“Everybody’s Liking It”—Intentional Use of Xylazine in Fentanyl Among People Who Use Drugs

Background: Xylazine, a veterinary tranquilizer, is increasingly found in the unregulated fentanyl supply. Researchers and public health officials have generally characterized this substance as an unwanted adulterant, associated with outcomes such as extreme sedation and necrotic wounds. However, some literature suggests a small percentage of people who use drugs (PWUD) may prefer using xylazine. Thus, in this exploratory study, we aimed to understand the intentional use of xylazine among PWUD. Methods: From August to November 2024, we conducted a mixed methods study in Connecticut, composed of surveys and in-depth interviews. We recruited n = 114, of which 56 had a lifetime exposure to xylazine. Interviews were conducted with n = 31, analysis was restricted to the n = 11 with intentional xylazine use. We utilized Fisher's exact and t-tests to explore differences between intentional and accidental xylazine use. Thematic analysis was employed to understand xylazine seeking and use motivations. Results: Among the 56 people reporting xylazine use, 23% used xylazine intentionally (n = 13). Intentional use was found at a higher proportion among females (46.1% vs. 25.6%), White individuals (69.2% vs. 55.8%), those with a fentanyl preference (61.5% vs. 42.95%), and those with daily xylazine use (61.5% vs. 34.9). Analysis of the qualitative data revealed numerous intentional use motivations, including enjoying xylazine's embodied effects and self-managing withdrawal. Conclusions: A notable portion of PWUD intentionally use xylazine, even while understanding potential risks. Healthcare and harm reduction services should not focus solely on xylazine avoidance strategies but must also address the needs of PWUD who seek out xylazine.