# A Retrospective Toxicology Study of Polysubstance Use Patterns Associated with Xylazine

## TL;DR

This study examines how xylazine, a drug often mixed with illicit substances, is associated with different patterns of drug use and can indicate exposure to designer drugs.

## Contribution

The study introduces xylazine as a potential marker for identifying exposure to new psychoactive substances in drug users.

## Key findings

- Xylazine-positive samples showed higher concentrations of designer drugs compared to xylazine-negative samples.
- Xylazine is increasingly found in drug samples in Denver and may signal the presence of new psychoactive substances.
- Drug concentrations were significantly different between xylazine-positive and -negative samples.

## Abstract

In recent years, xylazine has emerged as a cutting agent combined with illicit drugs to extend their effects. The present study aimed to discover drug use patterns associated with xylazine-positive and -negative urine toxicology drug screens and to assess whether xylazine can be used as a marker for exposure to designer drugs/new psychoactive substances in our study population. This is a retrospective analysis of urine toxicology results from two different analytical platforms: a targeted, structurally confirmatory, high-performance liquid chromatography–tandem mass spectrometry (LC-MS/MS) assay that quantifies 136 drugs and metabolites including xylazine; and a non-targeted ThermoFisher Orbitrap Tribrid mass spectrometry system (Thermo ScientificTM, Bremen, Germany) in combination with database searches for the identification of drugs not captured by the targeted assay. All participants were patients receiving care through the Addiction Research and Treatment Services (ARTS), with documented substance misuse, undergoing routine urine drug toxicology testing at the iC42 Clinical Toxicology. Data analysis was performed using Sciex OS version 2.2.0.5738 after extraction using the targeted, structurally confirmatory and quantitative LC-MS/MS platform (SCIEX, Framingham, MA, USA). The drug patterns found in xylazine-positive and -negative urine samples were statistically significantly different (p < 0.001), indicating different consumption patterns associated with xylazine. Moreover, the overall concentrations of drugs (normalized to creatinine) were also statistically significantly different with higher concentrations in the urine samples that tested negative for xylazine. In contrast, samples that were positive for xylazine contained significantly higher concentrations of various designer drugs/new psychoactive substances as detected by the untargeted platform (p < 0.0001). The results indicated that xylazine has become increasingly common in Denver’s drug circulation and that xylazine may be used as a marker to prompt reflex testing with non-targeted high-resolution mass spectrometry assays in combination with database searches to test for the exposure to designer drugs/new psychoactive substances in our patient population.