Emerging Threat of Xylazine

The increasing reports of xylazine in clinical and postmortem toxicology necessitate a survey of its clinical impact. This review examines reports of xylazine across the peer-reviewed literature and grey literature (government and public health reports).

Before 2005, reports of xylazine abuse primarily involved veterinary-associated accidental and intentional exposures. A notable shift occurred in 2006 with increasing xylazine exposure documented among persons with illicit drug use, including fatal and nonfatal overdoses. Xylazine prevalence continued to increase in clinical and postmortem cases. Cases of xylazine abuse began in the northeast United States and expanded nationwide, with persistent high prevalence in the East and Midwest. Xylazine has been most frequently identified with fentanyl in clinical, drug-impaired driving, and postmortem analyses.

Xylazine's rising prevalence, especially as a fentanyl adulterant, contributes to increased opioid-related morbidity and mortality. Its presence across clinical, forensic, and environmental samples underscores the urgent need for enhanced surveillance, clinician education, public awareness, and targeted policy responses.