Losing limbs to drugs

[bedrock]

I was aware that it did this, but damn !!

https://www.wsj.com/us-news/tranq-turns-more-illicit-drug-users-into-amputees-954d74e8?st=sq5h4lvlgp6a32d&reflink=article_copyURL_share

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[Agast]

Rough article. Felt like a sci-fi dystopic future except the future is now.

 

[BoardingDoc]

I was aware that it did this, but damn !!

https://www.wsj.com/us-news/tranq-turns-more-illicit-drug-users-into-amputees-954d74e8?st=sq5h4lvlgp6a32d&reflink=article_copyURL_share

It's like the reporting on krokodil that came out of Russia ~10 years ago.

Tranq hasn't made it to my neck of the woods yet, but colleagues in other parts of the state have said that they're getting constant ED visits for wound care related to this crap.

Not having to deal with that once it eventually reaches my part of the state is reason number 9487 I'm happy to be starting my pain fellowship next month.

 

[BobBarker]

It is an alpha agonist and they hypothesize it is causing vasoconstriction. I can’t see any references to trying phentolamine to reverse it or prazosin prophylaxis.

 

[Ducttape]

im sure its too late by the time they access medical care.

 

[pastafan]

It is an alpha agonist and they hypothesize it is causing vasoconstriction. I can’t see any references to trying phentolamine to reverse it or prazosin prophylaxis.

I have read that lesions/necrosis can occur in parts of the body not related to where drug was injected.

 

[Ducttape]

one of the first patients i took care of - way back in the day - had severe reaction to amphetamine use.

30s year old woman who had bilateral total arm and leg amputation due to severe vascular disease. she shot up only a couple of times in her arm...

 

[Agast]

So if you snort drugs instead does that make a difference?

 

[Ducttape]

Xylazine-induced skin ulcers are caused by chronic and repetitive usage of the drug and can occur on sites other than the site of injection, or even when the drug is snorted or inhaled. The proposed causes include a predominant peripheral alpha 2 and some alpha 1 adrenergic agonist activity,1 which cause vasoconstriction of cutaneous arterioles via Gi (via reduction in cyclic adenosine monophosphate) and Gq (calcium-calmodulin mediated) subunits of G protein coupled alpha adrenergic receptors, respectively, resulting in tissue ischemia. Additionally,alpha 2 adrenergic agents are associated with loca lanalgesia, which, coupled with ischemia and repeated trauma of injections, leads to extensive ulceration

https://www.jaad.org/article/S0190-9622(23)00594-7/pdf

In addition to its acute effects, xylazine is associated with severe necrotic skin ulcerations (see photo).5 Patients who use xylazine may present to the emergency department seeking care for these wounds. Such wounds are different from the wounds commonly seen in people who inject drugs; tissue injury may occur at or remote from an injection site and irrespective of the mode of use. The pathophysiology of tissue injury is unclear and probably multifactorial.

https://www.nejm.org/doi/pdf/10.1056/NEJMp2303120#:~:text=It%20can%20be%20consumed%20orally%20or%20by,smoking%2C%20snorting%2C%20or%20intramuscular%2C%20sub-cutaneous%2C%20or%20intravenous%20injec-tion.

so you should probably put down that pipe.... unless you plan on smoking Longbottom Leaf

 

[drusso]

Are they tender to palpation over the area near the distribution of the cluneal nerves?

 

[scv]

Are they tender to palpation over the area near the distribution of the cluneal nerves?

Most definitely