Using Urine Drug Testing to Track Xylazine-Fentanyl Copositivity in a Changing Drug Supply
By
Janet E. Childerhose
July 9, 2026
Clinical Scorecard: Monitoring Xylazine and Fentanyl Co-Detection Through Urine Drug Testing Amidst Evolving Substance Availability
At a Glance
Category Detail
Condition Xylazine and Fentanyl Co-Detection Key Mechanisms Xylazine is a nonopioid α-2 adrenergic agonist that causes prolonged sedation, bradycardia, and hypotension when co-occurring with fentanyl. Target Population Patients aged 18 years or older undergoing substance use treatment. Care Setting Substance use treatment practices, behavioral health settings, and primary care settings.
Key Highlights
16.91% of fentanyl-positive urine drug tests also tested positive for xylazine. Xylazine copositivity with fentanyl increased more in Western US regions than in Eastern regions. Xylazine detection peaked in 2023 but subsequently declined despite increased copositivity. Guideline-Based Recommendations
Diagnosis
Fentanyl-positive urine drug tests should prompt testing for xylazine co-exposure. Management
Positive xylazine UDT results require attention to wound assessment and sedation management. Monitoring & Follow-up
Awareness of xylazine in the drug supply should be increased among people who use drugs. Risks
Naloxone does not reverse the sedative effects of xylazine. Patient & Prescribing Data
Patients in substance use treatment settings.
Xylazine exposure may require specialized, multidisciplinary assessment and management.
Clinical Best Practices
Expand urine drug testing panels to include xylazine. Provide xylazine test strips in clinics as a teaching tool. Related Resources & Content
