Monitoring Xylazine and Fentanyl Co-Detection Through Urine Drug Testing

Overview

This study analyzes the co-occurrence of xylazine and fentanyl in urine drug tests across the U.S., revealing a 16.91% positivity rate for xylazine among fentanyl-positive specimens. The findings indicate regional variations in xylazine prevalence and concentration.

Background

Xylazine, a veterinary sedative not approved for human use, has emerged as an adulterant in the illicit drug supply, particularly in combination with fentanyl. Understanding the prevalence and concentration of xylazine in this context is important for clinical management.

Data Highlights

Key Findings

• 16.91% of fentanyl-positive urine drug tests were also positive for xylazine.
• Xylazine concentrations peaked in 2023 before declining.
• Copositivity with fentanyl increased by 13.46 percentage points in the Western U.S. over the study period.
• Xylazine detection remains highest in the Eastern U.S. census regions.
• Positive xylazine results necessitate specialized wound assessment and management.

Clinical Implications

Clinicians should consider testing for xylazine co-exposure in patients with fentanyl-positive urine drug tests.

Conclusion

The findings indicate the presence of xylazine in the drug supply, particularly in regions beyond traditional areas.

Related Resources & Content

1. Sugarman et al, JAMA Network Open, 2023 -- Monitoring Xylazine and Fentanyl Co-Detection Through Urine Drug Testing
2. JAMA Network Open, 2023 -- Hospital-Based Management of Opioid Use Disorder in the Fentanyl Era—The Role and Limits of Expert Consensus
3. Stat News, 2026 -- Jails are the frontline in fielding dangerous new type of drug withdrawal
4. JAMA Network Open, 2023 -- Development and Implementation of an AI System for Generating Clinical Urine Drug Test Sign-Outs
5. Journal of Analytical Toxicology, 2025 -- Xylazine and major urinary metabolites detected in patients positive for fentanyl and xylazine
6. Archives of Toxicology — Analysis of 108 illicit substances and their metabolites in bile using LC–MS/MS for toxicological evaluation in sudden death incidents
7. Rising to the Challenge Together: How ONDCP and CDC support jurisdictions through the Overdose Response Strategy
8. Multidisciplinary Guidance to Care for Persons With Xylazine-Associated Wounds
9. Xylazine and major urinary metabolites detected in patients positive for fentanyl and xylazine | Journal of Analytical Toxicology | Oxford Academic