Xylazine in Ohio: Insights from individuals with criminal legal system involvement and a history of illicit stimulant use.

BACKGROUND

Xylazine, a non-opioid sedative not approved for human use, poses serious health risks. It is primarily found in illicitly manufactured fentanyl, but xylazine-fentanyl combinations also appear as illicit stimulant adulterants. Although strategies exist to reduce the risk of xylazine-related harms, some high-risk populations may be unaware of the drug, including people with recent criminal legal system involvement who use illicit stimulants.

METHODS

A cross-sectional electronic survey was conducted in Ohio in October 2024 to assess xylazine-related knowledge, attitudes, and behaviors among people with criminal legal system involvement and prior illicit stimulant use. Participants were recruited from Ohio courts.

RESULTS

Among 229 respondents (43.5% response rate), 42.4% had heard of xylazine. The sample was 54.6% female, 83.3% White, 3.1% Hispanic or Latino, and mean age was 38.5 years (SD = 9.4). Individuals who had heard of xylazine were more likely to have used fentanyl (35.1% vs. 7.1%) or heroin (35.5% vs. 2.4%) in the past 6 months than those who had not heard of it. Most respondents (75.1%) indicated it was "very important" to know if xylazine is in their drugs and 66.4% would be "very" or "somewhat likely" to use xylazine test strips, if available at no cost. Among people who had heard of xylazine, 83.5% did not want to use xylazine and try to avoid it.

CONCLUSIONS

Most respondents were unaware of xylazine, despite its prevalence in Ohio. Xylazine education and easy access to harm reduction tools are critical for preventing xylazine-related harms among this high-risk population.