{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:32:51Z","timestamp":1786116771702,"version":"build-2736575974"},"reference-count":12,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Xylazine, a veterinary sedative and analgesic, has emerged as a novel adulterant in the US illicit drug supply, frequently co-occurring with fentanyl. This study examines trends in fentanyl-xylazine overdose death rates from 2018 to 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This serial cross-sectional study examined death certificates from the CDC WONDER database to identify International Classification of Diseases, 10th Revision codes for overdose deaths likely coinvolving fentanyl (T40.4) and xylazine (T42.7 or T46.5). Crude mortality rates per 100\u2009000 were calculated overall and by sex, race\/ethnicity, US Census Divisions and state to examine demographic and geographical trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Fentanyl-xylazine deaths increased from 99 in 2018 to 6020 in 2023. Crude mortality rates rose from 0.03 (95% CI 0.02 to 0.04) to 1.80 (95% CI 1.75 to 1.84) per 100\u2009000. In 2023, rates were higher among males than females (2.63 (95% CI 2.55 to 2.71) vs 0.99 (95% CI 0.93 to 1.03) per 100 000), and higher among black than white individuals (3.21 (95% CI 3.04 to 3.38) vs 1.86 (95% CI 1.80 to 1.92) per 100 000). The Middle Atlantic and New England Census Divisions had the highest regional rates at 5.72 (95% CI 5.49 to 5.95) and 4.32 (95% CI 3.99 to 4.65) per 100 000, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion and conclusions<\/jats:title>\n                    <jats:p>The sharp increase in fentanyl-xylazine deaths, particularly among black individuals, highlights both the growing infiltration of xylazine into the illicit drug supply and persistent structural disparities in addiction treatment. Addressing this escalating epidemic requires routine toxicological testing for xylazine and expanded access to trauma-informed care, harm reduction services and interventions such as naloxone, opioid agonist therapies and wound care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/ip-2024-045596","type":"journal-article","created":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T13:20:45Z","timestamp":1743600045000},"page":"490-494","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Fentanyl-xylazine overdose deaths in the USA, 2018\u20132023"],"prefix":"10.1136","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0173-495X","authenticated-orcid":false,"given":"David T","family":"Zhu","sequence":"first","affiliation":[{"name":"Virginia Commonwealth University, Richmond, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Cano","sequence":"additional","affiliation":[{"name":"Arizona State University, Tempe, Arizona, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,4,2]]},"reference":[{"key":"2026080605200755000_32.3.490.1","doi-asserted-by":"crossref","unstructured":"Spencer MR , Cisewski JA , Warner M , et al . Drug overdose deaths involving xylazine: United States, 2018\u20132021. Vital statistics rapid release; no 30. Hyattsville, MD National Center for Health Statistics; 2023.","DOI":"10.15620\/cdc:129519"},{"key":"2026080605200755000_32.3.490.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2303120"},{"key":"2026080605200755000_32.3.490.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2022.109380"},{"key":"2026080605200755000_32.3.490.4","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1080\/15563650.2023.2294619","article-title":"Closing the xylazine knowledge gap","volume":"61","author":"Hoffman","year":"2023","journal-title":"Clin Toxicol (Phila)"},{"key":"2026080605200755000_32.3.490.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2023.104154"},{"key":"2026080605200755000_32.3.490.6","doi-asserted-by":"crossref","unstructured":"Friedman JR . Assessing an icd-10 code approach for tracking xylazine-involved overdose deaths in the united states. medRxiv 2024. doi:10.1101\/2024.11.27.24318111","DOI":"10.1101\/2024.11.27.24318111"},{"key":"2026080605200755000_32.3.490.7","doi-asserted-by":"crossref","first-page":"721","DOI":"10.15585\/mmwr.mm7226a4","article-title":"Illicitly Manufactured Fentanyl\u2013Involved Overdose Deaths with Detected Xylazine \u2014 United States, January 2019\u2013June 2022","volume":"72","author":"Kariisa","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026080605200755000_32.3.490.8","doi-asserted-by":"crossref","DOI":"10.1186\/s12954-023-00867-x","article-title":"Public health impact and harm reduction implications of xylazine-involved overdoses: a narrative review","volume":"20","author":"Zhu","year":"2023","journal-title":"Harm Reduct J"},{"key":"2026080605200755000_32.3.490.9","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.20230917"},{"key":"2026080605200755000_32.3.490.10","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa2212412"},{"key":"2026080605200755000_32.3.490.11","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1016\/S0140-6736(23)01686-0","article-title":"The emerging fentanyl-xylazine syndemic in the USA: challenges and future directions","volume":"402","author":"Zhu","year":"2023","journal-title":"Lancet"},{"key":"2026080605200755000_32.3.490.12","article-title":"Overdose deaths involving non-BZD hypnotic\/sedatives in the USA: Trends analyses","volume":"10","author":"Tardelli","year":"2022","journal-title":"Lancet Reg Health Am"}],"container-title":["Injury Prevention"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/ip-2024-045596","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T12:20:24Z","timestamp":1786018824000},"score":1,"resource":{"primary":{"URL":"https:\/\/injuryprevention.bmj.com\/lookup\/doi\/10.1136\/ip-2024-045596"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,2]]},"references-count":12,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,5,15]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/ip-2024-045596"],"URL":"https:\/\/doi.org\/10.1136\/ip-2024-045596","relation":{},"ISSN":["1353-8047","1475-5785"],"issn-type":[{"value":"1353-8047","type":"print"},{"value":"1475-5785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,2]]}}}