosis, small vessel disease

Question 16

t/f: xylazine wounds are the progressive necrosis of skin, muscles, tendon, and bone

Answer 16

true

Question 17

why do patients on xylazine have difficulty ambulating?

Answer 17

pain from the wounds

Question 18

what are some complications of xylazine wounds?

Answer 18

bacteremia, endocarditis, sepsis, osteomyelitis, and limb amputation

Question 19

what is MAP (medication-assisted treatment)?

Answer 19

combo Rx of meds, counseling, and behavioral therapy

Question 20

what is the main Rx for opioid use disorder?

Answer 20

MAP

Question 21

what meds are used in MAP?

Answer 21

Methadone, Buprinorphine, and Naltrexone

Question 22

how does methadone work?

Answer 22

it is a weak agonist that prevents withdrawal symptoms and reduces cravings

Question 23

how does Buprenorphine work?

Answer 23

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

Question 24

t/f: combo products (buprenorphine-naloxone) are preferred to monotherapy and are less likely to be diverted

Answer 24

true

Question 25

how does naltrexone work?

Answer 25

it is a strong antagonist that blocks reinforcing effects of opioids, decreased reactivity to drug-conditioned cues, and reduces cravings

Question 26

what is vivitrol?

Answer 26

a long acting IM injection naltrexone taken monthly to prevent relapse following detox

Question 27

why do pts have to show stable recovery to be approved for vivitrol?

Answer 27

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

Question 28

what do PTs do with opioid use disorder?

Answer 28

we treat MSK conditions, chronic pain, and wound care in these overdose patients

Question 29

what is the most common dx associated with an opioid prescription?

Answer 29

MSK conditions

Question 30

if a pts answers yes to 3 or more questions on the rapid opioid dependence screen is this a concern?

Answer 30

yes, contact their PCP and be open and honest with the pt