Self-reported Xylazine Experiences: A Mixed Methods Study of Reddit Subscribers

Abstract

Objectives: Xylazine is an alpha-2 agonist increasingly prevalent in the illicit drug supply. Our objectives were to curate information about xylazine through social media from People Who Use Drugs (PWUDs). Specifically, we sought to answer the following: 1) what are the demographics of Reddit subscribers reporting exposure to xylazine? 2) is xylazine a desired additive? and 3) what adverse effects of xylazine are PWUDs experiencing? Methods: Natural Language Processing (NLP) was used to identify mentions of "xylazine" from posts by Reddit subscribers who also posted on drug-related subreddits. Posts were qualitatively evaluated for xylazine-related themes. A survey was developed to gather additional information about the Reddit subscribers. This survey was posted on subreddits that were identified by NLP to contain xylazine-related discussions from March 2022 to October 2022. Results: 76 posts mentioning xylazine were extracted via NLP from 765,616 posts by 16,131 Reddit subscribers (January 2018 to August 2021). People on Reddit described xylazine as an unwanted adulterant in their opioid supply. 61 participants completed the survey. Of those that disclosed their location, 25/50 (50%) participants reported locations in the Northeastern United States. The most common eoute of xylazine use was intranasal use (57%). 31/59 (53%) reported experiencing xylazine withdrawal. Frequent adverse events reported were prolonged sedation (81%) and increased skin wounds (43%). Conclusions: Among respondents on these Reddit forums, xylazine appears to be an unwanted adulterant. PWUDs may be experiencing adverse effects such as prolonged sedation and xylazine withdrawal. This appeared to be more common in the Northeast.

Research Priorities to Improve Treatment of Patients Exposed to Xylazine-fentanyl: Rapid Communication from a National Institute on Drug Abuse Center for the Clinical Trials Network Meeting

“…In the case of xylazine, it was comprehensive forensic testing conducted by medical examiners that first revealed escalating xylazine exposures in Philadelphia 3 . In parallel, the community of people who use drugs sounded the alarm of something new and different 4 . As the prevalence of xylazine increased, testing expanded to include confiscated drug samples, drug checking programs, and, less commonly, patients in health care settings.…”

“…3 In parallel, the community of people who use drugs sounded the alarm of something new and different. 4 As the prevalence of xylazine increased, testing expanded to include confiscated drug samples, drug checking programs, and, less commonly, patients in health care settings. New availability of xylazine test strips is patient-centered, feasible for use by people in the community, and has begun to define the gaps in our understanding of the clinical relevance of xylazine.…”