{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T15:42:55Z","timestamp":1789054975761,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T00:00:00Z","timestamp":1768262400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["3R01DA048009\u201004S1"],"award-info":[{"award-number":["3R01DA048009\u201004S1"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and aims<\/jats:title>\n                    <jats:p>Xylazine, an alpha\u20102 agonist used in veterinary anesthesia, is increasingly detected in the illicit opioid supply but little is known about the patient level factors associated with xylazine in non\u2010fatal opioid overdose. This study aimed to determine the demographic and clinical factors associated with xylazine detection among emergency department (ED) patients with opioid overdose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Observational study. The Toxicology Investigators Consortium (ToxIC) Fentalog Study is a multicenter, prospective cohort of adult patients with suspected opioid overdose. This analysis included patients enrolled from September 2020 to September 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>In this multicenter study, participating sites included 10 institutions across 9 states in 4 regions of the United States (US): Northeast, Southeast, Midwest and West.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients were eligible for Fentalog Study inclusion if they were at least 18\u2009years old, had a suspected opioid overdose and had waste blood available for toxicologic analysis. Only patients with qualitative serum detection of illicit opioids and\/or xylazine were included in the final cohort. Of 5554 patients screened, 1289 were eligible for Fentalog Study inclusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Based on results of liquid chromatography with a quadrupole time\u2010of\u2010flight mass spectrometer (LCQTOF\u2010MS) and\/or liquid chromatography with a triple quadrupole mass spectrometer (LC\u2010QQQ\u2010MS), patients were categorized into those with xylazine detected (positive cases) and without xylazine detected (negative controls). To determine clinical variables associated with xylazine detection, the primary outcome of interest was qualitative detection of xylazine on serum sampling by LCQTOF\u2010MS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>Xylazine was detected in 238 patients. Patients with xylazine were primarily male (78%), white (48%), non\u2010Hispanic (82%) and located in the Northeast US (75%). Bradycardia on initial ED vital signs was associated with higher likelihood of xylazine detection (adjusted odds ratio = 2.11, 95% confidence interval = 1.06\u20134.06).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Xylazine detection among emergency department opioid overdose patients appears to be more prevalent in the Northeast US and bradycardia appears to be a statistically significant clinical predictor.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/add.70289","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T06:57:06Z","timestamp":1768373826000},"page":"1227-1236","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Clinical factors linked to xylazine exposure in emergency department patients with illicit opioid overdose"],"prefix":"10.1111","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5882-4390","authenticated-orcid":false,"given":"Jennifer S.","family":"Love","sequence":"first","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals\/Elmhurst, Center for Research on Emerging Substances, Poisoning, Overdose and New Discoveries (RESPOND)  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Vargas\u2010Torres","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals\/Elmhurst, Center for Research on Emerging Substances, Poisoning, Overdose and New Discoveries (RESPOND)  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim","family":"Aldy","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology  Phoenix AZ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Brent","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine  Aurora CO USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Wax","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology  Phoenix AZ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Culbreth","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology  Phoenix AZ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Krotulski","sequence":"additional","affiliation":[{"name":"Center for Forensic Science Research and Education at the Fredric Rieders Family Foundation  Horsham PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharan","family":"Campleman","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology  Phoenix AZ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barry","family":"Logan","sequence":"additional","affiliation":[{"name":"Center for Forensic Science Research and Education at the Fredric Rieders Family Foundation  Horsham PA USA"},{"name":"NMS Labs  Horsham PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Abston","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology  Phoenix AZ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shao","family":"Li","sequence":"additional","affiliation":[{"name":"American College of Medical Toxicology  Phoenix AZ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex F.","family":"Manini","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, NYC Health + Hospitals\/Elmhurst, Center for Research on Emerging Substances, Poisoning, Overdose and New Discoveries (RESPOND)  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Fentalog Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,13]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Policy TWHOoNDC.Biden\u2010Harris administration designates fentanyl combined with xylazine as an emerging threat to the United States. April 12 2023. Available from:https:\/\/www.whitehouse.gov\/ondcp\/briefing-room\/2023\/04\/12\/biden-harris-administration-designates-fentanyl-combined-with-xylazine-as-an-emerging-threat-to-the-united-states\/"},{"key":"e_1_2_10_3_1","unstructured":"Policy TWHOoNDC.In continued fight against overdose epidemic the White House releases national response plan to address the emerging threat of fentanyl combined with xylazine. July 11 2023. Available from:https:\/\/www.whitehouse.gov\/ondcp\/briefing-room\/2023\/07\/11\/in-continued-fight-against-overdose-epidemic-the-white-house-releases-national-response-plan-to-address-the-emerging-threat-of-fentanyl-combined-with-xylazine\/"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2303120"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000001235"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2024.01.041"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.7326\/M23-2001"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/1747-597X-6-7"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-011-9662-6"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2022.109380"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-024-00940-z"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000001245"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2021.111083"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-021-00546-9"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cca.2021.07.010"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7037a5"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7037a4"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2024.2309326"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.0572"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000001264"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650.2022.2159427"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1197\/jamia.m1087"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2009.00554.x"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.50630"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.3109\/15563658108990293"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1080\/15563650601073520"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jemermed.2015.09.051"},{"key":"e_1_2_10_28_1","volume-title":"Goldfrank's Toxicologic emergencies, 11e","author":"Wightman RS","year":"2019"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00213-023-06390-y"},{"key":"e_1_2_10_30_1","doi-asserted-by":"crossref","unstructured":"BedardML MurrayJG HuangX\u2010P NowlanAC ConleySY MottSE et al.Xylazine is an agonist at kappa opioid receptors and exhibits sex\u2010specific responses to naloxone administration.2023.https:\/\/doi.org\/10.1101\/2023.09.08.556914","DOI":"10.1101\/2023.09.08.556914"}],"container-title":["Addiction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/add.70289","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/add.70289","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/add.70289","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T12:49:31Z","timestamp":1776430171000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/add.70289"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,13]]},"references-count":29,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1111\/add.70289"],"URL":"https:\/\/doi.org\/10.1111\/add.70289","archive":["Portico"],"relation":{},"ISSN":["0965-2140","1360-0443"],"issn-type":[{"value":"0965-2140","type":"print"},{"value":"1360-0443","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,13]]},"assertion":[{"value":"2025-01-13","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-10-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}