Observational studyAddiction (Abingdon, England)2026
Clinical factors linked to xylazine exposure in emergency department patients with illicit opioid overdose.
Observational study in Addiction (Abingdon, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
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The trial behind it
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Who cites it
3 citing papers in PubMed.
- An Emerging Synthetic Opioid in the Drug Supply: A Case of Opioid Overdose with Biological Confirmation of Cychlorphine.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2026Article
- The opioid flexion phenotype: postural flexion and nodding in the fentanyl era.Frontiers in neuroscience · 2026Article
- Xylazine Exposure and Association With Early Physiological and Withdrawal Symptoms in People With Opioid Use Disorder.Journal of addiction medicineArticle
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
BACKGROUND AND
aimsXylazine, an alpha-2 agonist used in veterinary anesthesia, is increasingly detected in the illicit opioid supply but little is known about the patient level factors associated with xylazine in non-fatal opioid overdose. This study aimed to determine the demographic and clinical factors associated with xylazine detection among emergency department (ED) patients with opioid overdose.
designObservational study. The Toxicology Investigators Consortium (ToxIC) Fentalog Study is a multicenter, prospective cohort of adult patients with suspected opioid overdose. This analysis included patients enrolled from September 2020 to September 2023.
settingIn this multicenter study, participating sites included 10 institutions across 9 states in 4 regions of the United States (US): Northeast, Southeast, Midwest and West.
participantsPatients were eligible for Fentalog Study inclusion if they were at least 18 years old, had a suspected opioid overdose and had waste blood available for toxicologic analysis. Only patients with qualitative serum detection of illicit opioids and/or xylazine were included in the final cohort. Of 5554 patients screened, 1289 were eligible for Fentalog Study inclusion. MEASUREMENTS: Based on results of liquid chromatography with a quadrupole time-of-flight mass spectrometer (LCQTOF-MS) and/or liquid chromatography with a triple quadrupole mass spectrometer (LC-QQQ-MS), patients were categorized into those with xylazine detected (positive cases) and without xylazine detected (negative controls). To determine clinical variables associated with xylazine detection, the primary outcome of interest was qualitative detection of xylazine on serum sampling by LCQTOF-MS.
findingsXylazine was detected in 238 patients. Patients with xylazine were primarily male (78%), white (48%), non-Hispanic (82%) and located in the Northeast US (75%). Bradycardia on initial ED vital signs was associated with higher likelihood of xylazine detection (adjusted odds ratio = 2.11, 95% confidence interval = 1.06-4.06).
conclusionsXylazine detection among emergency department opioid overdose patients appears to be more prevalent in the Northeast US and bradycardia appears to be a statistically significant clinical predictor.
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