To determine temporal trends in xylazine-involved deaths in Cook County, the Cook County Medical Examiner’s Office and Cook County Health Department analyzed suspected substance-related deaths from January 2017 to October 2021 for the presence of xylazine and co-occurring substances.
The findings highlight a concerning trend in xylazine-involved deaths in Cook County, Illinois. Increased monitoring and public education within Cook County are warranted along with expanded surveillance in other jurisdictions, particularly those in which fentanyl use is highly prevalent. These findings can be helpful in guiding overdose prevention and response efforts because naloxone has not been shown to reverse the effects of xylazine. Although a specific antidote is not available for xylazine, naloxone should still be administered in suspected cases of potentially fatal overdose because most cases co-occur with opioids. Cardiovascular and respiratory support are critical to the management of serious xylazine toxicity; health care providers should be made aware that cases of suspected fentanyl overdose that are refractory to naloxone administration might involve xylazine toxicity. Designation of xylazine as a controlled substance has occurred in some states and would be an important policy to be considered more broadly. In addition, expanded postmortem testing for xylazine and co-occurring substances across jurisdictions could better define the role of xylazine in opioid-related deaths.