ASSESSING XYLAZINE KNOWLEDGE AND HARM REDUCTION BEHAVIORS AMONG UNHOUSED PATIENTS

Anna Patterson, B.S.

University of Illinois Chicago, MD/PhD Candidate

Chicago Street Medicine, Nonprofit Board President

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Project team members: Mason Clark, BS; Jenny Wang, BS; Pal Shah, MD; Jordan Morling, MD; Pavitra Kotini-Shah, MD

Overview of Talk

• Xylazine as a Growing Threat to the United States
• University of Illinois Chicago Street Medicine Study
• Preliminary Results: Patients
• Preliminary Results: Providers
• Key takeaways and Future Directions

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Poll Question

Is Xylazine an Opioid?

1. Yes
2. No
3. It Can Be

Poll Question

Is Xylazine an Opioid?

1. Yes
2. No
3. It Can Be

Xylazine

• Xylazine is a nonopioid sedative not approved for human use that is increasingly detected in the US drug supply, most commonly mixed with synthetic opioids like fentanyl and heroin.
• Xylazine was originally developed in the 1960s for use in large animals.
• In humans, xylazine is typically injected.
• It acts as an alpha-2 adrenergic agonist, producing sedation, muscle relaxation, and pain relief.
• Xylazine is not approved for human use due to its significant side effects, including hypotension, bradycardia, and central nervous depression.

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CDC, 2023; Greene, 1988

Poll Question

Does Xylazine Overdose Respond to Narcan?

1. Yes
2. No
3. It Depends

Poll Question

Does Xylazine Overdose Respond to Narcan?

1. Yes
2. No
3. It Depends

Xylazine as an Emerging Threat Nationwide

• As of 2024, the DEA has seized xylazine and fentanyl mixtures in 48 of 50 states.
• The amount of seized fentanyl containing xylazine has increased significantly from 2022-2023 (25-30%).
• The percentage of IMF-involved deaths with xylazine increased by 276% nationally between January 2019 and June 2022.

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CDC, 2023; DEA, 2024

Xylazine in Chicago

• The percentage of IMF-involved deaths with xylazine increased by over 300% in Illinois between 2020 and 2022.
• In Chicago, the first xylazine death was reported in December 2018; rising to a maximum of 20 deaths (13.8% of fentanyl-involved deaths) in May 2022.
• Other consequences: severe, non-healing skin ulcers and soft tissue infections.
• There is no known antidote for xylazine.
• The prevalence of xylazine in the Chicago drug supply and its risk in drug overdose has not been extensively studied, particularly in unhoused populations.

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IDPH, 2023; Ball et. al., 2022

1. What are the experiences of people experiencing homelessness in Chicago regarding xylazine, and associated harm-reduction measures?

2. What are UICCOM and UIHealth medical personnel’s awareness, clinical experience, and comfort with xylazine?

Methods for Aim 1: Patient Surveys

• Chicago Street Medicine (CSM) travels across the Chicago area on regular “street runs” to provide healthcare and supportive services to people in encampments and other locations where social support is needed.
• Individuals who interact with CSM members are asked to participate in a private, 5-10-minute-long verbal survey during outreach efforts.
• After consenting and completing the survey, surveys are recorded electronically by a CSM member and secured in REDCap.

Preliminary Results for Aim 1

• As of September 1, 2025, 14 participants (13 men, 1 woman) completed the survey.

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Preliminary Results for Aim 2: Medical Student Knowledge

• As of September 1st, 83 medical students completed the survey.

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Preliminary Results for Aim 2: Continued

Key Takeaways

• Preliminary results indicate that the majority of CSM patients on the west side of Chicago are aware of xylazine and its dangers.
• While most survey participants had experience with xylazine, over half had never used xylazine test strips.
• 60% of people who used test strips said a positive result would cause them to use less in the future, but not stop entirely.
• Most participants did not know that xylazine overdose would not respond to Narcan.
• Medical students reported limited education on xylazine and harm reduction in the medical school curriculum and are not confident in counseling or treating patients who use xylazine.
• Students who volunteer with CSM were more familiar with xylazine and harm reduction than their peers who do not participate in street medicine.

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There is an urgent need for comprehensive education on xylazine overdose prevention and management among our patients and students!

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Future Directions

• We have added additional survey questions about medetomidine, another deadly sedative with increasing prevalence in the drug supply.
• We will survey more patients, healthcare professionals, and students on their knowledge of xylazine and their comfort with treating patients who use or overdose on xylazine to develop educational programming.

Questions?

Thank you!