An Analysis of the Prevalence of Xylazine in Overdose Cases in Miami-Dade County

Xylazine is a veterinary sedative that is becoming an increasingly popular cutting agent in fentanyl samples. This combination of drugs is commonly referred to as “Traq”. Xylazine is not approved for use in humans, so it is not fully understood how xylazine contributes to overdose deaths. To gain insight into its prevalence in overdose cases, the Miami Dade Medical Examiner’s Office (MDME) reviewed all cases received between 2015 and 2022 in which xylazine was reported. Xylazine was identified during routine toxicology screening of either whole blood or tissue homogenates, which utilizes UCT’s Clean Screen® DAU extraction cartridges. The cartridges were conditioned, and samples were loaded at pH 6. The cartridges were washed, then eluted with an 80:20:2 mixture of dichloromethane:isopropanol:ammonium hydroxide. Samples were screened by either GC-NPD/MS or LC-Ion Trap-MS.

There were 170 overdose cases reviewed over the course of this study. Of those cases, 37% listed xylazine as the cause of death. 13% of those cases contained fentanyl and xylazine only, but the
remaining 87% of deaths were attributed to polydrug use involving two or more substances. Between 2019 and 2021, the MDME observed a sixfold increase in the detection of xylazine. Similar xylazine trends are being experienced in many regions across the U.S.

Citation: Potoukian RB, Gonyea J, Shoff EN, Hime GW, Moore DM. Prevalence of xylazine in overdose cases: An analysis of Miami-Dade County medical examiner case data. J Forensic Sci. 2023;00:1–6. https://doi.org/10.1111/1556-4029.