Pilot findings on the real-world performance of xylazine test strips for drug residue testing and the importance of secondary testing methods

Background Xylazine is a sedative found increasingly in the illicit fentanyl supply that can cause hypotension, bradycardia, necrosis and death. This pilot examined the real-world performance of BTNX xylazine test strips (XTS) in drug residue samples. Methods This study was nested within a drug checking service in Rhode Island. We tested unmeasured drug residue dissolved in 5mL of distilled water using XTS and Liquid Chromatography Quadrupole Time-of-Flight Mass Spectrometry (LC-QTOF-MS). Analyses compared XTS and LC-QTOF-MS results to calculate XTS detection of xylazine in residue. Results Among 41 residue samples, xylazine was detected in 11% by the XTS and 44% by the laboratory. The LC-QTOF-MS detected xylazine in 18 samples: 4 major, 9 minor, 5 trace by volume relative to the whole sample. The XTS disagreed with the LC-QTOF-MS by indicating a negative result in 77.8% (N=14) of the samples but never indicated a positive when the LC-QTOF-MS reported xylazine’s absence. The XTS correctly detected xylazine 22% of the time, however, this increased to 100% of the time if xylazine was a major active component. Conclusions In this study, the BTNX XTS often disagreed with LC-QTOF-MS by indicating a negative result, likely due to the dilution levels used and sample composition. The XTS may not be accurate in detecting residual amounts of xylazine, especially if xylazine is not a dominant component of the tested sample. Given the novelty of BTNX’s XTS products, we recommend XTS only be used in conjunction with other advanced drug checking modalities for residue testing.