Xylazine in Ohio: “It’s a fentanyl thing.”

Study finds xylazine with fentanyl, not other drugs

How much xylazine is in Ohio’s drug supply? Today, Harm Reduction Ohio publishes the first data-driven analysis on the frequency of xylazine in Ohio’s illicit drug supply.

Key findings

  • Xylazine is paired with fentanyl in nearly every case.
  • Xylazine is almost non-existent in the supply of cocaine, methamphetamine, benzodiazepines, psychedelics and other drugs, except when fentanyl is also present.
  • Xylazine is found across Ohio without significant regional variations.
  • Xylazine frequency was consistent throughout the nine months studied, indicating the drug was well-established in Ohio’s fentanyl supply before 2023 and is not currently increasing or decreasing in frequency.

In six charts provided below, this article will detail how frequently xylazine was found in different drugs and drug combinations over  nine month periods in 2023. We will describe the data set, what they show and what this may mean for the health of people who use drugs. (Click here to see only charts and data.)

This report is based on more than 13,000 lab tests done on drugs confiscated by law enforcement in Ohio in 2023. This analysis is the largest study done in the United States, based on samples tested, examining the presence of xylazine in the drug supply. As a result, comparing the presence of xylazine in Ohio to other states is not possible. Readers are encouraged to examine the data in all charts to form their own conclusions.

What is xylazine?

Xylazine, sometimes called tranq, is a sedative used in veterinary medicine. It can cause skin lesions and abscesses that, without proper care, may become infected and lead to serious health problems. (Xylazine Wound Care Guide here.)

Xylazine Wound Care Guide

Xylazine-related skin wounds can appear anywhere on the body, not just where the drug entered. The wounds are especially common when people inject drugs containing xylazine but also occur in people who do not inject. Xylazine has not be shown to be significantly correlated to overdose death, although research is limited. A small study by the Cuyahoga County Medical Examiner found no correlation.

Xylazine is not an opioid and, therefore, does not respond to naloxone in the same way opioids do. However, xylazine may extend an overdose or make one more likely to occur. Naloxone should always be used when an overdose is suspected because fentanyl, rather than xylazine, is the likely primary cause of a fatal overdose. (Naloxone can be ordered free from Harm Reduction Ohio here as part of the Ohio Department of Heath’s Project DAWN program.)

Why xylazine has entered the opioid supply in a significant way is not well understood. Some opioid users report that xylazine extends the length of an opioid’s effect, something especially valuable in combination with a short-lasting opioid such as fentanyl.  However, other opioid users report no difference in effect or length of effect, only undesirable changes.

Xylazine data

Xylazine is not a federally controlled substance, although Congress is considering legislation to change that. However, Ohio Gov. Mike DeWine made xylazine a controlled substance in Ohio effective March 29, 2023. This change resulted in the Ohio Bureau of Criminal Investigation’s crime labs testing comprehensively for xylazine on all substances confiscated by law enforcement on March 29 or later.

BCI crime labs ran gas chromatography/mass spectrometry (GC/MS) tests on 13,219 samples of drugs confiscated in all 88 Ohio counties from March 29 through November 28, 2023. This data set consists almost entirely of small, street-level seizures. It is the basis for this analysis.

Harm Reduction Ohio has used BCI lab data for five years to monitor what’s in Ohio’s drug supply. The data set now includes more than 330,000 GC-MS lab tests done on seized drugs in Ohio since 2013. Only 13,219 records from drug seized from March 29 through November 28, 2023, — the xylazine testing period — are used in this analysis.

In the nine months studied, xylazine’s frequency was stable over time and geographically widespread. Because xylazine data prior to March 2023 does not exist, it cannot be known when or where xylazine entered Ohio’s drug supply or how quickly its presence expanded.

Xylazine results

Of all 13,219 drugs subject to GC-MS analysis, 1,382 (10.5%) were found to contain xylazine and 3,563 (27.0%) contained fentanyl. In nearly every case when xylazine was found, fentanyl also was present. When fentanyl was present, xylazine also was  there 37.3% of the time.

The chart shows the frequency of xylazine or fentanyl in all drugs and specific drugs.  A later chart will show that 96.2% of drugs with xylazine also contained fentanyl. The presence of xylazine in various drug combinations will be shown in later charts.

In a nutshell, fentanyl doesn’t always have xylazine, but xylazine pretty much always has fentanyl. Xylazine found in heroin, cocaine and meth is virtually always found when those drugs are mixed with fentanyl. Xylazine-fentanyl can be viewed as a drug pair.

Drug combinations

The next chart shows xylazine’s frequency — or absence — in different drug combinations.

In short, the crime lab found meth in 5,505 of 13,219 drugs tested. (First chart.) Of the 5,055 meth samples, drugs tested 299 (5.4%) also contained fentanyl. Of those 299 meth-fentanyl substances, 56.2% contained xylazine and 42.8% did not contain xylazine. (Above chart.)

For people who use drugs: Risk summary

If you use drugs in Ohio, here’s are rules of thumb to evaluate risk:

Meth: If you use meth, about 5% of meth contains fentanyl — and about half of that 5% also contains xylazine. Fentanyl carries overdose risk; xylazine carries risk of skin wounds.

Cocaine: If you use cocaine, almost 20% of cocaine contains fentanyl —  and about half of those times, the cocaine will also contain xylazine. Fentanyl carries overdose risk; xylazine carries risk of skin wounds.

Benzodiazepines: If you use benzos (valium, xanax, etc.) bought in the free market, there’s a 23.5% chance the sedative also contains fentanyl — and nearly all benzo-fentanyl combinations (87.6.%) contain xylazine as well.

Heroin:  Heroin is rare in Ohio, but it is found. In nearly every case, heroin also contains fentanyl, so if you use heroin, you should absolutely assume you are also using fentanyl, Heroin and fentanyl mixtures contain xylazine two-thirds of theh time — far more than when fentanyl is found without heroin. As a practical matter, assume you’re heroin is mixed with fentanyl, if not only fentanyl, and very likely also contains xylazine.

Marijuana: As readers of this web site know, fentanyl-laced marijuana is a myth. Thus, marijuana-xylazine is almost certainly not a risk, especially since reports of cannabis users suffering skin wounds are non-existent. However, BCI does not test for cannabis, so this data set cannot answer the question empirically.

Click for free xylazine test strips

Fentanyl test strips makes a lot of sense for people who use cocaine, meth or benzos to assess the risk of fentanyl and to get a rough sense of what additional xylazine risk might be. Xylazine test strips are currently illegal in Ohio, but can be purchased online, obtained from some health departments or obtained online by Ohio residents from the SOAR Initiative.

Paired: Xylazine-fentanyl 

The next two charts show the near complete pairing of xylazine and fentanyl. Xylazine is found with fentanyl 96.2% of the time.

In 1.1% of cases, xylazine was found alone, with no other drugs.

This chart shows xylazine was found with another drug but not fentanyl only 2.7% of the time. This data suggest that xylazine is targeted to the opioid (fentanyl) market, not broader drug markets for cocaine, meth, benzos, psychedelics and other drugs.

In sum, xylazine does not function as an all-purpose adulterant in the drug market. It is a fentanyl supplement. In all, 99.4% of non-fentanyl drugs are xylazine-free.

Xylazine and cocaine, meth

The next chart shows how rarely xylazine is found when fentanyl is not present — less than 1% of time with cocaine and meth.

If fentanyl is in a drug mixture, xylazine is more likely than not to be there too.

Article by Harm Reduction Ohio President Dennis Cauchon. Contact: dennis@harmreductionohio.org

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