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Dr. Nabarun Dasgupta Profile picture
@nabarund
Apr 12, 2023 • 14 tweets • 10 min read • Read on X
Based on our lab data, I reckon #xylazine shows up in the drug supply 5 specific ways:
🧵👇
1. Veterinary diversion is rare, niche, and localized to interconnected Caribbean communities:

Philly


Puerto Rico
link.springer.com/article/10.118…
2. Most commonly... Fentanyl and #xylazine in combo, about 3:1.

We don't see xylazine-related synthesis impurities but do see fentanyl impurities, so our hypothesis is that xyl is being added intentionally in pure form.
Example from Lexington NC: streetsafe.supply/results/p/3003…
3. #xylazine as a ridealong.

Xylazine one part of *premixed cut* you can buy online from China. Esp in metro NYC, we see specific constellations of 5-8 substances (quinine, lidocaine, gabapentin, procaine, levamisole, etc) that match.

streetsafe.supply/results/p/3003… Image
4. #Xylazine as cross-contamination.

Sometimes xylazine is in trace abundance, mixed with actives: gabapentin, cocaine, methamphetamine plus opioids. Likely product VERY stepped on.

From TN:
streetsafe.supply/results/p/4001…
From NC:
streetsafe.supply/results/p/nc01…
5. #Xylazine without fentanyl, but with other alpha-2 agonists, caffeine, and/or designer benzos.

This is rare but emerging.
OH: streetsafe.supply/results/p/4001…
NC: streetsafe.supply/results/p/3004…
NY: streetsafe.supply/results/p/3009…
NC: streetsafe.supply/results/p/4006…
Here's @mary_figgatt and my deep dive from 2021 into #xylazine history and science

And shout out to Don Jackson of @nc_usu who was the first person in public health to detect #xylazine in North Carolina Image
Sadly, missed opportunity. Local law enforcement knew about this 4 years ago and chose not to work with anyone in public health on education and prevention.

latimes.com/california/sto…
Props to our amazing chemist @LunaJBear who has been analyzing #xylazine samples in the lab!!
Here's our live report with data on where #xyalzine has been detected in North Carolina

ncxylazine.streamlit.app
Why are we concerned about #xylazine? @hcharmreduxxx @WeezieBeale @nc_usu lay it out in this short video

This webinar is the most current and useful resource for info on #xylazine from @NASTAD. Covers antidotes, skin wounds, naloxone, etc.

Our friends in Pittsburgh @Raaginizzle have great info on how to treat #xylazine wounds.

Download free at:
addiction-training.org/resources/?cat…

Wound-specific training session April 27 register NOW: addictiontraining.org/training/regis… ImageImage

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More from @nabarund

Dr. Nabarun Dasgupta Profile picture
Jun 7
Let's bring some science into all this talk about #medetomidine. 🧵

TLDR: Expect unexpected sedation.

We predicted it would soon emerge in illicit supply, and @US_FDA agreed, and so we have this grant to investigate its pharmacology, etc. @nanopharmNC

fda.gov/science-resear…
We first observed #medetomidine in NC in a sample collected in October 2022, in Raleigh. Combined with xylazine, and traces of fentanyl and meth. @LunaJBear
streetsafe.supply/results/p/3004…
If you've seen me present in the last year, #medetomidine has been sitting on our team's Watch List (slide 52) for awhile now.
cdr.lib.unc.edu/concern/schola…
Read 24 tweets
Dr. Nabarun Dasgupta Profile picture
Sep 9, 2023
1 🚨Attention please: Turns out #xylazine is a kappa opioid. This validates experience from frontline folks and PWUD. Fresh science from collaborators @nanopharmNC @MadiganLBedard @zenbrainest
Pre-print:
Public health 🧵 below
#TwitteRx #harmreductionbiorxiv.org/content/10.110…
Check out @nanopharmNC's explainer on the lab science. I'll breakdown the #publichealth implications.
@nanopharmNC Basic pharmacology. Mu is the opioid receptor in the brain we usually talk about when we say “opioid” – but there are others. Kappa is less popular, but still very much an opioid receptor. HOWEVER, it’s NOT canonically linked to opioid euphoria.

sites.tufts.edu/opioidpeptides…
Image
Read 18 tweets
Dr. Nabarun Dasgupta Profile picture
May 22, 2023
Let's talk #nalmefene for OD reversal, an old generic drug in new expensive clothes. FDA approved Rx-only nasal spray today. Will this help prevent overdose deaths in the fentanyl-xylazine-strongbenzo era?

🧵👇

fda.gov/news-events/pr…
Nalmefene was developed in the 1980s by erstwhile Key Pharma in Miami, with help from scientists at @UVA
europepmc.org/article/med/39…
It was marketed as an injectable by Baxter Pharma as Revex for alcohol dependence, initially approved in April 1995 and "discontinued on May 21, 2008, for business reasons."

federalregister.gov/documents/2017…
Read 21 tweets
Dr. Nabarun Dasgupta Profile picture
Feb 15, 2023
Y'all ready for this? 🍿👊
#NarcanAdCom about to pop off
Use this # to follow today's updates

CONCEPT
The culmination of 2 decades of advocacy to make naloxone OTC

REALITY
2 decades of advocacy erased by overdose crisis profiteers $EBS

Right out the gate, FDA frames this as a solution for saving kids from overdose. Guess that’s why there are so many pediatric anesthesiologists on the AdCom
In the review of the history FDA forgets to credit the people (like Dan Bigg) who invented the intervention
Read 53 tweets
Dr. Nabarun Dasgupta Profile picture
Sep 23, 2022
🚨 Something huge happened today. 🚨

@US_FDA @DrCaliff_FDA listened to harm reduction programs and made it infinitely easier to purchase #naloxone in bulk. With 100,000+ overdose deaths each year, we need BIG solutions.

w/@RemedyAlliance @ejwheeler9 @coreysdavis
🧵 1/26
@US_FDA @DrCaliff_FDA @RemedyAlliance @ejwheeler9 @coreysdavis The FDA Guidance provides clear federal support for bulk purchase and distribution of naloxone to meet one of the biggest public health challenges of our times.

Full text via link below, but let's break it down.


2/26
@US_FDA @DrCaliff_FDA @RemedyAlliance @ejwheeler9 @coreysdavis This is a watershed moment. Along with low-cost naloxone available through @RemedyAlliance and state standing orders, this Guidance establishes a trifecta of innovations that will help rapidly scale up naloxone distribution.
3/26
Read 33 tweets
Dr. Nabarun Dasgupta Profile picture
Sep 21, 2022
“There are a lot of abandoned people who were on pain medications, who cannot get access to adequate pain management anymore, and are therefore, increasingly, turning to the street. We hear those stories every day.”

time.com/6214811/overdo…
Thanks to @ibdgirl76 @LelenaPeacock and others who have shared with me many stories about abandoned CPP. This article from @TaraLaw27 is a solid starting point to recentering folks in pain who can’t get the help they deserve.
To be clear, overdose deaths now mostly involve unregulated street drugs. Those who are dying are heterogenous: people who were on Rx opioids for years, people who never got a single script, suicides from lack of pain ctrl, and occasional users w/o tolerance.
Read 4 tweets

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