Pilot findings on the real-world performance of xylazine test strips for drug residue testing and the importance of secondary testing methods

Thompson, Erin; Tardif, Jessica; Ujeneza, Merci; Badea, Adina; Green, Traci C.; McKee, Haley; McKenzie, Michelle; Park, Ju Nyeong

doi:10.1016/j.dadr.2024.100241

Cited by 2 publications

References 24 publications

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Assessing an ICD-10 Code Approach for Tracking Xylazine-Involved Overdose Deaths in the United States

Friedman

2024

Preprint

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Introduction The national prevalence of the veterinary sedative xylazine in US overdose deaths rose between 2018 and 2021. More updated estimates are limited, partially due to the lack of a dedicated ICD-10 code--a primary mechanism used to specify drugs implicated in overdose deaths in the US, including in the CDC WONDER system, which provides public data requests with a 6-month lag. For other emerging substances lacking dedicated codes, over time umbrella codes have come to de facto represent them, yet this has not yet been demonstrated for xylazine. Methods Overdose deaths in CDC WONDER involving T42.7 ("Antiepileptic and sedative-hypnotic drugs, unspecified") or T46.5 ("Other antihypertensive drugs, not elsewhere classified") were compared to two more specific, albeit delayed, sources: NVSS describing national trends in 2018-2021 and SUDORS describing state-level trends in 2020-2022. The CDC WONDER approach was also used to visualize trends in xylazine-involved deaths through Q1 2024 by geography, race/ethnicity, substance co-involvement, and demographic categories. Results At the national level, concordance between CDC WONDER records and previous NVSS estimates improved after 2019 and became highly similar in 2021 (3,480 vs 3,468 deaths). Concordance was also high for estimates stratified by race, age, and region. At the state-level, across 49 state-year pairs, correlation between CDC WONDER and SUDORS was 0.97. Xylazine-involved deaths doubled between 2021 and 2024 Q1, and racial inequalities widened. Discussion T42.7 or T46.5, together, may have become the de-facto coding scheme representing xylazine-involved deaths. This approach provides more up-to-date results, showing increasing prevalence and worsening racial inequalities in xylazine-involved deaths into 2024.

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Assessing an ICD-10 Code Approach for Tracking Xylazine-Involved Overdose Deaths in the United States

Friedman

2024

Preprint

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Xylazine-Associated Necrotic Upper-Extremity Wounds

Arango,

Flynn,

Zeitlin

et al. 2024

Journal of Bone and Joint Surgery

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Background: The rise in xylazine-adulterated heroin and fentanyl poses novel challenges to hand surgeons and a rising epidemic of necrotic upper-extremity wounds. While prior case studies have focused on particularly severe and complex xylazine-associated necrotic (XAN) wounds, the aim of this consecutive case series was to characterize the variability of presentations (ranging from mild to severe) at a single institution at the epicenter of the xylazine epidemic. Methods: Patients presenting to a tertiary referral center for XAN upper-extremity wounds were retrospectively identified from emergency department visits and hospital admissions between January 2021 and December 2023. Patient characteristics, clinical findings, treatment, and hospitalization-related measures were recorded. Wounds were classified according to the depth, density, size, and presence of osteomyelitis. All of the variables were quantified using descriptive statistics. Results: In total, 82 patients with 125 XAN wounds were included in the study. The mean age was 40.3 ± 8.2 years, and 57% of the patients were men. Of the 125 wounds, 54% had associated osteomyelitis, 78% were confluent, and 47%involved more than two-thirds of the anatomic region. Surgery was recommended for 78% of the patients and was performed in 62%, with 13% undergoing amputation. Complications rates were high (77%) and included bacteremia (40%) and death (5%). Patients were hospitalized a mean of 4.1 times and were discharged against medical advice 2.8 times per year. Conclusions: This study presents a broad perspective on demographic, social, and medical factors in patients with XAN wounds of the upper extremity. Given the complexity and burden of this public health crisis, early intervention is important to prevent complications and mitigate costs. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Pilot findings on the real-world performance of xylazine test strips for drug residue testing and the importance of secondary testing methods

Cited by 2 publications

References 24 publications

Assessing an ICD-10 Code Approach for Tracking Xylazine-Involved Overdose Deaths in the United States

Assessing an ICD-10 Code Approach for Tracking Xylazine-Involved Overdose Deaths in the United States

Xylazine-Associated Necrotic Upper-Extremity Wounds

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