Analysis of Xylazine Exposure and Experiences among Reddit Users

This study examines self-reported xylazine exposure and experiences among Reddit users through a mixed methods approach. Natural Language Processing (NLP) was employed to extract mentions of xylazine from posts on opioid-related subreddits. Findings suggest a concerning presence of xylazine in illicit drug supply and potential impacts on sedation and withdrawal syndromes. The study aims to explore the demographics of xylazine users, its withdrawal effects, and reported complications. The research sheds light on the growing chatter and concerns surrounding xylazine use on Reddit.

• Xylazine Analysis
• Reddit Users
• Drug Exposure
• NLP
• Withdrawal Effects

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1. Self Reported Xylazine Exposure and Experiences: A Mixed Methods Study of Reddit Users Tony Spadaro, MD MPH Hospital of the University of Pennsylvania, Dept of Emergency Medicine Anthony.Spadaro@pennmedicine.upenn.edu @TSpadaro91

2. Conflicts of Interest I have no financial conflicts of interest to disclose

3. Background: Xylazine Xylazine is an A2-agonist and analog of clonidine that is approved for use in veterinary medicine as a sedative- hypnotic. Image from @moraffreports Increasingly present in illicit drug supply Potentially can cause sedation not responsive to naloxone Reports of increased skin ulcers as far back as 2012 From: https://doi.org/10.1093/jat/bkac049

4. Background: Reddit Has more monthly active users than Twitter Posts are completely anonymous Allows for longer form posts Organized into Subreddits

5. What is the chatter around xylazine in Reddit What are the demographics of people who use xylazine on Reddit Objectives What impact does Xylazine have on withdrawal syndromes What are the complications of xylazine use that people are reporting

6. Natural Language Processing (NLP) was used to retrieve mentions of xylazine from posts by Reddit subscribers who also posted on opioid- related subreddits. Posts were qualitatively evaluated for xylazine- related themes. An anonymous survey was also developed to gather demographic information, use patterns of other drugs, and experiences with xylazine. This study was exempted from Institutional Review Board. Methods

7. NLP results Subreddit Quote r/heroin The sleep aid is called xylazine. Here in northeast it will out you right to sleep. Like car running,, at stop light or watching TV show and 2 hours goes by like 2 mins. It's very strange stuff because it's not like a sleep nod, it's like unconcious sleep. r/fentanyl Tell tale symptoms are cold limbs especially your feet hands, fingers, numbness in limbs, Low HR, low BP, heart palpitations, It also has a weird feeling a lot of people first mistake it for the stuff just being a little strong or it being a RC, but usually they'll do it and either fall asleep r/HeroinHeroines Are you sure your h is actually h? Could be xylazine- in my area, huge open air market A total of 76 posts mentioning xylazine were extracted via NLP from 765,616 posts by 16,131 subscribers (January 2018 to August 2021)

8. Survey Results: Demographics Demographics (N=58) Age (Media, Range) 30-39 Race (%) White 81 African American 3.4 Other 15.6 Geography (%) Northeast* 47 Southeast 0 Midwest 16 Southwest 14 West 8 Other Country** 14 *Pennsylvania was most common answer (25% of total) **Other countries included Canada, Sweden and Ecuador

9. Reddit Users are not representative of general population Reddit Users might not be representative of PWUD Requires internet access Requires knowledge of these subreddits If xylazine is more commonly present in some drugs (fentanyl) than other drugs (cocaine), exposure may be unequally distributed Diversity Equity and Inclusion

10. Survey Results: Patterns of use fentanyl no 22% Most Common Routes of Use: 1.Intranasal 2.Injection 3.Inhalation 4.Oral Do you seek out xylazine intentionally? yes 78% cannabis yes 36% yes 46% no 54% no 64% cocaine yes 24% no 76%

11. Survey Results: Withdrawal Have you ever experienced withdrawal from xylazine? Since using xylazine, how has your withdrawal from other drugs changed? better no same yes worse 26 26.5 27 27.5 28 28.5 29 29.5 0 5 10 15 20 25 30

12. Increased skin and soft tissue infections (25%) Increased overdoses (15%) Survey Results: Complications of Xylazine Use Increased ED visits (8%) Extreme wounds and necrosis Scars all over Very high blood pressure, can feel heart beat

13. Conclusions People are posting on Reddit that xylazine is an unwanted adulterant in opioid supply Xylazine use among people who use Reddit seems to be more prevalent in the Northeast People who use fentanyl are probably the most exposed to xylazine More study is needed to confirm the effects of xylazine use and possible withdrawal syndromes Concern for increased skin wounds and autonomic effects

14. Questions/Acknowledgements Mentors: Jeanmarie Perrone, Abeed Sarker, Co-authors: Sahithi Lakamana, Karen O Conner, Rachel Wightman, Jennifer Love