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de Lima LF, de Araujo WR. Laser-scribed graphene on polyetherimide substrate: an electrochemical sensor platform for forensic determination of xylazine in urine and beverage samples. Mikrochim Acta 2022; 189:465. [DOI: 10.1007/s00604-022-05566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
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Kacinko SK, Mohr ALA, Logan BK, Barbieri EJ. Xylazine: Pharmacology Review and Prevalence and Drug Combinations in Forensic Toxicology Casework. J Anal Toxicol 2022; 46:911-917. [PMID: 35770859 DOI: 10.1093/jat/bkac049] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/13/2022] [Accepted: 06/29/2022] [Indexed: 11/14/2022] Open
Abstract
Xylazine, an alpha-2 receptor agonist used in veterinary medicine for its sedative and muscle relaxant effects, has been reported in forensic toxicology casework since the 1980s. It is not approved for human use, but it is used as an adulterant in heroin and illicit fentanyl. The prevalence and concentrations of xylazine in 2.5 years (January 2019-June 2021) of driving-under-the-influence-of-drugs (DUID) and medical-death-investigation (MDI) cases was investigated, including other drugs detected in combination with xylazine. Of over 170,000 cases screened for xylazine, 97% were classified as MDI. Over the course of the study period the prevalence and geographical spread of xylazine increased. Overall, 2.8% of DUID and 2.1% of MDI cases screened positive for xylazine with concentrations of 5.1-450 ng/mL (mean = 36 ng/mL) and 5.0-11,000 ng/mL (mean = 41 ng/mL), respectively. Two MDI cases which had xylazine concentrations of 9,100 and 11,000 ng/mL were drug overdose suicides that did not involve any opioids. Opioids, primarily fentanyl and/or a fentanyl byproduct/metabolite were detected in 100% of DUID and all but two MDI cases. After opioids, stimulants, phyto-cannabinoids and benzodiazepines were the most common drug classes detected in conjunction with xylazine in both DUID and MDI casework. In summary, xylazine exposure continues to increase, mostthrough the adulteration of illicit opioids. There is extensive overlap in the concentrations between living and deceased individuals making it difficult to interpret the role of the drug in MDI or DUID cases without other case information.
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Affiliation(s)
- S K Kacinko
- NMS Labs, 200 Welsh Rd, Horsham, PA 19044, USA
| | - A L A Mohr
- Center for Forensic Science Research and Education at the Fredric Rieders Family Foundation, 2300 Stratford Ave, Willow Grove, PA 19090, USA
| | - B K Logan
- NMS Labs, 200 Welsh Rd, Horsham, PA 19044, USA.,Center for Forensic Science Research and Education at the Fredric Rieders Family Foundation, 2300 Stratford Ave, Willow Grove, PA 19090, USA
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Bowles JM, McDonald K, Maghsoudi N, Thompson H, Stefan C, Beriault DR, Delaney S, Wong E, Werb D. Xylazine detected in unregulated opioids and drug administration equipment in Toronto, Canada: clinical and social implications. Harm Reduct J 2021; 18:104. [PMID: 34645480 PMCID: PMC8511847 DOI: 10.1186/s12954-021-00546-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The North American opioid overdose crisis is driven in large part by the presence of unknown psychoactive adulterants in the dynamic, unregulated drug supply. We herein report the first detection of the psychoactive veterinary compound xylazine in Toronto, the largest urban center in Canada, by the city's drug checking service. METHODS Toronto's Drug Checking Service launched in October 2019. Between then and February 2021, 2263 samples were submitted for analysis. The service is offered voluntarily at harm reduction agencies that include supervised consumption services. Samples were analyzed using gas chromatography-mass spectrometry or liquid chromatography-high resolution mass spectrometry. Targeted and/or untargeted screens for psychoactive substances were undertaken. RESULTS In September 2020, xylazine was first detected by Toronto's Drug Checking Service. Among samples analyzed from September 2020 to February 2021 expected to contain fentanyl in isolation (610) or in combination with methamphetamine (16), xylazine was detected in 46 samples (7.2% and 12.5% of samples, respectively). Samples were predominantly drawn from used drug equipment. Three of the samples containing xylazine (6.5%) were associated with an overdose. CONCLUSION We present the first detection of xylazine in Toronto, North America's fourth-largest metropolitan area. The increased risk of overdose associated with use of xylazine and its detection within our setting highlights the importance of drug checking services in supporting rapid responses to the emergence of potentially harmful adulterants. These data also highlight the clinical challenges presented by the dynamic nature of unregulated drug markets and the concomitant need to establish regulatory structures to reduce their contribution to overdose morbidity and mortality.
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Affiliation(s)
- Jeanette M Bowles
- Centre on Drug Policy Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, Canada
| | - Karen McDonald
- Centre on Drug Policy Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, Canada
| | - Nazlee Maghsoudi
- Centre on Drug Policy Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, 55 College St Room 500, Toronto, ON, Canada
| | - Hayley Thompson
- Centre on Drug Policy Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, Canada
| | - Cristiana Stefan
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Daniel R Beriault
- Department of Laboratory Medicine, St Michael's Hospital, 30 Bond St., Toronto, ON, Canada
| | - Sarah Delaney
- Department of Laboratory Medicine, St Michael's Hospital, 30 Bond St., Toronto, ON, Canada
| | - Ernest Wong
- Clinical Laboratory and Diagnostic Services, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, Unity Health Toronto, 209 Victoria St, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, 9500 Gilman Dr., La Jolla, CA, USA.
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Kariisa M, Patel P, Smith H, Bitting J. Notes from the Field: Xylazine Detection and Involvement in Drug Overdose Deaths - United States, 2019. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:1300-1302. [PMID: 34529640 PMCID: PMC8445380 DOI: 10.15585/mmwr.mm7037a4] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Nunez J, DeJoseph ME, Gill JR. Xylazine, a Veterinary Tranquilizer, Detected in 42 Accidental Fentanyl Intoxication Deaths. Am J Forensic Med Pathol 2021; 42:9-11. [PMID: 33031124 DOI: 10.1097/paf.0000000000000622] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Xylazine is an emerging adulterant with fentanyl in fatal drug intoxications, which has public health, safety, and criminal investigative implications. Xylazine is a nonnarcotic sedative used for analgesia and muscle relaxation exclusively in veterinary medicine. Its chemical structure is similar to clonidine and acts as a central α-2 agonist which may cause bradycardia and transient hypertension followed by hypotension. We report the detection of xylazine in 42 deaths in Connecticut from March to August 2019. Xylazine combined with an opioid or stimulant may affect the toxicity of these drugs. Detection of xylazine may help the forensic pathologist distinguish illicit from prescribed fentanyl, and law enforcement agents track the illicit drugs to a specific drug supplier. Because of its lack of response to naloxone, emergency medicine physicians need to be aware of its potential presence as it may affect therapy.
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Determination of morphine and its metabolites in the biological samples: an updated review. Bioanalysis 2020; 12:1161-1194. [PMID: 32757855 DOI: 10.4155/bio-2020-0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Morphine (MO) as an opioid analgesic is used for the treatment of moderate-to-severe pains, particularly cancer-related pains. Pharmacologic studies on MO are complicated due to drugs binding to the protein or metabolization to active metabolites, and even inter-individual variability. This necessitates the selection of a reliable analytical method for monitoring MO and the concentrations of its metabolites in the biological samples for the pharmacokinetic or pharmacodynamic investigations. Therefore, this study was conducted to review all the analytical research carried out on MO and its metabolites in the biological samples during 2007-2019 as an update to the study by Bosch et al. (2007).
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Ultra-high performance liquid chromatography-MS/MS (UHPLC-MS/MS) in practice: analysis of drugs and pharmaceutical formulations. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2019. [DOI: 10.1186/s43094-019-0007-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
UHPLC-MS/MS is connected in various research facilities for the qualitative and quantitative investigation of a pharmaceutical substance, pharmaceutical items, and biological specimen.
Main body
The commence review article is an endeavor to offer pervasive awareness around assorted aspects and details about the UHPLC-MS/MS and related techniques with the aim on practice to an estimation of medicinal active agents in the last 10 years. The article also focused on isolation, separation, and characterization of present impurity in drug and biological samples.
Conclusion
Review article compiles a general overview of medicinally important drugs and their analysis with UHPLC-MS/MS. It gives fundamental thought regarding applications of UHPLC-MS/MS for the study on safety limit. The summary of developed UHPLC-MS/MS methods gives a contribution to the future trend and limitations in this area of research.
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Petrochilou E, Athanaselis S, Nikolaou P, Papadodima S, Panderi I, Spiliopoulou C, Papoutsis I. Synovial fluid as an alternative specimen for quantification of drugs of abuse by GC–MS. Forensic Toxicol 2019. [DOI: 10.1007/s11419-019-00465-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Mendes LF, Souza e Silva ÂR, Bacil RP, Serrano SHP, Angnes L, Paixão TRLC, de Araujo WR. Forensic electrochemistry: Electrochemical study and quantification of xylazine in pharmaceutical and urine samples. Electrochim Acta 2019. [DOI: 10.1016/j.electacta.2018.10.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Assessing cocaine abuse using LC-MS/MS measurements in biological specimens. Bioanalysis 2016; 7:1497-525. [PMID: 26168256 DOI: 10.4155/bio.15.72] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Cocaine use is still a problem in today's world, and this has several implications on human activities. Indeed, important problems related to cocaine derive from its use in situations where concentration and focus skills are necessary, namely while driving and/or working. The need of analytical methods for drug analysis in specimens of biological origin for proper documentation of human exposure is increasing. While GC-MS-based procedures represented the state-of-the-art of analytical techniques a few years ago, there is a growing trend for their replacement by LC-MS/MS, which can be justified by the increased sensitivity presented by these new technologies. This paper will review recently published papers on the use of LC-MS/MS-based procedures for cocaine measurement in biological specimens.
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Baciu T, Borrull F, Neusüß C, Aguilar C, Calull M. Capillary electrophoresis combined in-line with solid-phase extraction using magnetic particles as new adsorbents for the determination of drugs of abuse in human urine. Electrophoresis 2016; 37:1232-44. [DOI: 10.1002/elps.201500515] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/01/2016] [Accepted: 02/02/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Tatiana Baciu
- Department of Analytical Chemistry and Organic Chemistry; Universitat Rovira i Virgili; Tarragona Spain
| | - Francesc Borrull
- Department of Analytical Chemistry and Organic Chemistry; Universitat Rovira i Virgili; Tarragona Spain
| | | | - Carme Aguilar
- Department of Analytical Chemistry and Organic Chemistry; Universitat Rovira i Virgili; Tarragona Spain
| | - Marta Calull
- Department of Analytical Chemistry and Organic Chemistry; Universitat Rovira i Virgili; Tarragona Spain
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Doran GS, Bradbury LA. Quantitation of the anaesthetic xylazine in ovine plasma by LC–MS/MS. J Chromatogr B Analyt Technol Biomed Life Sci 2015; 997:81-4. [DOI: 10.1016/j.jchromb.2015.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 05/23/2015] [Accepted: 06/04/2015] [Indexed: 11/26/2022]
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Gao X, Guo H, Du Y, Gu C. Simultaneous Determination of Xylazine and 2,6-Xylidine in Blood and Urine by Auto Solid-Phase Extraction and Ultra High Performance Liquid Chromatography Coupled with Quadrupole-Time of Flight Mass Spectrometry. J Anal Toxicol 2015; 39:444-50. [DOI: 10.1093/jat/bkv040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Silva-Torres L, Veléz C, Álvarez L, Zayas B. Xylazine as a drug of abuse and its effects on the generation of reactive species and DNA damage on human umbilical vein endothelial cells. J Toxicol 2014; 2014:492609. [PMID: 25435874 PMCID: PMC4243599 DOI: 10.1155/2014/492609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/05/2014] [Accepted: 10/15/2014] [Indexed: 01/14/2023] Open
Abstract
Human xylazine (XYL) abuse among addicts has received great interest due to its potential toxic effects upon addicts and the need to understand the mechanism of action associated with the potential health effects. XYL is an alpha-2 agonist restricted to veterinarian applications, without human medical applications. Our previous work demonstrated that XYL and its combination with cocaine (COC) and/or 6-monoacetylmorphine (6-MAM) induce cell death through an apoptotic mechanism. The aim of this study was to determine the effect of xylazine on the generation of reactive oxygen species (ROS) and reactive nitrogen species (RNS) as well as DNA damage on endothelial cell. Human umbilical vein endothelial cells (HUVEC) were treated with XYL (60 μM), COC (160 μM), 6-MAM (160 μM), camptothecin (positive control, 50 μM), XYL/COC (50 μM), XYL/6-MAM (50 μM), and XYL/COC/6-MAM (40 μM) for a period of 24 hours. Generation of intracellular ROS, RNS, and DNA fragmentation were analyzed using a fluorometric assay. Results reveal that XYL and 6-MAM increase levels of ROS; no induction of RNS production was observed. The combination of these drugs shows significant increase in DNA fragmentation in G2/M phase, while XYL, COC, and 6-MAM, without combination, present higher DNA fragmentation in G0/G1 phase. These findings support that these drugs and their combination alter important biochemical events aligned with an apoptotic mechanism of action in HUVEC.
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Affiliation(s)
- Luz Silva-Torres
- Pharmacology and Toxicology Department, School of Medicine, University of Puerto Rico, Medical Science Campus, P.O. Box 335067, San Juan, PR 00936-5067, USA
- Puerto Rico Institute of Forensic Science, PR, USA
| | - Christian Veléz
- School of Environmental Affairs, Universidad Metropolitana, PR, USA
| | - Lyvia Álvarez
- Pharmacology and Toxicology Department, School of Medicine, University of Puerto Rico, Medical Science Campus, P.O. Box 335067, San Juan, PR 00936-5067, USA
- Puerto Rico Institute of Forensic Science, PR, USA
| | - Beatriz Zayas
- Pharmacology and Toxicology Department, School of Medicine, University of Puerto Rico, Medical Science Campus, P.O. Box 335067, San Juan, PR 00936-5067, USA
- School of Environmental Affairs, Universidad Metropolitana, PR, USA
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Silva-Torres LA, Vélez C, Lyvia Alvarez J, Ortiz JG, Zayas B. Toxic effects of xylazine on endothelial cells in combination with cocaine and 6-monoacetylmorphine. Toxicol In Vitro 2014; 28:1312-9. [PMID: 25017475 DOI: 10.1016/j.tiv.2014.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 11/19/2022]
Abstract
The use of xylazine as a drug of abuse has emerged worldwide in the last 7 years, including Puerto Rico. Clinical findings reported that xylazine users present greater physiological deterioration, than heroin users. The aim of this study was to assess the xylazine toxicity on endothelial cells, as this is one of the first tissues impact upon administration. Human umbilical vein endothelial cells in culture were treated with xylazine, cocaine, 6-monoacetylmorphine (heroin metabolite) and its combinations, at concentrations of 0.10-400 μM, for periods of 24, 48 and 72 h. IC50 were calculated and the Annexin V assay implemented to determine the cell death mechanism. Results indicated IC50 values at 24h as follow: xylazine 62 μM, cocaine 210 μM, 6-monoacetylmorphine 300 μM. When these drugs were combined the IC50 value was 57 μM. Annexin V results indicated cell death by an apoptosis mechanism in cells treated with xylazine or in combination. Results demonstrated that xylazine use inhibits the endothelial cell proliferation, at lower concentrations than cocaine and 6-monoacetylmorphine. These findings contribute to the understanding of the toxicity mechanisms induced by xylazine on endothelial cells.
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Affiliation(s)
- L A Silva-Torres
- University of Puerto Rico, Pharmacology and Toxicology Department, School of Medicine, Medical Science Campus, Puerto Rico; Puerto Rico Institute of Forensic Science, San Juan, Puerto Rico.
| | - C Vélez
- Universidad Metropolitana, School of Environmental Affairs, San Juan, Puerto Rico
| | - J Lyvia Alvarez
- Puerto Rico Institute of Forensic Science, San Juan, Puerto Rico; University of Puerto Rico, School of Health Professions, Medical Science Campus, Puerto Rico
| | - J G Ortiz
- University of Puerto Rico, Pharmacology and Toxicology Department, School of Medicine, Medical Science Campus, Puerto Rico
| | - B Zayas
- University of Puerto Rico, Pharmacology and Toxicology Department, School of Medicine, Medical Science Campus, Puerto Rico; Universidad Metropolitana, School of Environmental Affairs, San Juan, Puerto Rico
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Ruiz-Colón K, Chavez-Arias C, Díaz-Alcalá JE, Martínez MA. Xylazine intoxication in humans and its importance as an emerging adulterant in abused drugs: A comprehensive review of the literature. Forensic Sci Int 2014; 240:1-8. [PMID: 24769343 DOI: 10.1016/j.forsciint.2014.03.015] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/28/2014] [Accepted: 03/12/2014] [Indexed: 10/25/2022]
Abstract
Xylazine is not a controlled substance; it is marketed as a veterinary drug and used as a sedative, analgesic and muscle relaxant. In humans, it could cause central nervous system depression, respiratory depression, bradycardia, hypotension, and even death. There have been publications of 43 cases of xylazine intoxication in humans, in which 21 (49%) were non-fatal scenarios and 22 (51%) resulted in fatalities. Most of the non-fatal cases required medical intervention. Over recent years xylazine has emerged as an adulterant in recreational drugs, such as heroin or speedball (a cocaine and heroin mixture). From the 43 reported cases, 17 (40%) were associated with the use of xylazine as an adulterant of drugs of abuse. Its chronic use is reported to be associated with physical deterioration and skin ulceration. Literature shows some similar pharmacologic effects between xylazine and heroin in humans. These similar pharmacologic effects may create synergistic toxic effects in humans. Therefore, fatalities among drug users may increase due to the use of xylazine as an adulterant. Xylazine alone has proven harmful to humans and even more when it is combined with drugs of abuse. A comprehensive review of the literature of non-fatal and fatal xylazine intoxication cases including those in which the substance was used as adulterant is presented, in order to increase the awareness in the forensic community, law enforcement, and public health agencies.
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Affiliation(s)
- Kazandra Ruiz-Colón
- Puerto Rico Institute of Forensic Sciences, P.O. Box 11878 Caparra Heights Station, San Juan 00922-1878, Puerto Rico.
| | - Carlos Chavez-Arias
- Puerto Rico Institute of Forensic Sciences, P.O. Box 11878 Caparra Heights Station, San Juan 00922-1878, Puerto Rico.
| | | | - María A Martínez
- Instituto Nacional de Toxicología y C. Forenses, Ministerio de Justicia, Las Rozas de Madrid, C/ José Echegaray, 4, 28232 Las Rozas de Madrid, Madrid, Spain.
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