ArticleDrug and alcohol dependence2022
Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis.
Article in Drug and alcohol dependence, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06855836 (Efficacy and Implementation Considerations for a Peer-led Motivational Interviewing Intervention to Promote Uptake of Drug Checking Services and Safe Drug Use Behaviors to Reduce Overdose), which is not on this map. Cited by 195 papers, 3 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Efficacy and Implementation Considerations for a Peer-led Motivational Interviewing Intervention to Promote Uptake of Drug Checking Services and Safe Drug Use Behaviors to Reduce Overdose
Who cites it
195 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Management of xylazine toxicity, overdose, dependence, and withdrawal: A systematic review.The American journal on addictions · 2025Pooled it
- Supervised consumption sites and population-level overdose mortality: a systematic review of recent evidence, 2016-2024.Health promotion and chronic disease prevention in Canada : research, policy and practice · 2025Pooled it
- Exploring the Confluence of Animal Medicine and its Implications for Human Health: A Systematic Literature Review.Current neuropharmacology · 2025Pooled it
- Community-Based Cluster-Randomized Trial to Reduce Opioid Overdose Deaths.The New England journal of medicine · 2024Trial
- Healthcare provider approaches to managing the health harms of xylazine: A qualitative study.Journal of substance use and addiction treatment · 2026Article
- Trends in diagnosis of amyloid kidney disease in people who inject drugs (PWID).Preventive medicine reports · 2026Article
- A population-based study exploring racial and gender inequities in polysubstance-related deaths across the United States from 2004 to 2022.Addiction (Abingdon, England) · 2026Article
- Musculoskeletal imaging findings of xylazine-associated wounds.Emergency radiology · 2026Article
- Pharmacokinetics of xylazine and fentanyl in patients presenting to the emergency department after non-fatal opioid overdose.Drug and alcohol dependence · 2026Article
- Discovery, Structural Characterization, and Preclinical Evaluation of Monoclonal Antibodies against Xylazine Poisoning.ACS pharmacology & translational science · 2026Article
- Toxicological evidence of xylazine in fatal and non-fatal human intoxication: a systematic review.Forensic science, medicine, and pathology · 2026Review
- Integrating harm reduction interventions for older adults in opioid treatment programs: a qualitative study of patient and provider perspectives.Harm reduction journal · 2026Article
- Xylazine-Fentanyl Positivity and Concentration in Urine Drug Tests.JAMA network open · 2026Article
- Oxytocin attenuates respiratory depression and reduces mortality from fentanyl and the combination of xylazine-fentanyl in rats.Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie · 2026Article
- Theorizing causality: A qualitative study of xylazine-related wound diversity and perceived etiology among people who inject drugs.Addiction (Abingdon, England) · 2026Article
- Navigating an unpredictable supply: lived experiences of xylazine exposure among people who use drugs.Harm reduction journal · 2026Article
- Xylazine in Ohio: Insights from individuals with criminal legal system involvement and a history of illicit stimulant use.Drug and alcohol dependence reports · 2026Article
- Does Kappa Agonism Improve Reversal of 'Tranq-Dope' Overdose? Evidence from a Rodent Model.Pharmaceuticals (Basel, Switzerland) · 2026Article
- Adverse maternal and neonatal effects associated with perinatal xylazine exposure: a systematic review.Journal of perinatology : official journal of the California Perinatal Association · 2026Review
- A mixed methods examination of organizational approaches to fentanyl test strip distribution and training across multiple states.Harm reduction journal · 2026Article
135 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundSharp exacerbations of the US overdose crisis are linked to polysubstance use of synthetic compounds. Xylazine is a veterinary tranquilizer, long noted in the street opioid supply of Puerto Rico, and more recently Philadelphia. Yet its national trends, geographic distribution, and health risks are poorly characterized.
methodsIn this sequential mixed-methods study, xylazine was increasingly observed by ethnographers in Philadelphia among drug-sellers and people who inject drugs (PWID). Subsequently, we systematically searched for records describing xylazine-present overdose mortality across the US and assessed time trends and overlap with other drugs.
resultsIn 10 jurisdictions - representing all four US Census Regions - xylazine was increasingly present in overdose deaths, rising from 0.36% of deaths in 015m 6.7% in 2020. The highest xylazine prevalence data was observed in Philadelphia, (25.8% of deaths), followed by Maryland (19.3%) and Connecticut (10.2%). Illicitly-manufactured-fentanyls were present in 98.4% of xylazine-present-overdose-deaths - suggesting a strong ecological link - as well as cocaine (45.4%), benzodiazepines (28.4%), heroin (23.3%), and alcohol (19.7%). PWID in Philadelphia described xylazine as a sought-after adulterant that lengthens the short duration of fentanyl injections. They also linked it to increased risk of soft tissue infection and naloxone-resistant overdose.
conclusionsXylazine is increasingly present in overdose deaths, linked to the proliferation of illicitly-manufactured-fentanyls. Ethnographic accounts associate it with profound risks for PWID. Nevertheless, many jurisdictions do not routinely test for xylazine, and it is not comprehensively tracked nationally. Further efforts are needed to provide PWID with services that can help minimize additional risks associated with a shifting drug supply.
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