Differences in Xylazine and Xylazine Test Strip Usage Among Racial and Ethnic Minoritized Populations: Findings from the Stay Safe Study.

Xylazine is increasingly detected in overdose fatalities across the US. Xylazine test strips (XTS) are provided at no cost to people who use drugs (PWUD) in New York State (NYS) to encourage informed decision-making and safer drug-use behavior. XTS were only made available publicly in 2023, so there are likely discrepancies in XTS access and availability. This study aims to explore the differences in xylazine and XTS use across racial and ethnic groups. The Stay Safe Study (SSS) is a multi-state study examining drug-checking behaviors among PWUD over a 28-day observation period. Questions about XTS use were added to the parent study’s baseline survey of PWUD in NYS alone (n = 254). Logistic regression models were used to assess differences in xylazine and XTS use across racial and ethnic subgroups. Compared to non-Hispanic White (NHW) respondents, Black participants reported 63% lower odds and other participants reported 82% lower odds of intentionally using xylazine in the past 30 days. Compared to NHW respondents, Black participants reported 83% lower odds of using XTS in their lifetime and 82% lower odds of trusting XTS. Lastly, compared to NHW respondents, Hispanic or Latino respondents reported 2.5 times greater odds of using XTS to avoid skin wounds. These findings underscore the need to culturally tailor harm reduction outreach and engagement strategies to racial and ethnic minoritized populations. The study findings, in conjunction with the disproportionately higher burden of overdose deaths among minoritized populations, call for stronger investment in harm reduction strategies and outreach approaches.