Pregnant Women Face Serious Risks from Xylazine Use

What is xylazine and why is it dangerous?

Xylazine is a veterinary tranquilizer that has seen an increase in human use in the past few years. ^[1] This is primarily due to it being added to other street drugs, such as fentanyl, to increase their bulk and increase the effects, such as sedation. Yet, it can also cause more unwanted effects such as severe skin ulcers. ^[2] However, the effects of xylazine are not reversed with typical overdose treatments (like naloxone), resulting in increasing deaths involving xylazine year after year. ^[3]

Additionally, xylazine is reported to be more addictive than opioids like fentanyl and heroin, which complicates recovery and makes the addiction cycle harder to break. ^[2] This is even further complicated by there being no effective treatment for xylazine withdrawal, nor are there effective therapies for xylazine addiction. All these factors combined make xylazine an extremely dangerous drug.

How xylazine addiction affects pregnant women

There has been a sharp increase in the number of pregnant women with xylazine in their system at the time of delivery, who also take non-prescribed opioids. ^[4] This is particularly concerning as it can affect the health of both the woman and the unborn child. Opioid use disorders are one of the leading causes of mortality in pregnancy, and this is further increased if the opioids are cut with xylazine. ^[5] Xylazine causes slowed breathing, reduced heart rate, and lowered blood pressure, alongside central nervous system depression. Animal studies have also shown that it can reduce blood flow to the uterus, resulting in less oxygen and nutrients available for the fetus.

Because xylazine is so addictive and is often consumed without knowledge, individuals can become addicted to it without realizing it. Withdrawal from xylazine can cause severely unpleasant symptoms similar to opioid withdrawal, such as anxiety, restlessness, and nausea. ^[2] This drives the individual to seek more of the drug to alleviate these symptoms. This is further enhanced during pregnancy, as the stigma associated with drug use during this period can prevent the individual from seeking professional help.

Impact of xylazine on babies and newborns

Because xylazine reduces blood flow to the uterus (and thus the placenta), it reduces the blood and oxygen available for the fetus. Compounded by the fact that xylazine decreases the fetal heart rate, these can lead to hypoperfusion, putting the fetus at risk of hypoxemia (lowered oxygenation throughout the body) and intrauterine growth restriction (IUGR), as fewer nutrients are available to sustain growth. ^[5] The complications of hypoxemia and IUGR persist after birth.

Fetal hypoxia can lead to changes in the structure and function of the brain, so it’s linked to the development of neurological disorders after birth. ^[6] Fetuses with IUGR have a significantly higher risk of neonatal mortality and complications. ^[7] This can also cause long-term physiological problems and could be linked to the development of chronic diseases, such as cardiovascular disease and diabetes mellitus.

Xylazine can cause significant and long-lasting complications for the fetus after exposure to it during pregnancy. The xylazine epidemic in pregnant women must be addressed to reduce the risk of long-term harm to the population.

Why pregnant women are at risk of xylazine addiction

Several factors put pregnant women at risk of addiction. During pregnancy, they are more likely to feel isolated, have uncomfortable physical symptoms, experience undesired psychological changes, and undergo changes in their lifestyles, all of which could increase the risk of using drugs. This is especially the case if they already use drugs recreationally. The drug-taking can then continue to spiral, and when highly addictive substances (like xylazine) are involved, it can be even more difficult to stop.

Additionally, many pregnant women do not seek help for their addiction due to stigma and fear of losing their child. ^[8] By admitting they are addicted to xylazine or other illegal drugs, they are admitting to criminal activity (and one that can potentially harm their child). So, the potential repercussions of these factors drive pregnant women away from seeking help, which further exacerbates their addiction.

Addressing the xylazine crisis among pregnant women

While the xylazine crisis is alarming, there are several ways it can be tackled. Recent studies have identified the need to improve screening for substance use during pregnancy. ^[9] Having accurate screening for xylazine use early in the prenatal period could allow early interventions to be made, protecting the health of the mother and the fetus.

Once xylazine use has been identified, the next step is removing the barriers to treatment for pregnant women. Establishing specialized clinics that can initiate treatment plans, including mental health support and social services coordination, would help remove the stigma associated with xylazine addiction treatment, allowing individuals to get the help they need.

More practical steps, such as education about the negative effects of xylazine use, community support groups, and the distribution of testing strips to check for xylazine in other drugs, may also play a role. It is also important to continue research studies into potential reversal agents and medications to help with xylazine withdrawal symptoms.

Resources for pregnant women struggling with addiction

If you or a loved one are pregnant and struggling with addiction, please seek help straight away. You can speak to a medical professional about this who can refer you to a prenatal clinic specializing in addiction. If you need to talk to someone urgently, day or night, you can use the following contacts:

• SAMHSA's National Helpline: 1-800-662-4357
• National Council on Alcoholism and Drug Dependence: 1-800-622-2255