A Content Analysis of Xylazine-associated Stigma in Web-based Media Driven by the Zombie Term and Stigmatizing Imagery.

BACKGROUND

Drug use-related stigma amplifies the harms faced by people who use drugs (PWUD). Media often dehumanizes PWUD, particularly those using xylazine, a veterinary sedative and opioid adulterant, by labeling them with terms like "zombie." This perpetuates discrimination and stigma, distracting from the public health crisis. To assess this, we conducted a content analysis to quantify the prevalence of stigmatizing terms like "zombie" and related imagery in xylazine-related web-based media.

METHODS

We analyzed web-based news media reporting on xylazine from October 1, 2022, to September 30, 2023, using Google News. "Stigmatizing term" was defined as the use of the word "zombie," and "stigmatizing imagery" was defined as an embedded image of nonsterile or discarded drug use supplies, visibly intoxicated individuals, unhoused persons, or necrotic wounds. Two trained reviewers followed a standardized protocol to examine article titles, text, and images. Articles using stigmatizing term and/or imagery were coded as stigmatizing; and data were aggregated by month to assess any temporal changes in relation to federal xylazine alerts.

RESULTS

In a 12-month period, 910 news articles mentioned xylazine, 23.9% featured stigmatizing content, of which 57% (124/217) used "zombie" only, 26.3% (57/217) had stigmatizing imagery only, and 16.6% (36/217) had both. Stigmatizing articles peaked in March and July 2023, coinciding with federal alerts about xylazine in the opioid supply. Of the 601 articles with embedded images, 15% had stigmatizing imagery.

CONCLUSIONS

Stigmatizing content in web-based news media about xylazine continues to proliferate, highlighting the need for more efforts to challenge these narratives.