TO THE EDITOR: Gupta et al. state that the first illicit use of xylazine was reported in Puerto Rico in 2001, but we reported and published an instance of abuse 10 years earlier.1 Our patient, who had previously had a heroin addiction, presented to an emergency department with symptoms suggestive of cerebrovascular accident, but no such event was confirmed on imaging. He was discharged without complications 24 hours later. We cited in our report two previously reported overdose cases: an accidental overdose related to equestrian care2 and a “therapeutic” use in the wife of a veterinarian for intractable hand pain.3 As Gupta et al. rightly point out, although clonidine and lofexidine have been used in xylazine-withdrawal management, and yohimbine and tolazoline in acute overdose,4 new and more solid evidence should define the exact roles of these agents.
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