The illicit use of xylazine, a veterinary tranquillizer, is rapidly increasing across the United States. This drug is often combined with fentanyl, making it resistant to naloxone, the medication typically used to reverse opioid overdoses and can result in severe necrotic lesions.
Photo From New England Journal of Medicine
According to a report from Millennium Health, a speciality laboratory that provides medication monitoring for various treatment centres nationwide, there has been a notable rise in the number of urine samples testing positive for xylazine in U.S. drug treatment facilities over the past six months.
In late 2022, the FDA warned healthcare providers about the special considerations needed when dealing with opioid overdoses involving xylazine, also referred to as “tranq” or “tranq dope,” as previously reported by Medscape Medical News.
Following this, in early 2023, the White House Office of National Drug Control Policy identified the combination of xylazine and fentanyl as a new threat to the country.
Despite efforts from both the FDA and the DEA to curb the trafficking of this mixture, xylazine use has continued to increase.
The Millennium Health Signals report highlighted a significant increase in xylazine use, primarily in the western United States. In the first half of 2023, 3% of urine drug tests (UDTs) in Washington, Oregon, and California were positive for xylazine. This figure rose to 8% from November 2023 to April 2024, representing a 147% increase. In the Mountain West region, xylazine-positive UDTs grew from 2% in 2023 to 4% in 2024, marking a 94% increase. Besides the growth in the West, xylazine use more than doubled in New England, escalating from 14% in 2023 to 28% in 2024.
Nationally, 16% of all urine specimens tested positive for xylazine from late 2023 to April 2024, up from 14% between April and October 2023.
Xylazine use was most prevalent in the East and the mid-Atlantic United States, although positivity rates in the mid-Atlantic decreased from 44% to 33%. This region includes states like New York, Pennsylvania, Delaware, and New Jersey. The East North Central states (Ohio, Michigan, Wisconsin, Indiana, and Illinois) also saw a slight decrease in positive tests from 32% to 30%.
In the South Atlantic states, which encompass Maryland, Virginia, West Virginia, North and South Carolina, Georgia, and Florida, positivity increased by 17%, rising from 22% to 26%.
Between April 2023 and April 2024, state-level UDT positivity rates were 40% in Pennsylvania, 37% in New York, and 35% in Ohio. However, these rates vary locally. In Clermont and Hamilton counties in Ohio, located in the Cincinnati area, approximately 70% of specimens tested positive for xylazine.
Around one-third of specimens in Maryland and South Carolina contained xylazine.
“Since xylazine exposure remains a significant issue in the East and is becoming a concern in the West, healthcare providers across the U.S. need to be ready to identify and manage the consequences of xylazine use—such as reduced naloxone effectiveness and severe skin wounds that may require amputation—among individuals using fentanyl,” stated Angela Huskey, PharmD, Chief Clinical Officer at Millennium Health, in a press release.
The Health Signals Alert examined over 50,000 fentanyl-positive UDT specimens collected from April 12, 2023, to April 11, 2024. Millennium Health researchers studied xylazine positivity rates in fentanyl-positive UDT specimens by U.S. Census Division and state.
