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King's College London Institute of Psychiatry, Psychology and Neuroscience addictions head Prof Sir John Strang, who was not involved in the study, said: "We need to be constantly alert to changes in the nature of the illicit drug market, especially as these changes sometimes bring new health complications or challenges." A government spokesperson said: "We are aware of the threat from xylazine and are determined to protect people from the threat posed by this drug and other illicit synthetic drugs

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A patient who smokes heavily but refuses to modify their habits presents a higher risk than someone who smokes occasionally or is willing to follow medical advice