{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T03:09:29Z","timestamp":1784171369705,"version":"3.55.0"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Agency for Healthcare Research and Quality, United States","award":["T32HS013852"],"award-info":[{"award-number":["T32HS013852"]}]},{"name":"University of Alabama at Birmingham Center for Addiction and Pain Prevention and Intervention"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Harm Reduct J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Xylazine is a dangerous veterinary sedative found mainly in illicit fentanyl in the Northeast and Midwest. Its role in the Deep South overdose crisis is not well-characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective review of autopsy data in Jefferson County, Alabama to identify trends in xylazine prevalence among people who fatally overdosed from June 2019 through June 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>165 decedents met inclusion criteria. While the first identified xylazine-associated overdose was in June 2019, xylazine has become consistently prevalent since January 2021. All cases of xylazine-associated fatal overdoses were accompanied by fentanyl, and most (75.4%) involved poly-drug stimulant use. The average age was 42.2, and most decedents were white (58.8%) and male (68.5%). Overall, 18.2% of people were unhoused at the time of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Xylazine is prevalent in the Deep South. Efforts to promote harm reduction, publicly viewable drug supply trends, and legalization of drug checking and syringe service programs should be prioritized.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12954-024-00959-2","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T09:02:53Z","timestamp":1708419773000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Xylazine co-occurrence with illicit fentanyl is a growing threat in the Deep South: a retrospective study of decedent data"],"prefix":"10.1186","volume":"21","author":[{"given":"William","family":"Bradford","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary","family":"Figgatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen S.","family":"Scott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacy","family":"Marshall","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen F.","family":"Eaton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel W.","family":"Dye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,20]]},"reference":[{"issue":"26","key":"959_CR1","doi-asserted-by":"publisher","first-page":"721","DOI":"10.15585\/mmwr.mm7226a4","volume":"72","author":"M Kariisa","year":"2023","unstructured":"Kariisa M, O\u2019Donnell J, Kumar S, Mattson CL, Goldberger BA. Illicitly manufactured fentanyl-involved overdose deaths with detected xylazine\u2014United States, January 2019-June 2022. Morb Mortal Wkly Rep. 2023;72(26):721\u20137.","journal-title":"Morb Mortal Wkly Rep"},{"key":"959_CR2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2022.109380","volume":"233","author":"J Friedman","year":"2022","unstructured":"Friedman J, Montero F, Bourgois P, Wahbi R, Dye D, Goodman-Meza D, et al. Xylazine spreads across the US: a growing component of the increasingly synthetic and polysubstance overdose crisis. Drug Alcohol Depend. 2022;233: 109380.","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"959_CR3","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1186\/s12954-023-00879-7","volume":"20","author":"CM Zagorski","year":"2023","unstructured":"Zagorski CM, Hosey RA, Moraff C, Ferguson A, Figgatt M, Aronowitz S, et al. Reducing the harms of xylazine: clinical approaches, research deficits, and public health context. Harm Reduct J. 2023;20(1):141.","journal-title":"Harm Reduct J"},{"issue":"8","key":"959_CR4","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1080\/15563650.2022.2063135","volume":"60","author":"NS Ball","year":"2022","unstructured":"Ball NS, Knable BM, Relich TA, Smathers AN, Gionfriddo MR, Nemecek BD, et al. Xylazine poisoning: a systematic review. Clin Toxicol (Phila). 2022;60(8):892\u2013901.","journal-title":"Clin Toxicol (Phila)"},{"issue":"10","key":"959_CR5","doi-asserted-by":"publisher","first-page":"1370","DOI":"10.7326\/M23-2001","volume":"176","author":"J D'Orazio","year":"2023","unstructured":"D\u2019Orazio J, Nelson L, Perrone J, Wightman R, Haroz R. Xylazine adulteration of the heroin-fentanyl drug supply: a narrative review. Ann Intern Med. 2023;176(10):1370\u20136.","journal-title":"Ann Intern Med"},{"issue":"8","key":"959_CR6","volume":"14","author":"SV Malayala","year":"2022","unstructured":"Malayala SV, Papudesi BN, Bobb R, Wimbush A. Xylazine-induced skin ulcers in a person who injects drugs in Philadelphia, Pennsylvania, USA. Cureus. 2022;14(8):e28160.","journal-title":"Cureus"},{"issue":"1","key":"959_CR7","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1097\/ADM.0000000000001245","volume":"18","author":"R McFadden","year":"2024","unstructured":"McFadden R, Wallace-Keeshen S, Petrillo Straub K, Hosey RA, Neuschatz R, McNulty K, et al. Xylazine-associated wounds: clinical experience from a low-barrier wound care clinic in Philadelphia. J Addict Med. 2024;18(1):9-12.","journal-title":"J Addict Med"},{"issue":"1","key":"959_CR8","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1097\/PAF.0000000000000622","volume":"42","author":"J Nunez","year":"2021","unstructured":"Nunez J, DeJoseph ME, Gill JR. Xylazine, a veterinary tranquilizer, detected in 42 accidental fentanyl intoxication deaths. Am J Forensic Med Pathol. 2021;42(1):9\u201311.","journal-title":"Am J Forensic Med Pathol"},{"issue":"1","key":"959_CR9","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1186\/s12954-023-00867-x","volume":"20","author":"DT Zhu","year":"2023","unstructured":"Zhu DT. Public health impact and harm reduction implications of xylazine-involved overdoses: a narrative review. Harm Reduct J. 2023;20(1):131.","journal-title":"Harm Reduct J"},{"issue":"1_suppl","key":"959_CR10","doi-asserted-by":"publisher","first-page":"128s","DOI":"10.1177\/0033354920921817","volume":"135","author":"MH Fern\u00e1ndez-Vi\u00f1a","year":"2020","unstructured":"Fern\u00e1ndez-Vi\u00f1a MH, Prood NE, Herpolsheimer A, Waimberg J, Burris S. State laws governing syringe services programs and participant syringe possession, 2014\u20132019. Public Health Rep. 2020;135(1_suppl):128s-s137.","journal-title":"Public Health Rep"},{"issue":"2","key":"959_CR11","doi-asserted-by":"publisher","first-page":"281","DOI":"10.23907\/2016.029","volume":"6","author":"MD Cain","year":"2016","unstructured":"Cain MD, McGwin G, Atherton D. Surveillance of drug overdoses using google fusion tables. Acad Forensic Pathol. 2016;6(2):281\u201390.","journal-title":"Acad Forensic Pathol"},{"issue":"3","key":"959_CR12","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1080\/15563650.2022.2159427","volume":"61","author":"JS Love","year":"2023","unstructured":"Love JS, Levine M, Aldy K, Brent J, Krotulski AJ, Logan BK, et al. Opioid overdoses involving xylazine in emergency department patients: a multicenter study. Clin Toxicol (Phila). 2023;61(3):173\u201380.","journal-title":"Clin Toxicol (Phila)"},{"key":"959_CR13","unstructured":"Office JCCMEs. Annual Report of the Jefferson County Coroner\/Medical Examiner's Office. Birmingham, AL; 2020\u20132022."},{"key":"959_CR14","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2020.103080","volume":"90","author":"E Childs","year":"2021","unstructured":"Childs E, Biello KB, Valente PK, Salhaney P, Biancarelli DL, Olson J, et al. Implementing harm reduction in non-urban communities affected by opioids and polysubstance use: a qualitative study exploring challenges and mitigating strategies. Int J Drug Policy. 2021;90: 103080.","journal-title":"Int J Drug Policy"},{"issue":"8\u20139","key":"959_CR15","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1093\/jamia\/ocz050","volume":"26","author":"AJ Boslett","year":"2019","unstructured":"Boslett AJ, Denham A, Hill EL, Adams MCB. Unclassified drug overdose deaths in the opioid crisis: emerging patterns of inequity. J Am Med Inform Assoc. 2019;26(8\u20139):767\u201377.","journal-title":"J Am Med Inform Assoc"},{"issue":"5","key":"959_CR16","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1080\/00952990.2022.2072223","volume":"48","author":"A Denham","year":"2022","unstructured":"Denham A, Vasu T, Avendano P, Boslett A, Mendoza M, Hill EL. Coroner county systems are associated with a higher likelihood of unclassified drug overdoses compared to medical examiner county systems. Am J Drug Alcohol Abuse. 2022;48(5):606\u201317.","journal-title":"Am J Drug Alcohol Abuse"},{"key":"959_CR17","unstructured":"County-level provisional drug overdose death counts. National Center for Health Statistics. 2023."},{"key":"959_CR18","doi-asserted-by":"publisher","DOI":"10.1016\/j.dadr.2022.100074","volume":"4","author":"MK Reed","year":"2022","unstructured":"Reed MK, Imperato NS, Bowles JM, Salcedo VJ, Guth A, Rising KL. Perspectives of people in Philadelphia who use fentanyl\/heroin adulterated with the animal tranquilizer xylazine; Making a case for xylazine test strips. Drug Alcohol Depend Rep. 2022;4: 100074.","journal-title":"Drug Alcohol Depend Rep"},{"issue":"24","key":"959_CR19","doi-asserted-by":"publisher","first-page":"2209","DOI":"10.1056\/NEJMp2303120","volume":"388","author":"R Gupta","year":"2023","unstructured":"Gupta R, Holtgrave DR, Ashburn MA. Xylazine\u2014medical and public health imperatives. N Engl J Med. 2023;388(24):2209\u201312.","journal-title":"N Engl J Med"}],"container-title":["Harm Reduction Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12954-024-00959-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12954-024-00959-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12954-024-00959-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T09:09:18Z","timestamp":1708420158000},"score":1,"resource":{"primary":{"URL":"https:\/\/harmreductionjournal.biomedcentral.com\/articles\/10.1186\/s12954-024-00959-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,20]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["959"],"URL":"https:\/\/doi.org\/10.1186\/s12954-024-00959-2","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-3777534\/v1","asserted-by":"object"}]},"ISSN":["1477-7517"],"issn-type":[{"value":"1477-7517","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,20]]},"assertion":[{"value":"19 December 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 February 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 February 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This research was approved by the IRB (IRB-300012218).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"46"}}