Experiences with Xylazine among Residential Treatment Patients

Background: Xylazine, a non-opioid alpha-2 adrenergic verterinary tranquilizer, is increasingly seen as an adulterant in the illicit opioid supply in North America. In addition to increasing risk for overdose, xylazine is associated with negative health outcomes such as skin ulcers and infections. We explore experiences and perspectives of Xylazine exposure among a cohort of residential treatment patients in Baltimore, Maryland.     
 
Methods: A cross-sectional survey of 322 patients starting residential treatment was conducted from September 2023 through January 2024. Patients were queried about their knowledge and opinions of Xylazine in the local drug supply, including self-reported preference for drugs that contain Xylazine. We examine characteristics of the cohort (including age, gender, race, ethnicity, housing status, education, and employment), as well as the opinions and experiences with xylazine-contaminated drugs. 
                                  
Results: Most participants identified as male (66.8%) and non-Hispanic Black (59.3%), with a mean age of 41.3 years (SD=12.1). The majority of patients reported at least a high school education (63.4%) and were unemployed at the time of enrollment (56.2%), while over one quarter reported homelessness (27.6%). When asked about their experience with Xylazine, a small minority of participants reported intentionally using drugs containing Xylazine (3.4%). While 15.2% thought that the drugs they were taking just before coming to treatment contained Xylazine, most participants (58.1%) were not sure that their drug supply was contaminated with Xylazine. Participants overwhelmingly reported that they did not prefer drugs with xylazine in them (98.8%) and 82.3% reported being somewhat or very worried about Xylazine in the local drug supply. 
 
Conclusions: These findings highlight a strong aversion to xylazine-contaminated drugs, which has increasingly penetrated the local drug supply. Due to the negative health consequences of Xylazine use, it is critical to provide people who use drugs with education about the drug supply and related harms, as well as resources that promote harm reduction, such as drug checking and wound care.