Clinical Report: Detection and Levels of Xylazine and Fentanyl in Urine Toxicology Screens

Overview

This study analyzes urine toxicology screens to assess the prevalence and concentration of xylazine in combination with fentanyl.

Background

The opioid crisis remains a critical public health issue in the US, with rising overdose fatalities linked to synthetic opioids like fentanyl. Xylazine, a veterinary sedative not approved for human use, has emerged in the illicit drug supply, complicating treatment and increasing health risks for users. Understanding the prevalence and concentration of xylazine in drug samples is essential for addressing health challenges.

Data Highlights

No numerical data was provided in the source material.

Key Findings

• Xylazine was detected in 38% of fentanyl powder samples and over 12% of pills seized by the DEA by the end of 2024.
• The presence of xylazine in the drug supply has increased significantly since 2019.
• Xylazine-involved overdose mortality increased by 5- to 10-fold between 2020 and 2021.
• Clinical guidance for treating xylazine-related wounds is still developing.
• Many users of xylazine-containing drugs are unaware of its presence.

Clinical Implications

Healthcare providers should be aware of the increasing prevalence of xylazine in the drug supply.

Conclusion

The study highlights the concern regarding xylazine as an adulterant in the opioid supply.

Related Resources & Content

1. JAMA Network Open, 2023 — Using Urine Drug Testing to Track Xylazine-Fentanyl Copositivity in a Changing Drug Supply
2. Archives of Toxicology, 2023 — Analysis of 108 illicit substances and their metabolites in bile using LC–MS/MS for toxicological evaluation in sudden death incidents
3. Frontiers in Pediatrics, 2026 — Is urinary toxicology rapid screening a useful first-line diagnostic tool for paediatric coma in the emergency department?
4. JAMA Network Open, 2023 — Development and Implementation of an AI System for Generating Clinical Urine Drug Test Sign-Outs
5. Frequently Asked Questions About Federal Workplace Drug Testing | SAMHSA
6. Xylazine and major urinary metabolites detected in patients positive for fentanyl and xylazine - PubMed
7. Case Series: Magnitude and duration of fentanyl and xylazine detection in the urine of persons with opioid use disorder - PubMed