{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T02:41:39Z","timestamp":1783651299272,"version":"3.55.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T00:00:00Z","timestamp":1738627200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Xylazine, a veterinary sedative, is increasingly being discovered in the illegal drug supply across the United States and is associated with overdose fatalities. Not approved for human use, xylazine poses life-threatening risks, particularly when used in conjunction with opioids such as fentanyl. This study evaluates the prevalence of xylazine in urine samples that screened positive for fentanyl. The evaluation involved measuring the parent drug xylazine and its metabolites, xylazine glucuronide and hydroxy-xylazine, as well as finding their correlation with fentanyl and norfentanyl concentrations in patient samples.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Samples were collected over a one-month period. Urine samples were analyzed for fentanyl, norfentanyl, and 3 xylazine-specific analytes (i.e., xylazine, xylazine glucuronide, and hydroxy-xylazine). Briefly, reverse-phase chromatographic separation was performed on a Bonshell Phenyl-Hexyl column utilizing a binary mobile phase gradient. The eluents were detected through positive electrospray ionization and multiple reaction monitoring analysis on a triple quadrupole mass spectrometer.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Out of a total of 230 urine samples, 184 were confirmed positive for fentanyl. Xylazine was detected in 56 out of the 184 fentanyl-positive samples, accounting for 30% of the fentanyl-positive confirmatory test. Xylazine (or its metabolites) was not observed in fentanyl-negative samples. Furthermore, the parent xylazine drug was detected in all 56 samples, whereas the metabolite glucuronide and hydroxy forms were only detected in 28 and 6 samples, respectively.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study estimated a xylazine prevalence of 30% in fentanyl-positive urine samples within our local Western New York population. This study represents the first report within our clinical population.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jalm\/jfae158","type":"journal-article","created":{"date-parts":[[2025,2,4]],"date-time":"2025-02-04T17:39:59Z","timestamp":1738690799000},"page":"572-582","source":"Crossref","is-referenced-by-count":8,"title":["The Prevalence of Xylazine in Patient Urine Samples That Were Positive for Fentanyl in Western New York"],"prefix":"10.1093","volume":"10","author":[{"given":"Brandy L","family":"Young","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Rochester Medical Center , Rochester, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4125-4333","authenticated-orcid":false,"given":"Putuma P","family":"Gqamana","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Rochester Medical Center , Rochester, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinghua","family":"Qiu","sequence":"additional","affiliation":[{"name":"Rexel Medicine Diagnostics, College of Medicine, Drexel University , Philadelphia, PA ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas E","family":"Nacca","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of Rochester Medical Center , Rochester, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y Victoria","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Rochester Medical Center , Rochester, NY ,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,4]]},"reference":[{"key":"2025050206371944600_jfae158-B1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.2344\/0003-3006-62.1.31","article-title":"Alpha-2 adrenergic receptor agonists: a review of current clinical applications","volume":"62","author":"Giovannitti","year":"2015","journal-title":"Anesth Prog"},{"key":"2025050206371944600_jfae158-B2","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1111\/j.1365-2885.1988.tb00189.x","article-title":"Xylazine\u2014a review of its pharmacology and use in veterinary medicine","volume":"11","author":"Greene","year":"1988","journal-title":"J Vet Pharmacol Ther"},{"key":"2025050206371944600_jfae158-B3","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/S0921-4488(96)00919-4","article-title":"Clinical effects of epidurally administered ketamine and xylazine in goats","volume":"24","author":"Aithal","year":"1997","journal-title":"Small Rumin Res"},{"key":"2025050206371944600_jfae158-B4","doi-asserted-by":"crossref","first-page":"470","DOI":"10.2460\/ajvr.73.4.470","article-title":"Evaluation of a midazolam-ketamine-xylazine infusion for total intravenous anesthesia in horses","volume":"73","author":"Hubbell","year":"2012","journal-title":"Am J Vet Res"},{"key":"2025050206371944600_jfae158-B5","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1056\/NEJMc2308155","article-title":"Medical and public health imperatives of xylazine","volume":"389","author":"Cole","year":"2023","journal-title":"N Engl J Med"},{"key":"2025050206371944600_jfae158-B6","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1136\/injuryprev-2020-043968","article-title":"Increasing presence of xylazine in heroin and\/or fentanyl deaths, Philadelphia, Pennsylvania, 2010\u20132019","volume":"27","author":"Johnson","year":"2021","journal-title":"Inj Prev"},{"key":"2025050206371944600_jfae158-B7","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1111\/j.1556-4029.2007.00648.x","article-title":"Concurrent detection of heroin, fentanyl, and xylazine in seven drug-related deaths reported from the Philadelphia Medical Examiner\u2019s Office","volume":"53","author":"Wong","year":"2008","journal-title":"J Forensic Sci"},{"key":"2025050206371944600_jfae158-B8","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1080\/15563650.2022.2159427","article-title":"Opioid overdoses involving xylazine in emergency department patients: a multicenter study","volume":"61","author":"Love","year":"2023","journal-title":"Clin Toxicol (Phila)"},{"key":"2025050206371944600_jfae158-B9","first-page":"e40983","article-title":"The new stealth drug on the street: a narrative review of xylazine as a street drug","volume":"15","author":"Pergolizzi","year":"2023","journal-title":"Cureus"},{"key":"2025050206371944600_jfae158-B10","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.7326\/M23-2001","article-title":"Xylazine adulteration of the heroin-fentanyl drug supply a narrative review","volume":"176","author":"D\u2019Orazio","year":"2023","journal-title":"Ann Intern Med"},{"key":"2025050206371944600_jfae158-B11","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.15585\/mmwr.mm7037a5","article-title":"Notes from the field: xylazine, a veterinary tranquilizer, identified as an emerging novel substance in drug overdose deaths\u2014Connecticut, 2019\u20132020","volume":"70","author":"Thangada","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025050206371944600_jfae158-B12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.forsciint.2014.03.015","article-title":"Xylazine intoxication in humans and its importance as an emerging adulterant in abused drugs: a comprehensive review of the literature","volume":"240","author":"Ruiz-Colon","year":"2014","journal-title":"Forensic Sci Int"},{"key":"2025050206371944600_jfae158-B13","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1097\/PAF.0000000000000622","article-title":"Xylazine, a veterinary tranquilizer, detected in 42 accidental fentanyl intoxication deaths","volume":"42","author":"Nunez","year":"2021","journal-title":"Am J Forensic Med Pathol"},{"key":"2025050206371944600_jfae158-B14","doi-asserted-by":"crossref","first-page":"100074","DOI":"10.1016\/j.dadr.2022.100074","article-title":"Perspectives of people in Philadelphia who use fentanyl\/heroin adulterated with the animal tranquilizer xylazine; making a case for xylazine test strips","volume":"4","author":"Reed","year":"2022","journal-title":"Drug Alcohol Depend Reports"},{"key":"2025050206371944600_jfae158-B15","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1080\/15563650.2017.1360496","article-title":"Recreational drug use at a major music festival: trend analysis of anonymised pooled urine","volume":"56","author":"Hoegberg","year":"2018","journal-title":"Clin Toxicol (Phila)"},{"key":"2025050206371944600_jfae158-B16","first-page":"e36864","article-title":"Xylazine in the opioid epidemic : a systematic review of case reports and clinical implications methods","volume":"15","author":"Ayub","year":"2023","journal-title":"Cureus"},{"key":"2025050206371944600_jfae158-B17","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1093\/jat\/bkac049","article-title":"Xylazine: pharmacology review and prevalence and drug combinations in forensic toxicology casework","volume":"46","author":"Kacinko","year":"2022","journal-title":"J Anal Toxicol"},{"key":"2025050206371944600_jfae158-B18","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1186\/s12954-024-00959-2","article-title":"Xylazine co-occurrence with illicit fentanyl is a growing threat in the Deep South: a retrospective study of decedent data","volume":"21","author":"Bradford","year":"2024","journal-title":"Harm Reduct J"},{"key":"2025050206371944600_jfae158-B19","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1097\/ADM.0000000000001132","article-title":"Widespread distribution of xylazine detected throughout the United States in healthcare patient samples","volume":"17","author":"Holt","year":"2023","journal-title":"J Addict Med"},{"key":"2025050206371944600_jfae158-B20","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.cca.2021.07.010","article-title":"High prevalence of xylazine among fentanyl screen-positive urines from hospitalized patients, Philadelphia, 2021","volume":"521","author":"Korn","year":"2021","journal-title":"Clin Chim Acta"},{"key":"2025050206371944600_jfae158-B21","doi-asserted-by":"crossref","first-page":"100209","DOI":"10.1016\/j.dadr.2023.100209","article-title":"Prevalence of xylazine among people who inject drugs seeking medical care at a syringe services program clinic: Miami, Florida, 2023","volume":"9","author":"Hauschild","year":"2023","journal-title":"Drug Alcohol Depend Reports"},{"key":"2025050206371944600_jfae158-B22","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1186\/s12954-021-00546-9","article-title":"Xylazine detected in unregulated opioids and drug administration equipment in Toronto, Canada: clinical and social implications","volume":"18","author":"Bowles","year":"2021","journal-title":"Harm Reduct J"},{"key":"2025050206371944600_jfae158-B23","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.1016\/j.jpba.2004.09.024","article-title":"Determination of fentanyl in human plasma and fentanyl and norfentanyl in human urine using LC-MS\/MS","volume":"37","author":"Huynh","year":"2005","journal-title":"J Pharm Biomed Anal"},{"key":"2025050206371944600_jfae158-B24","doi-asserted-by":"crossref","first-page":"9779","DOI":"10.1007\/s00216-013-7419-7","article-title":"Qualitative metabolism assessment and toxicological detection of xylazine, a veterinary tranquilizer and drug of abuse, in rat and human urine using GC\u2014MS, LC\u2014MS","volume":"405","author":"Meyer","year":"2013","journal-title":"Anal Bioanal Chem"},{"key":"2025050206371944600_jfae158-B25","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1016\/j.jchromb.2010.05.033","article-title":"Development and validation of a sensitive ultra performance liquid chromatography tandem mass spectrometry method for the analysis of fentanyl and its major metabolite norfentanyl in urine and whole blood in forensic context","volume":"878","author":"Verplaetse","year":"2010","journal-title":"J Chromatogr B Anal Technol Biomed Life Sci"},{"key":"2025050206371944600_jfae158-B26","article-title":"Opioid deaths in Monroe County in 2022. Monroe County Office of the Medical Examiner, 2022. Monroe County Government","author":"Granger"},{"key":"2025050206371944600_jfae158-B27","first-page":"567","article-title":"Pharmacokinetics of ketamine and xylazine in young and old Sprague\u2014Dawley rats","volume":"52","author":"Veilleux-lemieux","year":"2013","journal-title":"J Am Assoc Lab Anim Sci"},{"key":"2025050206371944600_jfae158-B28","article-title":"Xylazine: what clinicians need to know. New York State Department of Health","author":"New York State Department of Health\u2014AIDS Institute","year":"2023"}],"container-title":["The Journal of Applied Laboratory Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jalm\/article-pdf\/10\/3\/572\/61752736\/jfae158.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jalm\/article-pdf\/10\/3\/572\/61752736\/jfae158.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T10:37:30Z","timestamp":1746182250000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jalm\/article\/10\/3\/572\/7998794"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,4]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2,4]]},"published-print":{"date-parts":[[2025,5,2]]}},"URL":"https:\/\/doi.org\/10.1093\/jalm\/jfae158","relation":{},"ISSN":["2475-7241"],"issn-type":[{"value":"2475-7241","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,5]]},"published":{"date-parts":[[2025,2,4]]}}}