ArticleDrug and alcohol dependence2025
Characterization of xylazine-related overdose deaths in Maryland (2020-2023).
Article in Drug and alcohol dependence, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Toxicological evidence of xylazine in fatal and non-fatal human intoxication: a systematic review.Forensic science, medicine, and pathology · 2026Review
- Theorizing causality: A qualitative study of xylazine-related wound diversity and perceived etiology among people who inject drugs.Addiction (Abingdon, England) · 2026Article
- Xylazine exacerbates fentanyl-induced respiratory depression and prevents rescue by naloxone in mice.Psychopharmacology · 2026Article
- Acute fentanyl and xylazine co-exposure uniquely increase the excitability of dopamine type 2 receptor-expressing striatal medium spiny neurons.Journal of neurophysiology · 2026Article
- The xylazine-fentanyl nexus: A public health emergency.SAGE open medicine · 2025Review
Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
backgroundXylazine is a fentanyl contaminant which has been increasingly detected in drug overdose deaths in Maryland. This study explored risk factors and time trends of xylazine-related overdose deaths (XRODs) in Maryland from 2020 to 2023.
methodsThis serial cross-sectional study utilized data from the Maryland Office of the Chief Medical Examiner on fentanyl overdose deaths that occurred from 2020 to 2023. XROD was defined as someone who died from overdose and had a positive postmortem blood xylazine test. Multivariable logistic regression modeled associations between demographic variables and presence of co-occurring substances with XROD. Annual population-based XROD rates were calculated for the overall sample and by race, age group, and sex.
resultsThere were 8721 fentanyl overdose deaths in Maryland between 2020 and 2023. Among these, 1798 (20.6 %) were XRODs. Annual XROD rates peaked in 2021 and have declined since then. Although Black Marylanders experienced the highest overall burden of overdose, xylazine was significantly more likely to contribute to fentanyl overdose deaths among White individuals compared to Black individuals (aOR 1.18) and those aged 31-40 years compared to those 60 or older (aOR 1.25). Morphine (aOR 1.36), methadone (aOR 1.41), benzodiazepines (aOR 1.20), and tramadol (aOR 2.12) were associated with higher odds of XROD.
conclusionsXRODs are a major problem in Maryland, and there are significant differences in XROD mortality by race, age, and co-occurring substance use. Efforts to reduce xylazine-related mortality in Maryland should provide overdose prevention education and harm reduction services to the most vulnerable populations.
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