Abstract

Introduction: In the U.S., xylazine, the veterinary non-opioid sedative, has emerged as a major threat to people who use illicitly manufactured fentanyl and other drugs. The aim of this study was to compare wastewater detection of xylazine with other public health and safety surveillance data from 2019 to 2023 in Kentucky.

Methods: Wastewater samples from 5 rest areas, 2 truck weigh stations, and 4 wastewater treat- ment plants were tested for xylazine. Wastewater xylazine positivity rates were compared with xyla- zine-positive submission rates from the National Forensic Laboratory Information System and Kentucky’s fatal overdoses in 6-month periods (Period 1=January−June; Period 2=July−December).

Results: Xylazine was detected in 61.6% (424 of 688) of daily wastewater samples from roadway sites/ wastewater treatment plants. For roadways, detection increased from 55% (Period 1, 2021) to 94% (Period 1, 2023), and wastewater treatment plants had an overall detection of 25.8% (n=66 samples, Periods 1 and 2, 2022). Increasing roadway positivity corresponded to trends in National Forensic Lab- oratory Information System xylazine-positive submission rates: from 0.19 per 1,000 submissions (Period 1, 2019) to 2.9 per 1,000 (Period 2, 2022, latest available). No deaths from xylazine were reported publicly in Kentucky, although this study’s authors identified 1−4 deaths (true count sup- pressed) in the overdose surveillance system, which, in back-of-the-envelope comparisons with other states, is far fewer than expected.

Conclusions: Wastewater signals indicate broad geographic exposure to xylazine in Kentucky, yet health outcomes data suggest otherwise. These findings may inform regional, national, and interna- tional efforts to incorporate wastewater-based drug surveillance. Harm-reduction activities along roadways and other suitable locations may be needed

Document Type

Article

Publication Date

6-2024

Notes/Citation Information

© 2024 The Authors. Published by Elsevier Inc. on behalf of The American Journal of Pre- ventive Medicine Board of Governors. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Digital Object Identifier (DOI)

https://doi.org/10.1016/j.focus.2024.100203

Funding Information

This project was supported by Award #2020-R2-CX-0013, awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this presen- tation are those of the authors and do not necessarily reflect those of the Department of Justice. Additional support provided by the NIH grants 1U01DA053903-01 and pilot funds from the University of Kentucky’s Substance Use Priority Research Area (SUPRA), supported by the Vice President for Research. The authors acknowledge the following: Jeremy Triplett of the Ken- tucky State Police Central Forensic Laboratory, the Jones/Ross Research Center, Chemistry Department, Murray State Univer- sity for providing access to the UPLC-MS/MS, David Cornett (Kentucky Transportation Cabinet), Sharon Lovejoy, Benton Hoagland, James Owen, Derek Petrey, Larry Bailey, and Tony Hicks for assistance in sampling access at the rest areas, and Anna Stites, Katherine Gray, Tyler Whitt, Andrew Windhorst, Landon Jones, and DeMarkus for sample analysis/data prepa- ration. Declaration of interest: none.

Share

COinS