Overdose deaths from fentanyl laced with xylazine jumped 276% in just 3 years

Key takeaways:

• From January 2019 to June 2022, the monthly percentage of fentanyl-involved deaths with xylazine rose from 2.9% to 10.9%.
• Officials are piloting a low-cost strip that tests substances for fentanyl and xylazine.

The number of overdose deaths attributable to illegally manufactured fentanyl laced with xylazine has skyrocketed in recent years, according to data in CDC’s MMWR.

Xylazine — a powerful animal tranquilizer also known as “tranq” — is not approved for human use and has no known antidote, Mbabazi Kariisa, PhD, Oak Ridge Institute for Science and Education fellow at the CDC, and colleagues wrote. Research has indicated that, in humans, xylazine can cause bradycardia, central nervous system depression, hypotension and respiratory depression.

Despite this, xylazine is being increasingly detected in illicitly manufactured fentanyl (IMF) products. In April, the Biden administration declared fentanyl laced or associated with xylazine as an “emerging threat” to the United States.

Prevalence of IMF-involved deaths with xylazine

Using data from CDC’s State Unintentional Drug Overdose Reporting System, Kariisa and colleagues described IMF-involved overdose deaths that did and did not detect xylazine from January 2019 to June 2022.

Among 21 jurisdictions, including 20 states and the District of Columbia, the monthly percentage of IMF-involved deaths with xylazine detected increased 276% — from 2.9% to 10.9%. In the same time frame, the monthly number of IMF-involved deaths with xylazine co-involved rose from 12 to 188.

Among 32 jurisdictions from January 2021 to June 2022, xylazine was detected in 9% of 53,969 IMF-involved deaths and co-involved in 6.9%. Kariisa and colleagues noted that xylazine detection varied by jurisdiction.

The states with the highest percentages and numbers of IMF-involved deaths with xylazine were:

• Maryland, 27.7% (923 deaths);
• Connecticut, 26.4% (507 deaths); and
• Pennsylvania, 23.3% (1,285 deaths).

Kariisa and colleagues wrote that the “geographic variation in xylazine detection could reflect differences in postmortem toxicology testing protocols, as well as its varying presence in regional drug supplies.”

“Detection of xylazine and its co-involvement in IMF-involved deaths were most frequent in the Northeast, where IMF-involved deaths increased earlier and IMFs are predominantly found in powdered form,” they wrote. “Xylazine detection was lowest in the West, where IMF-involved deaths increased later and IMFs are more commonly found in counterfeit pills.”

The researchers also noted that overdose circumstances, drug co-involvement in death and decedent demographics were “largely similar among IMF-involved deaths with and without xylazine detected,” suggesting that certain demographic groups are not disproportionately affected by xylazine, and specific drugs are not more often used with IMF products with vs. without xylazine.

“Further investigation of whether persons who use drugs are aware of xylazine presence in their products, and motivations for seeking it out or avoiding it, could help tailor prevention messaging,” they wrote.

Kariisa and colleagues also noted that more research is needed to determine xylazine’s effects on humans and characterize overdose risk, and expanded postmortem and drug product testing for xylazine is necessary to clarify its prevalence in drug supply.

“It is important for overdose prevention and response messages to highlight the potential presence of xylazine in IMF products and emphasize the need for respiratory and cardiovascular support to address the sedative effects of xylazine,” they wrote.

Health officials pilot test strip for xylazine, fentanyl

The effects of xylazine cannot be reversed with naloxone hydrochloride, according to the Drug Enforcement Agency, highlighting the importance of detection.

To improve detection efforts, health officials in Delaware partnered with SIVAD Diagnostic Medical Group LLC — a company that aims to address the needs of underserved and unserved communities — to pilot HarmGuard FX, a low-cost strip that tests substances for fentanyl and xylazine. The test has been validated by an FDA-registered testing lab that can quickly detect fentanyl and xylazine in various substances including pills, powders, residue from baggies and more.

“Delaware is committed to responding to the opioid crisis with the urgency it demands. We know harm reduction strategies work, and this new test provides another useful tool we can use to protect residents and save lives," Lt. Governor Bethany Hall-Long, PhD, RN, chair of the Delaware Behavioral Health Consortium, said in a press release.

References:

• DEA reports widespread threat of fentanyl mixed with xylazine. https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine. Published April 13, 2023. Accessed July 5, 2023.
• Kariisa M, et al. MMWR Morb Mortl Wkly Rep. 2023;doi:10.15585/mmwr.mm7226a4.
• SIVAD Diagnostic Medical Group LLC (SIVAD) combats opioid deaths with launch of HarmGuard FX, the only combination fentanyl and xylazine test strip available in the U.S. https://www.prnewswire.com/news-releases/sivad-diagnostic-medical-group-llc-sivad-combats-opioid-deaths-with-launch-of-harmguard-fx-the-only-combination-fentanyl-and-xylazine-test-strip-available-in-the-us-301865252.html?tc=eml_cleartime. Published June 28, 2023. Accessed July 5, 2023.