![]() ![]() All respondents gave digital informed consent prior to beginning the survey. The survey was created on the survey hosting platform Qualtrics ( ) which allowed for web-based distribution of survey via a link. 23Īn anonymous English-language survey was developed to include questions about demographics, patterns of xylazine use, and experiences from using xylazine. The coding process was a multi-label classification and each post could be assigned one or many codes. 23, 24 A consensus approach among the authors was used to assign codes to the posts. We used a thematic content analysis approach to classify posts into different codes. and A.S.) reviewed a small sample of posts to identify relevant categories into which the posts could be coded. 21 We searched for mentions of ‘xylazine’ and ‘Tranq’, as well as lexical variants, from the subreddits using NLP to identify references to xylazine. 19 From the chosen subreddits, we collected all publicly available retrievable posts via the PRAW Python application programming interface (API) for Reddit. Initial subreddits were selected based on study group consensus of subreddit relevance and prior experience using Reddit to evaluate patterns in drug use. Several drug-related subreddits on Reddit were selected to search for xylazine-related posts. Specifically, we sought to answer the following: 1) what are the demographics of Reddit subscribers self-reporting exposure to xylazine? 2) is xylazine a desired additive? and 3) what adverse effects of xylazine are PWUDs experiencing? 19, 20 Our objectives were to better understand xylazine use by utilizing social media to survey PWUDs about their experience with xylazine. 18, 19 Given rising concerns about xylazine we sought to identify a cohort of people who self report exposure to xylazine in the drug supply by using public social media data from Reddit to conduct this study. 17 It allows subscribers to remain completely anonymous if they choose, and, due to this anonymity, Reddit has become a hub for the open discussion of sensitive or stigmatized topics including drug use. Reddit is one of the most popular and fastest-growing social networks currently, with over 430 million monthly active subscribers. 15 Despite its increasing prevalence, few studies have described the limited qualitative experience of concurrent xylazine use with opioids among people who use drugs (PWUDS). 16 More recently in Philadelphia, xylazine is being found in up to 75-90% of drug samples. 2, 13- 15 In 2019, the CDC reported that of 45,676 overdose deaths in the State Unintentional Drug Overdose Reporting System (SUDORS) there were 826 (1.8%) that were xylazine-positive, and that 99.1% of all xylazine-involved deaths also involved fentanyl or fentanyl analogues. 11, 12Įmerging evidence from forensic, confiscated, and donated drug samples demonstrate that xylazine is increasingly found in the opioid drug supply in the Northeast and rapidly spreading to the rest of the country. 4, 8- 10 There are sporadic reports of xylazine being present in the illicit drug supply in Philadelphia and Puerto Rico prior to 2019. ![]() 6, 7 Until recently, descriptions of human exposures to xylazine in the medical literature were limited to case reports of xylazine intentional exposures. 1, 4, 5 Veterinary studies have evaluated its use as a sedative in a number of different species. 1, 5 In addition to sedative effects caused by central A 2 agonism there is evidence that xylazine acts at multiple receptors contributing to its clinical effects. The chemical structure of xylazine resembles phenothiazines, tricyclic antidepressants, and clonidine. Xylazine was investigated for potential use in humans, but rejected due to severe central nervous system and blood pressure adverse effects 2- 4. Xylazine is an α 2-agonist used in veterinary medicine as a sedative-hypnotic, muscle relaxant, and anti-emetic. ![]()
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