# Navigating an Unpredictable Supply: Lived Experiences of Xylazine Exposure Among People Who Use Drugs

## TL;DR

People who use drugs in Massachusetts are increasingly exposed to xylazine in opioids, leading to sedation, unconsciousness, and wounds, with limited ability to avoid it due to financial and health constraints.

## Contribution

This study provides insights into how people who use drugs perceive and respond to xylazine exposure in real-world settings.

## Key findings

- 80% of respondents reported past-90-day xylazine exposure, with common effects including sedation, loss of consciousness, and wounds.
- Participants expressed fear and frustration about xylazine as an unwanted contaminant but felt unable to avoid it due to financial and health constraints.
- The study highlights the urgent need for real-time xylazine detection and improved wound prevention and care.

## Abstract

As xylazine-adulterated opioids become more prevalent in the U.S., people who use drugs (PWUD) face growing risks from sedation, withdrawal, and wounds. This study explores PWUD perceptions on recognizing xylazine exposure including its physical effects and clinical harms and how these factors shape their drug use practices.

In August 2023, we surveyed adult PWUD clients reporting at least one past-year drug use-related wound across three Massachusetts syringe service programs with high xylazine prevalence. We compared demographics, drug use factors, physical effects, and clinical symptoms between those with and without self-reported past-90-day xylazine exposure and conducted content analysis of open-ended responses.

Of the 171 respondents, 80% (n=136) reported past-90-day xylazine exposure. The majority of respondents were male, white, non-Hispanic, and aged 36–45 years, with no significant differences by xylazine exposure. Xylazine-exposed participants commonly reported sedation (77%), loss of consciousness (52%), and wounds (91%). Most participants were afraid and frustrated, seeing xylazine as an unwanted contaminant but were often unable to avoid it due to financial constraints, withdrawal symptoms, and limited alternative options.

Syringe service program clients in Massachusetts commonly reported xylazine-adulterated fentanyl exposure, recognized through heavy sedation and skin wounds. Their experiences highlight the urgent need for real-time xylazine detection, safer supply, overdose and sedation risk mitigation, and improved wound prevention and care.