Table 1 Strategies to manage xylazine-fentanyl overdose in the field

Field Pulse Oximetry

Portable, battery-powered pulse oximetry can be used in the field to monitor oxygenation status in patients who have not regained consciousness.

Titrate Naloxone to Oxygenation Status

Naloxone administration, either intramuscular or intranasal, can be titrated to oxygenation status, not level of consciousness, to avoid inducing unnecessary opioid withdrawal symptoms after the xylazine sedation period passes.

Portable Oxygen and Airway Management

Portable oxygen tanks, and proper positioning of patients (laying on their side, jaw thrust, visualize airway) can assist in improving oxygenation after naloxone administration, assess for vomit and gastric contents, employ portable suction as needed.

Scene Safety

Patients with prolonged periods of sedation are vulnerable to traffic, assault, and other physical risks. Response team staff members can help secure the scene.

Distribute Xylazine Testing Supplies

Testing strips for xylazine presence using immunoassay technology are inexpensive (about $1 per strip) and easy to use. They can be distributed to participants to assist them in screening their drugs. In practice many patients show positivity in urine samples, although the strips have not yet been FDA approved for this purpose, and false negatives may occur.

Communnity Education

Many patients prefer to avoid xylazine once they are aware of it, understand the health risks, and are equipped with testing strips to detect it. Providers can counsel patients about the risks of xylazine and suggest safer options. This can help encourage patients to switch to methadone or buprenorphine treatment.