Citation

Spencer MR, Cisewski JA, Warner M, Garnett MF. U.S. Centers for Disease Control and Prevention. Hyattsville, MD USA: U. S. National Vital Statistics System; Centers for Disease Control and Prevention, 2023.

Copyright

(Copyright 2023, U.S. Centers for Disease Control and Prevention)

The full document is available online.

Abstract

Objectives—This study presents trends in drug overdose death rates involving xylazine from 2018 through 2021, overall and by sex. Rates of drug overdose deaths involving xylazine are also presented by age group and race and Hispanic origin from 2020 through 2021, and by the U.S. Department of Health and Human Services public health regions in 2021. Co-involvement for the most frequent drugs involved with xylazine in 2018 through 2021 is also reported.

Methods—Using an established methodology for examining death certificate literal text, drug overdose deaths involving xylazine for deaths occurring in the United States for U.S. residents were identified. Drug overdose deaths were limited to those with International Classification of Diseases, 10th Revision underlying cause-of-death codes X40–X44, X60–X64, X85, or Y10–Y14.

Results—The age-adjusted rate of drug overdose deaths involving xylazine increased from 0.03 per 100,000 standard population in 2018 to 1.06 in 2021. Rates for males were at least twice the rates for females for each year between 2018 and 2021. Between 2020 and 2021, rates increased across all age groups and reportable race and Hispanic-origin categories. In 2020, rates were highest among those aged 25–34 and 35–44, while in 2021, rates were highest among those aged 35–44. In 2020 and 2021, rates were highest among Black or African-American non-Hispanic people (0.68 and 1.82, respectively). However, the largest increase in rates occurred among Hispanic or Latino people compared with other groups, tripling from 0.21 in 2020 to 0.64 in 2021. In 2021, the highest rate of drug overdose deaths involving xylazine occurred in Region 3 (which includes Delaware, the District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia), followed by other regions along the East Coast. Fentanyl was the most frequently co-occurring drug mentioned on xylazine death records between 2018 and 2021.

Keywords: drug involved • mortality surveillance • poisoning • National Vital Statistics System