Xylazine Awareness, Desire, Use and Exposure: Preliminary Findings from the Rhode Island CUTS Drug Checking Cohort

Abstract

BackgroundXylazine, an α2 adrenergic receptor agonist, is a veterinary sedative that causes severe health complications yet interventions to detect, prevent and treat human exposure remain underdeveloped. Community-based drug checking services (DCS) involve the consensual collection and testing of small amounts of drugs to increase community awareness and reduce drug-related harms. This study characterized xylazine awareness, desire, use and exposure among people who use drugs (PWUD) in Rhode Island, USA.MethodsWe linked and analyzed DCS and survey data from an ongoing cohort of PWUD. Between February and August 2023, 125 PWUD were recruited and enrolled from harm reduction organizations and surveyed about xylazine awareness and use behaviors. Using point-of-care Fourier Transform infrared spectroscopy (FTIR-S), at least one drug sample was tested from each participant and confirmed offsite at a laboratory. Results were conveyed in real-time, along with harm reduction education, referrals to resources and care.ResultsVirtually all participants (99%) wanted to avoid xylazine exposure. Half (51%) knew what xylazine was, and a quarter (26%) suspected previous exposure. Xylazine exposure was primarily surmised through sedating (45%) and ulcerative (26%) effects. Only 9% of participants submitted a sample that they perceived to contain xylazine. Xylazine was detected in 14% of samples using FTIR-S and in 21% of samples using a dual laboratory approach of gas chromatography mass spectrometry (GC-MS) and liquid chromatography quadrupole-time-of-flight mass spectrometry (LC-QTOF-MS). Participants thought that these xylazine-positive samples were fentanyl (77%), heroin (14%), or Percocet® (9%).ConclusionImplementing point-of-care DCS at harm reduction organizations could be useful in rapidly increasing xylazine awareness and engaging at-risk individuals in prevention, harm reduction, treatment, and rapid care for xylazine-related wounds.