Monitoring Xylazine and Fentanyl Co-Detection Through Urine Drug Testing Amidst Evolving Substance Availability
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By
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Janet E. Childerhose
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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.
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