ArticleHarm reduction journal2026
Navigating an unpredictable supply: lived experiences of xylazine exposure among people who use drugs.
Article in Harm reduction journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAs xylazine-adulterated opioids become more prevalent in the U.S., people who use drugs (PWUD) face growing risks from sedation, withdrawal, and wounds. This study explores PWUD perceptions on recognizing xylazine exposure including its physical effects and clinical harms and how these factors shape their drug use practices.
methodsIn August 2023, we surveyed adult PWUD clients reporting at least one past-year drug use-related wound across three Massachusetts syringe service programs with high xylazine prevalence. We compared demographics, drug use factors, physical effects, and clinical symptoms between those with and without self-reported past-90-day xylazine exposure and conducted content analysis of open-ended responses.
resultsOf the 171 respondents, 80% (n = 136) reported past-90-day xylazine exposure. The majority of respondents were male, white, non-Hispanic, and aged 36-45 years, with no significant differences by xylazine exposure. Xylazine-exposed participants commonly reported sedation (77%), loss of consciousness (52%), and wounds (91%). Most participants were afraid and frustrated, seeing xylazine as an unwanted contaminant but were often unable to avoid it due to financial constraints, withdrawal symptoms, and limited alternative options.
conclusionSyringe service program clients in Massachusetts commonly reported xylazine-adulterated fentanyl exposure, recognized through heavy sedation and skin wounds. Their experiences highlight the urgent need for real-time xylazine detection, safer supply, overdose and sedation risk mitigation, and improved wound prevention and care.
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