Max Mantych, MS; Cassandra Laibly, MS; Hunter Russell; Kirsten M.M. Beyer, MS, PhD; Yuhong Zhou, MS, PhD, ME; Ronald Anguzu, MD, PhD
WMJ. 2025;124(2): 148-152
ABSTRACT
Introduction: Xylazine association with fentanyl poses an emerging threat to public health. We conducted a retrospective study to analyze xylazine-related fatal overdoses in Milwaukee County, Wisconsin from 2019 through 2023.
Methods: Using medical examiner data, we compared fatal xylazine overdoses (n = 243) with fentanyl overdoses without xylazine (n = 1946). Demographic, polysubstance, temporal, and geographic characteristics were analyzed.
Results: Xylazine fatalities have surged since 2019, exhibiting different polysubstance profiles than fentanyl overdoses without xylazine. We identified 8 geospatial clusters contributing to 64% of xylazine overdoses.
Discussion: We encourage localized interventions to address the xylazine-fentanyl syndemic. Policy measures such as Wisconsin Act 217, which legalized xylazine testing materials, promote evidence-based harm reduction tools to mitigate the risks associated with xylazine’s increasing prevalence in the Midwest.