{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T06:18:13Z","timestamp":1789625893937,"version":"build-2803163510"},"reference-count":71,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Xylazine is increasingly reported in street drugs and fatal overdoses in the US, yet state-level data are limited, hampering local public health responses.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To gather available state-level data on xylazine involvement in overdose deaths and in forensic drug reports.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cross-sectional study was a secondary analysis of 2019 to 2022 data from the National Forensic Laboratory Information System (NFLIS), National Center for Health Statistics, and individual states' medical examiner or public health agency reports. Data were analyzed from August to October 2023.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n State.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Yearly xylazine-related overdose deaths per 100\u202f000 residents; xylazine NFLIS drug reports, both per 100\u202f000 residents and as a percentage of all NFLIS drug reports (from samples of drugs seized by law enforcement and analyzed by NFLIS-participating laboratories).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 63 state-years were included in analyses of mortality rates, while 204 state-years were included in analyses of NFLIS reports. According to the publicly available data compiled in this study, at least 43 states reported at least 1 xylazine-related overdose death from 2019 to 2022, yet yearly totals of xylazine-related deaths were available for only 21 states. Of states with data available, xylazine-involved overdose death rates were highest in Vermont (10.5 per 100\u202f000 residents) and Connecticut (9.8 per 100\u202f000 residents) in 2022. In 2019, 16 states had zero xylazine reports included in NFLIS reports; in 2022, only 2 states had zero xylazine reports and all but 3 states had recorded an increase in xylazine\u2019s representation in NFLIS reports. In 2022, xylazine represented 16.17% of all NFLIS reports in Delaware and between 5.95% and 7.00% of NFLIS reports in Connecticut, Maryland, District of Columbia, New Jersey, and Rhode Island, yet less than 1.0% of NFLIS reports in 35 different states.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cross-sectional study of publicly available data on fatal overdoses and drugs analyzed by forensic laboratories, xylazine\u2019s reported presence in overdose deaths and forensic reports was concentrated in the eastern US yet extended across the country to encompass nearly all states. In spite of xylazine\u2019s geographic reach, yearly state-level numbers of xylazine-related overdose deaths were publicly available for less than half of all states.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.50630","type":"journal-article","created":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T11:31:02Z","timestamp":1704454262000},"page":"e2350630","source":"Crossref","is-referenced-by-count":100,"title":["Xylazine in Overdose Deaths and Forensic Drug Reports in US States, 2019-2022"],"prefix":"10.1001","volume":"7","author":[{"given":"Manuel","family":"Cano","sequence":"first","affiliation":[{"name":"School of Social Work, Arizona State University, Phoenix"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raminta","family":"Daniulaityte","sequence":"additional","affiliation":[{"name":"College of Health Solutions, Arizona State University, Phoenix"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Marsiglia","sequence":"additional","affiliation":[{"name":"School of Social Work, Arizona State University, Phoenix"},{"name":"Global Center for Applied Health Research, Arizona State University, Phoenix"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,1,5]]},"reference":[{"issue":"24","key":"zoi231478r1","doi-asserted-by":"publisher","first-page":"2209","DOI":"10.1056\/NEJMp2303120","article-title":"Xylazine\u2014medical and public health imperatives.","volume":"388","author":"Gupta","year":"2023","journal-title":"N Engl J Med"},{"issue":"37","key":"zoi231478r3","doi-asserted-by":"publisher","first-page":"1300","DOI":"10.15585\/mmwr.mm7037a4","article-title":"Notes from the field: xylazine detection and involvement in drug overdose deaths\u2014United States, 2019.","volume":"70","author":"Kariisa","year":"2021","journal-title":"MMWR 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Accessed October 27, 2023. https:\/\/www.mass.gov\/doc\/opioid-related-overdose-deaths-among-ma-residents-june-2023\/download"},{"key":"zoi231478r34","unstructured":"Michigan Department of Health and Human Services. Emerging trend update: xylazine in Michigan 2019-2023 Year-to-Date. Updated April 17, 2023. Accessed October 28, 2023. https:\/\/www.michigan.gov\/opioids\/-\/media\/Project\/Websites\/opioids\/documents\/Emerging-Trend_Xylazine-2022.pdf?rev=357a7cbe248843e29cf9c9ff9e031eb9"},{"key":"zoi231478r35","unstructured":"Minnesota Department of Health. Xylazine in Minnesota. Published September 12, 2023. Accessed October 28, 2023. https:\/\/www.health.state.mn.us\/communities\/opioids\/documents\/2023xylazinebrief.pdf"},{"key":"zoi231478r36","unstructured":"Mississippi State Department of Health. MS Health Alert Network-20230523-00595. Published May 23, 2023. 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Accessed October 29, 2023. https:\/\/odh.ohio.gov\/wps\/wcm\/connect\/gov\/f6a615c9-170b-47f2-ae6a-0f6403aff8db\/Ohio+Quarterly+Overdose+Report_Preliminary+Data_Q3+2023.pdf?MOD=AJPERES&CONVERT_TO=url&CACHEID=ROOTWORKSPACE.Z18_K9I401S01H7F40QBNJU3SO1F56-f6a615c9-170b-47f2-ae6a-0f6403aff8db-oEZgdja"},{"key":"zoi231478r43","unstructured":"Oregon Health Authority. Fentanyl facts. Accessed October 29, 2023. https:\/\/www.oregon.gov\/oha\/ph\/preventionwellness\/substanceuse\/opioids\/pages\/fentanylfacts.aspx"},{"key":"zoi231478r44","unstructured":"Pennsylvania Department of Health. Substances involved in drug overdose deaths, 2017-2022. Pennsylvania Office of Drug Surveillance and Misuse Prevention. Published January 21, 2022. Updated October 19, 2023. Accessed October 29, 2023. https:\/\/public.tableau.com\/app\/profile\/pennsylvania.pdmp\/viz\/PennsylvaniaODSMPDrugOverdoseSurveillanceInteractiveDataReport\/Contents"},{"key":"zoi231478r45","unstructured":"Sorg? MH, Soucier? 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Fentanyl adulterated or associated with xylazine response plan. Accessed August 22, 2023. https:\/\/www.whitehouse.gov\/wp-content\/uploads\/2023\/07\/FENTANYL-ADULTERATED-OR-ASSOCIATED-WITH-XYLAZINE-EMERGING-THREAT-RESPONSE-PLAN-Report-July-2023.pdf"},{"key":"zoi231478r62","unstructured":"Millennium Health. Zeroing in on xylazine: the first 100 days after US emerging threat designation. Millennium Health Signals Report. 2023. Accessed October 31, 2023. https:\/\/resource.millenniumhealth.com\/signalsreportxylazine"},{"key":"zoi231478r63","unstructured":"US Department of Justice. New York\/New Jersey High Intensity Drug Trafficking Area drug market analysis. Published June 2007. Accessed October 31, 2023. https:\/\/www.justice.gov\/archive\/ndic\/pubs23\/23502\/23502p.pdf"},{"key":"zoi231478r66","unstructured":"Shuda? S, Lam? H. Characterization of xylazine test strips for use in drug checking. The Center for Forensic Science Research & Education. Accessed August 14, 2023. https:\/\/www.cfsre.org\/nps-discovery\/drug-checking"},{"key":"zoi231478r69","unstructured":"New York State Office of Addiction Services and Supports. Xylazine. 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