Trends and Adverse Outcomes of Xylazine Misuse: A Digital Surveillance Study

Background: Xylazine is an animal tranquilizer without approved medical use in humans that is increasingly being misused as an adulterant in illicit drugs. This study aimed to characterize national trends and adverse outcomes associated with the emerging misuse of xylazine using digital surveillance data. Methods: We examined online search trends and social media discussions related to xylazine misuse in the U.S. from 2019 to 2023 using Google Searches data and conducted Joinpoint regression to assess trends. We also examined social media attention using Almetric attention score and analyzed reports on xylazine in the FDA Adverse Event Reporting System (FAERS) through September 2023 using logistic regression. Results: Our analysis revealed an overall increasing trend in online searches for XYLAZINE nationally, with an average monthly percentage change of 4.6% (95% CI: 3.9 to 5.1, P trend <0.001), indicating growing awareness. On social media, mentions of xylazine rose exponentially starting in late 2021. Analysis of the FAERS data identified 94 reports of adverse events related to xylazine, most of which involved men (70.2%), with a mean age of 36.5 (SD: 14.3) years. Alarmingly, these xylazine-linked adverse events had an 87.2% fatality rate, which increased over 40-fold with concurrent fentanyl use (reported OR: 40.5, 95% CI: 4.0 to 407.4, P = 0.002). Conclusions: These findings underscore the urgent need for greater public health awareness, harm reduction strategies, and enhanced surveillance targeting the worsening xylazine addiction and overdose crisis.