Documenting the Emergence of Xylazine Among People Who Use Drugs in Rhode Island: An Analysis of Dried Blood Spot...

Xylazine has emerged in the unregulated drug supply and is associated with heavy sedation and severe skin wounds. This study uses dried blood spot (DBS) testing to examine xylazine exposure among a community-based sample of people who use drugs in Rhode Island.

We conducted a secondary analysis of 234 people who use drugs enrolled in a clinical trial with DBS samples from October 2020 to December 2023. Participants completed interviews at multiple visits (baseline, 6, and 12 months); DBS samples were tested at 1 or more of those time points. Samples were tested for xylazine, fentanyl, and fentanyl analogs. We compared baseline sociodemographic and drug use characteristics of participants with and without detectable xylazine at any time point using descriptive statistics.

We found that 69 (29%) participants had detectable fentanyl at 1 or more time points, and among those, 27 (39%) had detectable xylazine. Detection of xylazine was associated with younger age, non-Hispanic white race, and prior-month homelessness (all P < .05). Among 397 DBS samples, 97 (24%) had detectable fentanyl and 32 (8%) had detectable xylazine. Among samples with detectable fentanyl, xylazine positivity was 24%, 21%, and 80% in years 2021, 2022, and 2023, respectively.

DBS testing identified moderate levels of xylazine exposure among a sample of people who use drugs in Rhode Island during the observation period. Findings underscore the need for targeted xylazine education and harm reduction strategies focused on people who use fentanyl and unregulated opioids.