Top 5 Takeaways

1. Rising Incidence: Xylazine-associated deaths in Cook County, Illinois, increased from January 2017 to October 2021, peaking in October 2021.
2. Fentanyl Co-occurrence: 99.1% of xylazine-involved deaths also involved fentanyl or fentanyl analogs.
3. Common Co-occurring Substances: Other substances frequently found in xylazine-related deaths included diphenhydramine (78.1%), cocaine (41.9%), and quinine (33.8%).
4. Naloxone Detection: Naloxone was detected in 33.3% of xylazine-associated deaths, indicating attempts to reverse opioid overdose.
5. Public Health Implications: Increased monitoring, public education, and expanded surveillance are needed to address the rising trend of xylazine-involved deaths.

Original Article Author and Citation

Corresponding Author

Neeraj Chhabra, Nchhabra@cookcountyhhs.org

Suggested Citation

Chhabra N, Mir M, Hua MJ, et al. Notes From the Field: Xylazine-Related Deaths — Cook County, Illinois, 2017–2021. MMWR Morb Mortal Wkly Rep 2022;71:503–504. DOI: http://dx.doi.org/10.15585/mmwr.mm7113a3

Summary

Xylazine, a veterinary sedative not approved for human use, has been increasingly found in illicit opioids in the U.S. In Cook County, Illinois, xylazine-associated deaths rose from January 2017 to October 2021, with a peak in October 2021. Most of these deaths also involved fentanyl or its analogs. Other substances commonly found in these deaths included diphenhydramine, cocaine, and quinine. Naloxone, an opioid overdose reversal drug, was detected in a third of these cases, highlighting the challenges in reversing xylazine’s effects.

Methods

The study analyzed suspected substance-related deaths in Cook County from January 2017 to October 2021. Xylazine-associated deaths were identified through postmortem toxicology tests. Routine tests were also conducted for other substances like fentanyl, cocaine, and naloxone. The data was reviewed by the CDC and conducted in accordance with federal law and CDC policy.

Discussion

The findings indicate a concerning rise in xylazine-involved deaths, particularly in conjunction with fentanyl. This trend necessitates increased monitoring and public education. Health care providers should be aware that naloxone may not reverse xylazine effects, and cardiovascular and respiratory support are crucial. Designating xylazine as a controlled substance and expanding postmortem testing could help better understand and address this issue.

Conclusion

Xylazine-related deaths are on the rise in Cook County, Illinois, often involving fentanyl. Enhanced monitoring, public education, and expanded surveillance are essential to combat this trend. Health care providers need to be informed about the limitations of naloxone in reversing xylazine effects and the importance of supportive care.

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