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Multicenter Study
. 2023 Mar;61(3):173-180.
doi: 10.1080/15563650.2022.2159427.

Opioid overdoses involving xylazine in emergency department patients: a multicenter study

Jennifer S Love  1 , Michael Levine  2 , Kim Aldy  3   4 , Jeffrey Brent  5 , Alex J Krotulski  6 , Barry K Logan  6 , Carmen Vargas-Torres  1 , Sara E Walton  6 , Alexandra Amaducci  7 , Diane Calello  8 , Robert Hendrickson  9 , Adrienne Hughes  9 , Anita Kurt  7 , Bryan Judge  10 , Anthony Pizon  11 , Evan Schwarz  12 , Joshua Shulman  11 , Timothy Wiegan  13 , Paul Wax  3   4 , Alex F Manini  1
Affiliations
Multicenter Study

Opioid overdoses involving xylazine in emergency department patients: a multicenter study

Jennifer S Love et al. Clin Toxicol (Phila). 2023 Mar.

Abstract

Introduction: Illicit opioids, consisting largely of fentanyl, novel synthetic opioids, and adulterants, are the primary cause of drug overdose fatality in the United States. Xylazine, an alpha-2 adrenergic agonist and veterinary tranquilizer, is being increasingly detected among decedents following illicit opioid overdose. Clinical outcomes in non-fatal overdose involving xylazine are unexplored. Therefore, among emergency department patients with illicit opioid overdose, we evaluated clinical outcome differences for patients with and without xylazine exposures.

Methods: This multicenter, prospective cohort study enrolled adult patients with opioid overdose who presented to one of nine United States emergency departments between 21 September 2020, and 17 August 2021. Patients with opioid overdose were screened and included if they tested positive for an illicit opioid (heroin, fentanyl, fentanyl analog, or novel synthetic opioid) or xylazine. Patient serum was analyzed via liquid chromatography quadrupole time-of-flight mass spectroscopy to detect current illicit opioids, novel synthetic opioids, xylazine and adulterants. Overdose severity surrogate outcomes were: (a) cardiac arrest requiring cardiopulmonary resuscitation (primary); and (b) coma within 4 h of arrival (secondary).

Results: Three hundred and twenty-one patients met inclusion criteria: 90 tested positive for xylazine and 231 were negative. The primary outcome occurred in 37 patients, and the secondary outcome occurred in 111 patients. Using multivariable regression analysis, patients positive for xylazine had significantly lower adjusted odds of cardiac arrest (adjusted OR 0.30, 95% CI 0.10-0.92) and coma (adjusted OR 0.52, 95% CI 0.29-0.94).

Conclusions: In this large multicenter cohort, cardiac arrest and coma in emergency department patients with illicit opioid overdose were significantly less severe in those testing positive for xylazine.

Keywords: Opioids; adulterants; fentanyl; toxicosurveillance; xylazine.

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Conflict of interest statement

Conflicts of Interest/Disclosure Statement: JSL is a research fellow in the Mount Sinai Clinical Scientist Training Program for Emergency Care Research (NIH1T32HL160513, NHLBI). BKL, AJK and SEW are employees of NMS Labs which complete the toxicologic specimen testing for this study.

Figures

Figure 1.
Figure 1.
Chemical structures of xylazine and clonidine.
Figure 2.
Figure 2.
Patient eligibility and enrollment.
See this image and copyright information in PMC

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