Pharmacology and toxicology of xylazine: quid novum?

The current opioid overdose crisis is characterized by the presence of unknown psychoactive adulterants. Xylazine is an alpha-2 receptor agonist that is not approved for human use but is commonly used in veterinary medicine due to its sedative and muscle-relaxant properties. Cases of human intoxication due to accidental or voluntary use have been reported since the 1980s. However, reports of adulteration of illicit opioids (heroin and illicit fentanyl) with xylazine have been increasing all over Western countries. In humans, xylazine causes respiratory depression, bradycardia, and hypotension-posing individuals, using xylazine-adulterated opioids. We present a narrative review of the latest intoxication cases related to xylazine, to bring awareness to readers and also to help pathologists to detect and deal with xylazine cases.

Drug-facilitated sexual assaults (DFSA): a serious underestimated issue.

OBJECTIVE: Drug-facilitated sexual assault (DFSA) is a nonconsensual sexual act in which the victim is incapacitated or unconscious due to the effects of alcohol, a drug and/or other intoxicating substances. Dozens of drugs (including ethanol) can potentially be used to commit sexual assaults, but γ-Hydroxybutyric acid (GHB) and flunitrazepam are the most common "date rape drugs". MATERIALS AND METHODS: Multidisciplinary databases were browsed using the following search terms: "drug-facilitated sexual assault", "chemical submission", "date rape", "rape drugs", and "drink-spiking". Moreover, a search for reports was conducted on Institutional websites to identify documentation published by international agencies or institutions. Articles and reports were independently evaluated by each author. RESULTS: There are no accurate estimates of the number of DFSA occurring each year, although assaults are increasingly reported. Many DFSA, however, are still not reported. Victims are reluctant to report incidents because of embarrassment, guilt or perceived responsibility, or because they do not clearly remember the assault. Moreover, most of the drugs typically used in sexual assaults are rapidly metabolized, making them undetectable in routine drug screenings. CONCLUSIONS: Most of the substances involved in DFSA, with the exception of alcohol, are under international control and scheduled under the United Nations Single Convention on Narcotic Drugs of 1961 and the Convention on Psychotropic Substances of 1971. However, several psychotropic substances and antihistamines used in sexual assaults are still not under international control, allowing for trafficking, often via the Internet and courier. The absence of international control makes it difficult to obtain accurate data on the nature and the extent of the problem.