Xylazine-Involved Drug Deaths Skyrocket in U.S.

Overdose deaths involving the animal tranquilizer xylazine saw a 34-fold increase from 2018 to 2021, news research shows, highlighting the dangers tied to a drug federal officials say is part of a growing threat in the U.S.

The number of fatal overdoses involving xylazine – a drug that can be used to sedate large animals and was approved for veterinary use in the U.S. in 1971 – increased from 102 in 2018 to 3,468 in 2021, according to an analysis released Friday by the Centers of Disease Control and Prevention’s National Center for Health Statistics. Over the same period, the death rate tied to the drug rose from 0.03 deaths per 100,000 to 1.06 per 100,000.

The analysis marks the first NCHS examination into the number of overdose deaths specifically involving xylazine, and comes as the drug, also known as “tranq”, has drawn attention from federal officials amid reports of it being mixed with the deadly synthetic opioid fentanyl.

In February, the Food and Drug Administration announced xylazine imports would be subject to heightened scrutiny to curb illicit use. And in April, the Office of National Drug Control Policy announced it was taking the novel step of designating xylazine mixed with fentanyl an “emerging threat” in an effort to proactively address the problem.

For the new study, researchers searched the literal text of drug overdose death certificates, identifying where xylazine was mentioned in sections listing causes of death or significant conditions contributing to a death, or describing how an injury occurred. They found that fentanyl substances were mentioned alongside xylazine in nearly all overdose deaths involving the tranquilizer from 2018 through 2021, with cocaine, methamphetamine and heroin among other illicit substances listed.

Notably, a separate study published a day earlier by the CDC found xylazine was detected in nearly 4,900 of roughly 54,000 deaths involving illicit fentanyl substances and co-involved as a cause of death in more than 3,700 from January 2021 to June 2022, based on data from 32 U.S. jurisdictions from the CDC’s State Unintentional Drug Overdose Reporting System. Using data from 20 states and the District of Columbia, researchers also found the monthly percentage of deaths involving illicit fentanyl substances with xylazine also detected increased 276% (from 2.9% to 10.9%) between January 2019 and June 2022.

“These data show that fentanyl combined with xylazine is increasingly dangerous and deadly – this is why the Biden-Harris administration recently designated it as an emerging threat,” Dr. Rahul Gupta, director of the Office of National Drug Control Policy, said in a statement about the CDC study released Thursday. “The administration is working tirelessly to launch a whole-of-government approach to tackle this emerging threat head-on, protect public health and public safety, and save lives.”

“As a sedative, (xylazine) may accentuate the effects of fentanyl, and there is some data to suggest that it may increase the duration of high from the opioid,” Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse, tells U.S. News. “I’m using words like ‘may’ because I think we don’t completely understand what makes it appealing.”

The new study from the NCHS found a consistently higher rate of overdose deaths involving xylazine among men than women, as well as increases in rates of xylazine-involved overdose deaths across all age groups between 2020 and 2021. Adults 35 to 44 years old had the highest xylazine-involved mortality rate at 2.24 deaths per 100,000 in 2021, while those 55 to 64 years old experienced the largest year-over-year increase, with a rate of 1.48 deaths per 100,000 in 2021 that was more than 3 times the 2020 rate of 0.45 per 100,000.

Black, white and Hispanic people also all experienced year-over-year increases in overdose mortality involving xylazine, with the highest rate among Black individuals at 1.82 per 100,000 in 2021. Whites had the second-highest rate that year at 1.21 per 100,000, while the largest percentage increase in the death rate occurred among Hispanics, who saw a more than 200% increase from 0.21 per 100,000 in 2020 to 0.64 per 100,000 in 2021, according to the study.

“However, note that death rates involving xylazine were low for all years, which may magnify the relative changes over time,” researchers said.

The study researchers pointed to potential underreporting of xylazine involvement in some U.S. jurisdictions. At the same time, main study author and statistician Merianne Spencer says heightened attention on xylazine may be associated with more testing for its presence, ultimately leading to more reporting of its involvement.

Dr. Kelly Ramsey, chief of medical services for the New York State Office of Addiction Services and Supports, says while some places in the U.S. – including states like New York and Maryland, as well as cities such as Philadelphia – have been monitoring overdose deaths involving xylazine, the true impact of the drug may be largely unknown in other areas.

“In most of the country, xylazine I think is underrecognized,” says Ramsey, who’s also a member of the board of directors for the American Society of Addiction Medicine.

As more states focus on xylazine, Ramsey and Compton agree more attention needs to be paid to how polysubstance overdoses – those involving the use of two or more drugs – are contributing to overdose mortality in the U.S., which saw nearly 107,000 overdose deaths in 2021.

“I think it’s really important to think about overdoses as primarily being due to polysubstance use,” Ramsey says. “The reason why we’re having more fatalities is because there is an underrecognition of polysubstance overdoses.”

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