Growth in Reports of Xylazine in the US 2019-2022

"In 2019, relatively low rates of xylazine NFLIS [National Forensic Laboratory Information System] reports were observed; all states had a rate below 6 xylazine NFLIS reports per 100,000 residents, and 16 states had zero NFLIS xylazine reports (Figure 1; eTable 4 in Supplement 1). In contrast, in 2022, only 2 states had zero xylazine NFLIS drug reports, and the highest rates of xylazine NFLIS reports (per 100,000 residents) were observed in New Jersey (30.52), Rhode Island (22.82), Maryland (18.91), Virginia (15.47), New Hampshire (13.10), and Ohio (10.87). In 2019, xylazine NFLIS reports were limited to a few northeastern states; by 2022, xylazine NFLIS reports were still concentrated in northeastern states yet had extended to states south and west.

"In 2022, xylazine represented 16.17% of all NFLIS reports in Delaware and between 5.95% and 7.00% of NFLIS reports in Connecticut, Maryland, DC, New Jersey, and Rhode Island, yet less than 1.00% of NFLIS reports in 35 different states (Figure 2; eTable 5 in Supplement 1). Delaware, Maryland, Rhode Island, New Jersey, Connecticut, DC, and Virginia had the highest absolute change in xylazine reports as a percentage of all NFLIS drug reports (2019-2022), while Virginia, Maryland, North Carolina, Michigan, Kansas, Alabama, Minnesota, and Tennessee had the highest relative change. Only 1 state, Wisconsin, recorded a decrease in xylazine’s representation in NFLIS drug reports from 2019 (0.56% of drug reports) to 2022 (0.48% of drug reports), and 2 states reported no increase (0% in 2019 to 0% in 2022; South Dakota and Wyoming) yet in 30 states, across all regions, xylazine reports (as a percentage of all NFLIS drug reports) more than doubled."