Xylazine Awareness and Suspected Presence in the Illicit Drug Supply Among People Who Used Stimulants in an Overdose Hotspot, 2023

Xylazine is harmful to humans and detected in the United States fentanyl supply and sometimes in stimulants. Awareness of xylazine among people who use stimulants (PWUS) is underexplored. In 2023, 59 PWUS in Brockton, Massachusetts, were surveyed about their past 30-day substance use and xylazine awareness. A purposive sub-sample of 21 survey participants completed an in-depth interview, of which 18 discussed xylazine. Chi-square tests assessed global differences in demographics by xylazine awareness. Qualitative data were thematically analyzed by whether participants knew what xylazine was (i.e., xylazine awareness) and past-30-day opioid use - a proxy for xylazine exposure. Twenty-one (35.6%) participants were unaware of xylazine. A greater percentage of Hispanic (58.3%, n = 7), Black non-Hispanic (50%, n = 7), and Native American non-Hispanic (100%, n = 2) participants were unaware of xylazine than White, non-Hispanic participants (17.2%, n = 5) (p < 0.05). A greater percentage of participants with less education were unaware of xylazine (62.5%, n = 10) compared to participants with a high school degree or GED equivalent (37.5%, n = 9), or some college education (10.5%, n = 2) (p < 0.05). Interviews indicated limited xylazine knowledge among those only using stimulants. Participants who intended to use fentanyl but experienced deleterious effects of xylazine, including skin wounds and unexpected sedation, realized post-exposure that xylazine was the likely cause of their adverse use experiences. Differences in xylazine awareness by substance use, race, and education indicate a need to create literacy-appropriate, culturally relevant xylazine harm reduction messages that are communicated to PWUS by trusted messengers within diverse communities.