Americans in 2021 suffered a fatal xylazine overdose at a rate 35 times higher than in 2018, according to data from the Centers for Disease Control and Prevention released Friday.
Summary What is already known about this topic? Xylazine, a non-opioid sedative, has been increasingly detected in illicitly manufactured fentanyl pharmaceuticals (IMF) and in overdose deaths. What does this report add? Across 21 jurisdictions, the monthly percentage of xylazine IMF-related deaths detected increased 276% from January 2019 (2.9%) to June 2022 (10.9%). During January 2021 to June 2022 in 32 jurisdictions, xylazine was detected in a higher percentage of IMF-related deaths in the Northeast US Census Bureau region; Listing xylazine as a cause of death varied across jurisdictions. What are the implications for public health practice? Routine xylazine testing in suspected overdose deaths is critical for surveillance; More research into the effects of xylazine in humans is needed to guide prevention efforts. Overdose prevention and response messages should emphasize the need to seek treatment beyond the administration of naloxone. |
Figure : Number and percentage of drug overdose deaths involving illicitly manufactured fentanyls, by month and xylazine detection or co-involvement: State Unintentional Drug Overdose Reporting System, 21 jurisdictions, § January 2019 to June 2022
Comments
The big picture: The spike shows how the veterinary sedative known as a “tranquilizer” or “zombie drug” that is often laced with fentanyl is greatly complicating the addiction crisis.
Xylazine, which is not an opioid and resists common overdose reversal methods, still accounts for a small number of deaths, said Merianne Spencer, lead researcher on the CDC study, who analyzed death certificate records.
But, Spencer told Axios, "the number that has increased in recent years really draws attention to what makes this a major public health issue."
By the numbers: Age-adjusted mortality rates from xylazine overdose increased from 0.03 in 2018 to 1.06 in 2021, according to the study. Almost all of these death certificates also mentioned fentanyl.
Put another way, the number of people in the U.S. who died from a xylazine-related overdose rose from 102 Americans in 2018 to nearly 3,500 three years later.
While all age groups saw an increase, death rates were highest for people aged 25 to 34 in 2020 with 1 death per 100,000 people and then the age group 35 to 44 in 2021 with 2 ,24.
Among racial and ethnic groups, death rates from xylazine-related overdoses were highest among black people, who are also facing an overall increase in overdoses nationwide.
But the largest increase occurred in Hispanics, who saw the xylazine-related overdose death rate triple from 0.21 in 2020 to 0.64 in 2021.
Xylazine causes fainting, suppresses heart rate, and can cause skin-rotting wounds that have led to amputation if left untreated.
In a separate CDC study released Thursday, researchers found that death rates from xylazine overdoses had increased 276% nationwide from January 2019 to June 2022.
The Biden administration declared it an emerging drug threat in April, a month after the FDA announced it would begin restricting importation of the animal sedative.
A patchwork of surveillance systems scattered across state and local governments makes it difficult to track drug prominence in real time, Rahul Gupta, director of the White House Office of National Drug Control Policy, said in a call from April with journalists.
"Many communities are not even aware of the threat in their backyard," added Gupta.
What we’re watching : Delaware became the first U.S. state to begin distributing paper strips that test for both xylazine and fentanyl this week in hopes of slowing the rise in drug-related overdose deaths. xylazine. Fentanyl and xylazine test strips are usually offered separately.
Nearby Philadelphia is one of the hotspots for xylazine use, and "we’ve seen a skyrocketing number of serious injuries and individuals requiring, unfortunately, amputation," Delaware Lt. Gov. Bethany Hall-Long told Axios.
Jermonica Boardley, president of SIVAD Diagnostic Medical Group, which distributes the xylazine-fentanyl test strips, said the company is currently in talks to expand the programs to other states.
Discussion
This report highlights four findings related to the detection of xylazine in deaths related to fentanyl (FMI) pharmaceuticals. First, the percentage of FMI-related deaths detected with xylazine increased by 276% from January 2019 to June 2022. Second, xylazine was detected in <12.0% of deaths related to fentanyl pharmaceuticals ( IMF) overall, but varied by jurisdiction from none to 27.7%, and was highest in the Northeast. Third, when xylazine was detected, whether it was determined to cause death varied by jurisdiction. Finally, demographic characteristics, drug co-involvement, and circumstances were very similar between IMF-related deaths with and without xylazine detected.
The timing and magnitude of the increase in xylazine detection among FMI-related deaths could reflect both increased frequency of testing and increased actual presence in the drug supply in recent years; however, due to inconsistency in testing, detection is still likely to be underestimated.
