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. 2026 Jan 2;23(1):70.
doi: 10.3390/ijerph23010070.

Perceptions and Experiences of Xylazine, Disparities in Xylazine Awareness, and Correlates of Xylazine-Attributed Wounds Among People Who Use Opioids

Carl A Latkin  1   2 , Lauren Dayton  1 , Haley Bonneau  1 , Melissa A Davey-Rothwell  1 , Danielle German  1 , Ananya Bhaktaram  1 , Oluwaseun Falade-Nwulia  2
Affiliations

Perceptions and Experiences of Xylazine, Disparities in Xylazine Awareness, and Correlates of Xylazine-Attributed Wounds Among People Who Use Opioids

Carl A Latkin et al. Int J Environ Res Public Health. .

Abstract

Background: Xylazine, an adulterant in the illicit opioid supply, heightens the risks of overdose, withdrawal severity, and severe wounds among people who use opioids (PWUO). Despite increasing prevalence, gaps remain regarding xylazine awareness in the drug supply and effective harm reduction interventions to address it.

Methods: We conducted a cross-sectional survey of 703 PWUO in Baltimore, MD (2023-2025), to assess xylazine awareness, perceptions, and experiences. Multivariable logistic regression models examined correlates of xylazine awareness and self-reported xylazine-attributed wounds.

Results: 84.8% of White participants, 48.6% Black participants, 64.3% of males, and 51.4% females had heard of xylazine. Nearly half (45%) of those who used xylazine reported that it caused more severe withdrawal symptoms. In the multivariable model of xylazine awareness, the largest odds ratios were year of survey administration (2024 vs. 2023: aOR = 4.30, 95% CI = 2.91-6.37; 2025 vs. 2023: aOR = 6.32, 95% CI = 3.31-12.07) and White race (aOR = 3.22, 95% CI = 1.85-5.57). Other significant demographic variables included education and gender. In the multivariable model of xylazine-attributed wounds, survey year 2025 vs. 2023 (aOR = 2.65, 95% CI = 1.06-6.61) and injection drug use in the prior year (aOR = 17.74, 95% CI = 5.58-56.39) were statistically significant.

Conclusions: Awareness of xylazine in the drug supply remains incomplete among PWUO, with differences by race, age, and gender. The finding of a strong association of xylazine-attributed wounds and injection drug use should be the focus of future research. These findings underscore the need for enhanced surveillance systems, peer education, and community-based harm reduction strategies. Real-time monitoring and rapid response strategies are essential to protect against health risks of toxic adulterants, such as xylazine, medetomidine, and BTMP, in the drug supply.

Keywords: fentanyl; harm reduction; overdose; withdrawal; wound care; xylazine.

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Conflict of interest statement

The authors declare no conflicts of interest.

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