Xylazine Awareness, Desire, Use and Exposure: Preliminary Findings from the Rhode Island CUTS Drug Checking Cohort

Background Xylazine, an α2 adrenergic receptor agonist, is a veterinary sedative that causes severe health complications yet interventions to detect, prevent and treat human exposure remain underdeveloped. Community-based drug checking services (DCS) involve the consensual collection and testing of small amounts of drugs to increase community awareness and reduce drug-related harms. This study characterized xylazine awareness, desire, use and exposure among people who use drugs (PWUD) in Rhode Island, USA. Methods We linked and analyzed DCS and survey data from an ongoing cohort of PWUD. Between February and August 2023, 125 PWUD were recruited and enrolled from harm reduction organizations and surveyed about xylazine awareness and use behaviors. Using point-of-care Fourier Transform infrared spectroscopy (FTIR-S), at least one drug sample was tested from each participant and confirmed offsite at a laboratory. Results were conveyed in real-time, along with harm reduction education, referrals to resources and care. Results Virtually all participants (99%) wanted to avoid xylazine exposure. Half (51%) knew what xylazine was, and a quarter (26%) suspected previous exposure. Xylazine exposure was primarily surmised through sedating (45%) and ulcerative (26%) effects. Only 9% of participants submitted a sample that they perceived to contain xylazine. Xylazine was detected in 14% of samples using FTIR-S and in 21% of samples using a dual laboratory approach of gas chromatography mass spectrometry (GC-MS) and liquid chromatography quadrupole-time-of-flight mass spectrometry (LC-QTOF-MS). Participants thought that these xylazine-positive samples were fentanyl (77%), heroin (14%), or Percocet® (9%). Conclusion Implementing point-of-care DCS at harm reduction organizations could be useful in rapidly increasing xylazine awareness and engaging at-risk individuals in prevention, harm reduction, treatment, and rapid care for xylazine-related wounds. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by the National Institute of Drug Abuse (5UG3DA056881). JNP and TCG were supported in part by the NIGMS/NIH Center of Biomedical Research Excellence on Opioids and Overdose (P20GM125507). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the Lifespan Institutional Review Board and developed in consultation with the COBRE on Opioid and Overdose Community Advisory Board I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript