Wound Causing Agents in the Illicit Drug Supply: Evidence from a Statewide Drug Checking Program

Published

December 5, 2024

Author(s)

Emily Martin, Kristin Schneider, Edward Sisco, Meghan Appley, Margaret Rybak, Rae Elkasabany, Susan Sherman

Abstract

Objectives To examine the prevalence of wound causing agents (xylazine, levamisole, medetomidine) in Maryland's illicit drug supply and co-occurrence with other substances. Methods Using data from Maryland's statewide drug checking program, Rapid Analysis of Drugs (RAD), this paper discusses samples that were voluntarily provided at participating harm reduction centers and tested at the National Institute of Standards and Technology between October 2021 and October 2023 (N= 2,210). We calculated prevalence and chi-square significance to assess co-occurrence and evaluated xylazine's prevalence over time. Results Xylazine occurred in 33.4 % of samples and primarily co-occurred with fentanyl, heroin and related compounds, other opioids, other stimulants, and other anesthetics. Xylazine's prevalence decreased over time and varied geographically. Levamisole and medetomidine occurred in 1.9 % and 0.7 % of samples respectively with no significant co-occurrence. Conclusions These findings emphasize the importance of statewide monitoring amid an evolving drug market and the need to monitor wound causing agents' prevalence. Policy Implications Policymakers should advocate for drug checking, safe supply, and provision of overdose prevention and non-stigmatizing wound care services for people who use drugs (PWUD).

Citation

International Journal of Drug Policy

Pub Type

Journals

Download Paper

https://doi.org/10.1016/j.drugpo.2024.104677

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Keywords

Xylazine, PWUD, Wound-associated agents, Wounds, Unregulated drug supply, Drug checking

Citation

Martin, E. , Schneider, K. , Sisco, E. , Appley, M. , Rybak, M. , Elkasabany, R. and Sherman, S. (2024), Wound Causing Agents in the Illicit Drug Supply: Evidence from a Statewide Drug Checking Program, International Journal of Drug Policy, [online], https://doi.org/10.1016/j.drugpo.2024.104677, https://tsapps.nist.gov/publication/get_pdf.cfm?pub_id=957218 (Accessed October 14, 2025)