Xylazine in Overdose Deaths and Forensic Drug Reports in US States, 2019-2022

Abstract

ImportanceXylazine is increasingly reported in street drugs and fatal overdoses in the US, yet state-level data are limited, hampering local public health responses.ObjectiveTo gather available state-level data on xylazine involvement in overdose deaths and in forensic drug reports.Design, Setting, and ParticipantsThis cross-sectional study was a secondary analysis of 2019 to 2022 data from the National Forensic Laboratory Information System (NFLIS), National Center for Health Statistics, and individual states' medical examiner or public health agency reports. Data were analyzed from August to October 2023.ExposureState.Main Outcomes and MeasuresYearly xylazine-related overdose deaths per 100 000 residents; xylazine NFLIS drug reports, both per 100 000 residents and as a percentage of all NFLIS drug reports (from samples of drugs seized by law enforcement and analyzed by NFLIS-participating laboratories).ResultsA total of 63 state-years were included in analyses of mortality rates, while 204 state-years were included in analyses of NFLIS reports. According to the publicly available data compiled in this study, at least 43 states reported at least 1 xylazine-related overdose death from 2019 to 2022, yet yearly totals of xylazine-related deaths were available for only 21 states. Of states with data available, xylazine-involved overdose death rates were highest in Vermont (10.5 per 100 000 residents) and Connecticut (9.8 per 100 000 residents) in 2022. In 2019, 16 states had zero xylazine reports included in NFLIS reports; in 2022, only 2 states had zero xylazine reports and all but 3 states had recorded an increase in xylazine’s representation in NFLIS reports. In 2022, xylazine represented 16.17% of all NFLIS reports in Delaware and between 5.95% and 7.00% of NFLIS reports in Connecticut, Maryland, District of Columbia, New Jersey, and Rhode Island, yet less than 1.0% of NFLIS reports in 35 different states.Conclusions and RelevanceIn this cross-sectional study of publicly available data on fatal overdoses and drugs analyzed by forensic laboratories, xylazine’s reported presence in overdose deaths and forensic reports was concentrated in the eastern US yet extended across the country to encompass nearly all states. In spite of xylazine’s geographic reach, yearly state-level numbers of xylazine-related overdose deaths were publicly available for less than half of all states.

Reducing overdose deaths among persons with opioid use disorder in connecticut

“…As the baby boomer generation enters older adulthood, prior trends in substance use and aging may no longer hold true and problematic opioid use and overdose have been increasing among older adults [ 68 , 69 ]. The veterinary tranquilizer xylazine is increasingly detected in fatal heroin and fentanyl overdoses and Connecticut had among the highest rates of xylazine-involved deaths in 2022 [ 70 ], which is not explicitly captured in our model. However, our deterministic sensitivity analyses varied the model inputs, including rates of incarceration and overdose mortality, and suggests that our results are overall robust.…”

Classics in Chemical Neuroscience: Xylazine

“…A cross-sectional study examining xylazine-related fatalities and forensic reports from 2019 to 2022 revealed a concentration primarily along the East Coast, while indicating a burgeoning presence across the entirety of the United States. Remarkably, nearly every state, except for three, documented a surge in cases during this period …”