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MCHD Paramedic Podcast: Xylazine update

Dr. Jerry Snow shares xylazine pharmacology, treatment tips and high-dose naloxone implications

DALL·E 2024-01-30 11.11.12 - A realistic, horizontal image depicting a vial of xylazine placed on a clean, sterile surface. Next to the vial, there is a medical syringe with a ne.png


Friend of the podcast and toxicologist extraordinaire, Dr. Jerry Snow, MD, joins the podcast crew to discuss a scary and potentially deadly twist in the opiate crisis … xylazine. Dr. Snow will school us all on xylazine pharmacology, treatment tips and why EMS high-dose naloxone may not be ideal.

Together, they discuss:

  • The difference in patient presentation in fentanyl alone overdoses versus fentanyl/xylazine overdoses
  • How the naloxone and resuscitation approach differs if xylazine is involved in OD
  • Will we likely ever know if we see a xylazine OD?
  • Is there any risk for the medics encountering xylazine?

About our guest

Dr. Jerry Snow, MD, is assistant director of the Medical Toxicology Fellowship and director of the Toxicology rotation at Banner – University Medical Center in Phoenix.

Read more: White House warning: What you need to know about xylazine


1. ACEP. McAward A. Xylazine, an Emerging Adulterant

2. Reader G, Moreno C, Washington J. KXAN. Drug responsible for recent overdoses in Austin-Travis County identified by officials

3. Reyes, J. C., et al. “The emerging of xylazine as a new drug of abuse and its health consequences among drug users in Puerto Rico." Journal of Urban Health 89.3 (2012): 519-526.

4. Ruiz-Colón, Kazandra, et al. “Xylazine intoxication in humans and its importance as an emerging adulterant in abused drugs: a comprehensive review of the literature." Forensic Science International 240 (2014): 1-8.

5. Nunez, Jacqueline, Maura E. DeJoseph, and James R. Gill. “Xylazine, a veterinary tranquilizer, detected in 42 accidental fentanyl intoxication deaths." The American Journal of Forensic Medicine and Pathology 42.1 (2021): 9-11.

6. Johnson, Jewell, et al. “Increasing presence of xylazine in heroin and/or fentanyl deaths, Philadelphia, Pennsylvania, 2010–2019." Injury prevention 27.4 (2021): 395-398.

7. Friedman, Joseph, et al. “Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis." Drug and Alcohol Dependence (2022): 109380.

8. Maryland Poison Control. Xylazine

9. Drug Enforcement Administration. Xylazine

The MCHD Paramedic Podcast was launched in early 2018 in an effort to provide easily consumable core-content EMS education and insights from prehospital care thought leaders. The Clinical Services Department of The Montgomery County Hospital District EMS service developed the podcast as a tool to better engage and disseminate continuing education to our MCHD medics as well as first responders and EMS professionals nationwide.

Dr. Casey Patrick is the assistant medical director for Montgomery County Hospital District EMS and is a practicing emergency physician in multiple community emergency departments across Greater Houston. His EMS educational focus is on innovative paramedic teaching via the MCHD Paramedic Podcast. Dr. Patrick’s prehospital clinical research involves the investigation of paramedic use of bolus dose intravenous nitroglycerin for acute pulmonary edema and the implementation of lung protective ventilation strategies for intubated EMS patients. Casey and his wife, Alyssa, work and live in Conroe, Texas, and Spokane, Washington. Together they have five children: Mia, Ainsley, Brock, Dean and Will.

Dr. Dickson graduated with honors from the University of Texas Health Science Center San Antonio in 2001 and completed emergency medicine training at Indiana University in 2004. He serves as the EMS medical director at Montgomery County Hospital District EMS and an assistant professor of emergency medicine at Baylor College of Medicine in Houston, Texas. His academic interests include systems of care in stroke and other time-sensitive emergencies, neurologic emergencies and education. He is board certified in emergency medicine in both the U.S. and Australasia, and has subspecialty board certification in EMS medicine. He has authored multiple professional articles and presented at regional, national and international conferences on emergency medicine and EMS topics.