Xylazine Test Strip Use Among People Who Use Drugs in New York State

Xylazine test strips (XTS) allow for rapid identification of xylazine in drugs, yet little is known about those using XTS. Therefore, this study explores the characteristics of people who use drugs (PWUDs) who use XTS and examines risk reduction behaviors associated with XTS use.

This observational cohort study was conducted in New York between September and December 2023 as part of a larger study. Questions about XTS use were added to the parent study's baseline survey of PWUDs and were completed by 254 PWUDs. Sociodemographic characteristics compared XTS users to nonusers. Propensity score weighting using inverse probability of treatment weights was used to examine the association of ever-using XTS with risk reduction behaviors and the drug type used.

Sixty-six participants (26%) had used XTS; 80% trusted the results, and 79% were confident in their ability to use XTS to detect xylazine. Those who had used XTS were more likely to have naloxone nearby (aOR=7.51, 95% CI: 2.26-24.95, P =0.001), use a test shot (aOR=2.43, 95% CI: 1.18-5.01, P =0.016), have someone check on them while using (aOR=2.52, 95% CI: 1.23-5.19, P =0.012), and watch someone use the same drugs (aOR=2.35, 95% CI: 1.19-4.65, P =0.014). XTS use was associated with using opioids (aOR=3.68, 95% CI: 1.38-9.81, P =0.009) and injecting drugs (aOR=4.32, 95% CI: 1.91-9.77, P <0.001).

Our study demonstrates that XTS use appears to be associated with engaging in risk reduction behaviors, suggesting XTS can be a useful harm reduction tool. More research is needed to assess whether PWUDs change their drug consumption behaviors based on XTS results.