The first drug-related death associated with xylazine use in the UK and Europe

• Published in: Journal of forensic and legal medicine Vol. 97; p. 102542
• Main Authors: Rock, Kirsten L., Lawson, Alexander J., Duffy, Joanne, Mellor, Alice, Treble, Ric, Copeland, Caroline S.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.07.2023
• Subjects: Adult; Adulterant; Analgesics, Opioid; Death; Drug Overdose; Europe; Fentanyl; Heroin; Humans; Illicit Drugs; Male; Overdose; Pathology; Pharmaceutical Preparations; Substance-Related Disorders - epidemiology; Surveillance; Toxicology; United Kingdom - epidemiology; United States - epidemiology; Xylazine; United States; United Kingdom; Europe; Xylazine; Death; Toxicology; Adulterant; Overdose; Surveillance
• ISSN: 1752-928X; 1878-7487; 1878-7487
• DOI: 10.1016/j.jflm.2023.102542

On November 8th, 2022, the United States Food and Drug Administration (FDA) issued a statement alerting healthcare professionals to the increasing prevalence of xylazine in illicit drug overdoses in the country. Xylazine is a veterinary medicine with sedative, analgesic and muscle relaxant properties that is used as a heroin/fentanyl adulterant on the illicit drug market in North America. Here we report the first drug-related death associated with xylazine in the United Kingdom. The National Programme on Substance Abuse Deaths (NPSAD) receives reports on drug-related deaths from coroners In England, Wales and Northern Ireland on a voluntary basis. The NPSAD was searched for cases with xylazine detections in cases received by December 31, 2022. One drug-related death associated with xylazine use was reported to NPSAD by December 31, 2022. The deceased was a 43-year-old male who was found dead at home with drug paraphernalia located at the property in May 2022. The post-mortem examination identified recent puncture wounds to the groin. Coronial documentation reports that the deceased had a history of illicit drug use. A number of drugs were detected by post-mortem toxicology and xylazine was implicated in death alongside heroin, fentanyl and cocaine. To the best of our knowledge, this is the first death associated with xylazine use reported in the UK, and even Europe, and indicates the entry of xylazine into the UK drug supply. This report highlights the importance of monitoring changes in illicit drug markets and the emergence of new drugs. •Xylazine is a veterinary medicine with no approved human use.•In the United States, xylazine is used as an adulterant in the illicit drug supply.•This is the first drug-related death associated with xylazine in the United Kingdom.•The presence of xylazine in the illicit drug supply in Europe is cause for concern.