Philadelphia hospitals are pioneering a new treatment strategy to combat the severe withdrawal symptoms associated with 'tranq dope,' a dangerous combination of fentanyl and xylazine that dominates the city's street opioid supply. This innovative approach aims to reduce patient suffering and prevent premature hospital discharges, addressing a critical need in addiction medicine.
The Challenge of Tranq Dope Withdrawal
Traditional methods for treating opioid withdrawal, primarily using buprenorphine (Suboxone), have proven less effective against tranq dope. The addition of xylazine, an animal tranquilizer, to fentanyl creates a complex withdrawal syndrome characterized by intense restlessness, agitation, and severe physical symptoms. Patients often experience 'precipitated withdrawal' when given buprenorphine, paradoxically worsening their symptoms. This has led to high rates of patient-directed discharges, where individuals leave the hospital before completing treatment, increasing their risk of mortality, disability, and rehospitalization.
A Novel Treatment Approach
To address these challenges, a team of emergency and addiction physicians in Philadelphia began experimenting with a new approach in 2022. The strategy involves using short-acting opioids, such as oxycodone or hydromorphone, in combination with low-dose buprenorphine. This combination prevents precipitated withdrawal while effectively managing opioid withdrawal and pain.
The low-dose buprenorphine is gradually increased to stabilize patients and provide a bridge to long-term treatment. Adjunctive therapies, including ketamine, muscle relaxants, anti-nausea medications, and IV fluids, are also administered to alleviate symptoms and promote healing. Ketamine, in particular, has shown promise in treating pain, depression, PTSD and substance use disorders.
Promising Results
The results of this new approach have been encouraging. The likelihood of patients leaving the hospital before treatment completion has been reduced by more than half, dropping from 10% to under 4%. Additionally, the severity of withdrawal symptoms, as measured by patient-reported scores, has also been halved.
Implications and Future Directions
As fentanyl and xylazine become more prevalent in drug supplies across the United States, the need for effective withdrawal management strategies is growing. This pioneering work in Philadelphia offers a promising model for other emergency departments and hospitals to improve care for patients struggling with tranq dope addiction. The researchers hope their findings will inspire others to develop and implement better strategies for relieving the suffering associated with this complex and severe condition. While the risks of serious side effects were minimal in the study, continued monitoring and research are essential to optimize treatment protocols and ensure patient safety.
