Top 5 Takeaways

1. Xylazine Detection: Xylazine was detected in 1.8% of overdose deaths reported to the State Unintentional Drug Overdose Reporting System (SUDORS) in 2019.
2. Xylazine Involvement: Xylazine was listed as a contributing cause of death in 1.2% of overdose deaths, with 64.3% of those cases having xylazine as a cause of death.
3. Demographic Trends: The majority of xylazine-involved deaths were among males (73.1%), non-Hispanic White persons (75.4%), and occurred primarily in the Northeast Census region (67.0%).
4. Co-Involvement with Fentanyl: Fentanyl or its analogs were involved in 98.7% of xylazine-positive deaths and 99.1% of xylazine-involved deaths.
5. Testing Limitations: Routine postmortem toxicology panels might not include tests for xylazine, potentially leading to underestimation of its involvement in overdose deaths.

Original Article Author and Citation

Corresponding Author

Mbabazi Kariisa, mkariisa@cdc.gov

Suggested Citation

Kariisa M, Patel P, Smith H, Bitting J. Notes from the Field: Xylazine Detection and Involvement in Drug Overdose Deaths — United States, 2019. MMWR Morb Mortal Wkly Rep 2021;70:1300–1302. DOI: http://dx.doi.org/10.15585/mmwr.mm7037a4

Summary

Xylazine, a veterinary sedative not approved for human use, was detected in a small percentage of overdose deaths in the United States in 2019. The drug was often found in combination with fentanyl, significantly increasing the risk of fatal overdose due to its central nervous system depressant effects. The study highlights the need for improved surveillance and standardized testing protocols to better understand and respond to the role of xylazine in the ongoing overdose epidemic.

Methods

The CDC analyzed data from the State Unintentional Drug Overdose Reporting System (SUDORS) across 38 states and the District of Columbia. Cases were classified as xylazine-positive if the drug was detected in postmortem toxicology or listed on the death certificate. Xylazine-involved cases were those where xylazine was a contributing cause of death. Detailed narrative texts were reviewed for additional context on xylazine use.

Discussion

The study found that xylazine was frequently co-involved with fentanyl in overdose deaths, which complicates the effectiveness of naloxone in reversing overdoses. The demographic data indicate a higher prevalence among males and non-Hispanic White individuals, particularly in the Northeast. The findings underscore the importance of enhanced toxicology testing and continued surveillance to inform public health responses.

Conclusion

While xylazine was detected in fewer than 2% of overdose deaths, its presence alongside potent opioids like fentanyl poses significant risks. There is a critical need for standardized testing and immediate supportive care in suspected xylazine-involved overdoses. Ongoing surveillance and research are essential to mitigate the impact of xylazine in the drug overdose epidemic.

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