Xylazine has recently emerged as a significant factor in the ongoing overdose crisis, yet the full national scope of overdose deaths involving this substance remains unclear. While its presence in the drug supply was first noted in Puerto Rico in the early 2000s, data from 30 states between 2019 and 2022 reveals a concerning trend: xylazine detection in drug seizures more than doubled. According to the U.S. Centers for Disease Control and Prevention (CDC), analysis from the State Unintentional Drug Overdose Reporting System (SUDORS) across 20 states and the District of Columbia showed a dramatic 276% increase in the monthly percentage of fentanyl-related overdose deaths where xylazine was also detected. This rise occurred between January 2019 (2.9%) and June 2022 (10.9%). It’s important to note that these rates can fluctuate from state to state; for example, a study focused on fatal overdoses in Michigan in 2023 found xylazine present in 4.7% of cases.
Interestingly, initial research into the effects of xylazine when combined with opioids does not suggest an increased likelihood of fatal overdose. A NIDA-funded study investigated individuals who had both xylazine and fentanyl in their systems during an overdose. The findings indicated that this group experienced lower rates of heart attack and coma compared to those who only tested positive for opioids. Furthermore, this same study discovered that individuals with xylazine in their system during an opioid overdose were no more likely to die than those who overdosed on opioids alone without xylazine. Hospitalization rates and length of hospital stays were also similar between the two groups, suggesting xylazine exposure did not worsen these outcomes in opioid overdose cases.
Expanding on these findings, another study examined individuals with both fentanyl and xylazine in their systems at the time of an opioid overdose. This research revealed that this group was no less likely to receive naloxone, the overdose reversal medication. In fact, they were found to be more likely to have a pulse upon the arrival of emergency responders compared to those who had overdosed on fentanyl without xylazine. To gain a deeper understanding of these unexpected results, the National Institute on Drug Abuse (NIDA) is actively supporting further research. This ongoing investigation aims to clarify how xylazine interacts with fentanyl within the body and to confirm these initial findings through broader studies.
