Using Urine Drug Testing to Track Xylazine-Fentanyl Copositivity in a Changing Drug Supply

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Xylazine, a nonopioid veterinary sedative, has been present in the illicit drug supply for over a decade, primarily as an adulterant in the US Northeast.
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Sugarman et al found that only 16.91% of fentanyl-positive urine drug tests also tested positive for xylazine, indicating a lower prevalence than previously reported.
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Monthly xylazine concentrations peaked in 2023 but subsequently declined, while copositivity with fentanyl increased, especially in Western US regions.
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Xylazine co-occurrence with fentanyl poses challenges for clinical treatment, as it causes prolonged sedation and requires specialized wound management.
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The study highlights the need for expanded urine drug testing panels to include xylazine, as awareness of its presence in the drug supply remains limited.

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