Characterizing pediatric xylazine exposures reported to United States poison centers, 2010-2024

Xylazine is an alpha-2 adrenergic receptor agonist not approved for use in humans. Xylazine has been increasingly found in the United States illegal drug supply and has been detected in fentanyl-associated overdose deaths. There are limited data on xylazine exposures in the pediatric population.

Data were obtained from America's Poison Centers® National Poison Data System® (NPDS), a near real-time surveillance system that collects data from poison centers across the US. A retrospective descriptive analysis was performed for xylazine-associated exposures reported to National Poison Data System® from January 2010 to December 2024 in children and teenagers ages 0-19 years.

There were 109 xylazine-associated exposures. Exposures increased over time, with most occurring during 2022-2024. The age distribution of xylazine-associated exposures included 57 (52.3%) among ages 0-5 years, four (3.7%) among ages 6-12 years, and 48 (44.0%) among ages 13-19 years. Thirty-six (33.0%) exposures were coded as xylazine only and 73 (67.0%) as xylazine plus at least one co-occurring substance. The most commonly coded co-exposure was fentanyl 55 (50.5%). Among exposures to xylazine only, the most common clinical effects were central nervous system (CNS) depression 15 (41.7%) and bradycardia four (11.1%). Among exposures to xylazine plus fentanyl, the most common clinical effects were CNS depression 44 (80.0%) and respiratory depression 38 (69.1%). Six patients died, all in the setting of xylazine co-occurring with fentanyl.

In the pediatric population, the clinical effects of exposure to xylazine only are grossly similar to those of other alpha-2 agonists. Contrary to exposures in adults, the medical sequelae of fentanyl exposure may be worsened by xylazine co-exposure in some pediatric populations. The limitations of this study are discussed.

Based on National Poison Data System® data, pediatric xylazine-related exposures are relatively uncommon. Clinicians must remain vigilant for adulterants, including the possible re-emergence of xylazine, in the illegal drug supply.