National Drug Early Warning System (NDEWS) Weekly Briefing


Report from the Web Monitoring Team: Online mentions of xylazine

What was found? A Subreddit discussion trend for xylazine, a sedative used in veterinary anesthesia, is reaching record highs. The last peak close to this size was in mid-2022.
How is it being discussed?
 Recent discussions of xylazine on Reddit primarily involve warnings of the drug as a common cutting agent in illicit fentanyl. The recent increase in online discussions of xylazine may also be due in part to increased media attention on its presence in the drug supply and its associated adverse effects.
Drug Terms:
 Xylazine, fentanyl.

Quotes from NDEWS Sentinel Site Directors regarding xylazine's impact in their area

Minnesota:Through our [Minnesota Drug Overdose and Substance Use Surveillance Activity] MNDOSA system, which tests clinical specimens from participating hospitals, we have had several sample detections [of xylazine], with the number increasing in 2021 and 2022. The number of drug overdose deaths with xylazine involvement continues to increase. The number of deaths has increased from 4 in 2019 to 32 deaths through the third quarter of 2022. While some of this increase may be attributable to improved toxicology testing, xylazine involvement in drug overdose deaths continues to increase.

– Nate Wright, MPH, Epidemiologist Supervisor, Syndromic Surveillance & Drug Overdose Epidemiology Unit, Injury & Violence Prevention Section, Minnesota Department of Health, Duluth, MN. 1/18/2023.

Chicago, IL: [As of January 1, 2023 there have been144 [xylazine-relateddeaths in 2022 in Cook County (records for 2022 are not yet complete). Deaths were higher in the first half of 2022 (n=90) compared to the second half (n=54). Fentanyl was detected in all of these deaths.” 

– Lawrence Ouellet, PhD, Research Professor Emeritus, Associate Director, Community Outreach Intervention Projects, Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois Chicago.

"Tranq dope": Xylazine, an animal sedative mixed with fentanyl, brings unparalleled turmoil to US

A recent article from The New York Times warns of the veterinary tranquilizer xylazine, which has been increasingly detected as an adulterant in the illicit drug supply across the US. As the article reports, xylazine, also known as “tranq” and “tranq dope,” is being used to bulk up illicitly manufactured fentanyl. Its use has been associated with serious wounds, and because xylazine is not an opioid, standard opioid overdose reversal treatments may be less effective.  The drug currently exists in a "legal gray zone" and is not listed as a controlled substanceRead the article here.

Widespread distribution of xylazine detected throughout the US in patient samples collected in healthcare settings

In a study published January 6th in the Journal of Addiction Medicine, samples collected from patients in various outpatient healthcare settings were analyzed for the presence of xylazineOut of the 39 states that ordered xylazine testing, 25 states reported xylazine-positive samples. Of the samples that were positive for xylazine, fentanyl, buprenorphine, nicotine, cocaine, naloxone, D-methamphetamine, and delta-9-THC were also detected. The authors note the prevalence of xylazine has spread geographically throughout the US and is indicative of the wide incorporation into the illicit drug supply. Read the study here.

DEA: The growing threat of xylazine

A Joint Intelligence Report from the Drug Enforcement Administration (DEA) details the presence and dangers of xylazine in an increasing number of illicit drug mixtures and overdose deaths. The report provides an overview of xylazine, including its adverse effects, signs of overdose, and an outlook for its future in the US. Read the report here.

Xylazine test strips for use in drug checking

The Center for Forensic Science Research and Education (CFSRE) released a new report on the effectiveness of xylazine test strips for use in drug checkingFrom their research, the minimum concentration of xylazine needed for a positive detection was 650 ng/mL when dissolved in water. In a test with 25 drug samples, 20 samples contained xylazine, and all 20 samples containing xylazine produced positive responses on the xylazine test strips. The authors concluded that the xylazine test strips can reliably produce presumptive results of the presence of xylazine in drug samples. Read the report here.

Xylazine found to complicate opioid intoxication in children

In a study recently published in Pediatrics, the authors presented three cases of synthetic opioid intoxication complicated by the concomitant presence of xylazine. Three exposed children presented with severe signs and symptoms, two of whom experienced cardiac arrest. Xylazine was detected in urine studies only through the use of specialized toxicology testing. The authors note that xylazine is likely underreported due to variability in testing and awareness it has been ingested. Read the study here.


• 'We don’t live in a harm reduction world, we live in a prohibition world': tensions arising in the design of drug alerts

Isabelle Volpe, Rita Brien, Jasmin Grigg, Stephanie Tzanetis, Sione Crawford, Tom Lyons, Nicole Lee, Ginny McKinnon, Caitlin Hughes, Alan Eade, & Monica J. Barratt. Harm Reduction Journal; January 9, 2023.
Read the study here.


• UF HealthStreet Our Community, Our HealthMedical marijuana and public health

 Irvine PeDro Cohen, ED, MBA
Robert L. Cook, MD MPH
Bertha Madras, PhD
LaTrice Montgomery, PhD
Florida A&M’s Medical Marijuana Education and Research Initiative Team
Date: Monday, January 30, 2023
Time: 11 a.m. - 12 p.m. EST
Zoom link.

• NMS Labs: Tolerant or intolerant? Learning from studying drug concentrations in the living and the dead

Speaker: NMS Labs Director of Toxicological Services, Laura M. Labay, Ph.D., F-ABFT, DABCC-TC
Date: Wednesday, February 8, 2023
Time: 1 p.m. - 2 p.m. EST
Register here.

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