{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,4]],"date-time":"2026-01-04T05:22:32Z","timestamp":1767504152896,"version":"3.48.0"},"reference-count":37,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T00:00:00Z","timestamp":1767312000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIDA","award":["R01DA058659"],"award-info":[{"award-number":["R01DA058659"]}]},{"name":"NIDA","award":["R01DA050470"],"award-info":[{"award-number":["R01DA050470"]}]},{"DOI":"10.13039\/100023803","name":"Bloomberg American Health Initiative","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100023803","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Xylazine, an adulterant in the illicit opioid supply, heightens the risks of overdose, withdrawal severity, and severe wounds among people who use opioids (PWUO). Despite increasing prevalence, gaps remain regarding xylazine awareness in the drug supply and effective harm reduction interventions to address it. Methods: We conducted a cross-sectional survey of 703 PWUO in Baltimore, MD (2023\u20132025), to assess xylazine awareness, perceptions, and experiences. Multivariable logistic regression models examined correlates of xylazine awareness and self-reported xylazine-attributed wounds. Results: 84.8% of White participants, 48.6% Black participants, 64.3% of males, and 51.4% females had heard of xylazine. Nearly half (45%) of those who used xylazine reported that it caused more severe withdrawal symptoms. In the multivariable model of xylazine awareness, the largest odds ratios were year of survey administration (2024 vs. 2023: aOR = 4.30, 95% CI = 2.91\u20136.37; 2025 vs. 2023: aOR = 6.32, 95% CI = 3.31\u201312.07) and White race (aOR = 3.22, 95% CI = 1.85\u20135.57). Other significant demographic variables included education and gender. In the multivariable model of xylazine-attributed wounds, survey year 2025 vs. 2023 (aOR = 2.65, 95% CI = 1.06\u20136.61) and injection drug use in the prior year (aOR = 17.74, 95% CI = 5.58\u201356.39) were statistically significant. Conclusions: Awareness of xylazine in the drug supply remains incomplete among PWUO, with differences by race, age, and gender. The finding of a strong association of xylazine-attributed wounds and injection drug use should be the focus of future research. These findings underscore the need for enhanced surveillance systems, peer education, and community-based harm reduction strategies. Real-time monitoring and rapid response strategies are essential to protect against health risks of toxic adulterants, such as xylazine, medetomidine, and BTMP, in the drug supply.<\/jats:p>","DOI":"10.3390\/ijerph23010070","type":"journal-article","created":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T12:23:44Z","timestamp":1767356624000},"page":"70","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perceptions and Experiences of Xylazine, Disparities in Xylazine Awareness, and Correlates of Xylazine-Attributed Wounds Among People Who Use Opioids"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7931-2116","authenticated-orcid":false,"given":"Carl A.","family":"Latkin","sequence":"first","affiliation":[{"name":"Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA"},{"name":"Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1400-3670","authenticated-orcid":false,"given":"Lauren","family":"Dayton","sequence":"additional","affiliation":[{"name":"Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haley","family":"Bonneau","sequence":"additional","affiliation":[{"name":"Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa A.","family":"Davey-Rothwell","sequence":"additional","affiliation":[{"name":"Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9604-5817","authenticated-orcid":false,"given":"Danielle","family":"German","sequence":"additional","affiliation":[{"name":"Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6598-7078","authenticated-orcid":false,"given":"Ananya","family":"Bhaktaram","sequence":"additional","affiliation":[{"name":"Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oluwaseun","family":"Falade-Nwulia","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"109380","DOI":"10.1016\/j.drugalcdep.2022.109380","article-title":"Xylazine spreads across the US: A growing component of the increasingly synthetic and polysubstance overdose crisis","volume":"233","author":"Friedman","year":"2022","journal-title":"Drug Alcohol Depend."},{"key":"ref_2","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. 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