Intentional xylazine poisoning: a nationwide French poison control center study.

INTRODUCTION: Xylazine, an α2-adrenergic agonist used as a veterinary sedative, has emerged as an adulterant of illicit opioids, contributing to fatal overdoses in North America and has recently been detected in Europe. In France, despite alarmist media reports, data on xylazine exposures are scarce.

METHODS: We retrospectively reviewed intentional xylazine exposures reported to the eight French poison control centers from January 2010 to December 2024. Cases were extracted from the French National Database of Poisonings. Inclusion required intentional use; severity was assessed using the Poison Severity Score.

RESULTS: Nineteen intentional exposures were identified: seventeen in the context of a suicide attempt, one homicidal, and one recreational. Mean age was 36.4 years; sex ratio 2.6 (male/female). For the cases occurring in the context of a suicide attempt, eleven involved xylazine alone, and six in combination with other drugs (mainly ketamine or fentanyl). Three fatalities occurred (16%), and six patients developed severe clinical features (Poisoning Severity Score 3), including coma, bradycardia, and hypotension. The single recreational case involved a fentanyl/xylazine mixture with full recovery.

DISCUSSION: Over a 14-year period, intentional xylazine poisonings reported to French Poison Control Centers were uncommon, mainly occurring in the context of a suicide attempt, and often linked to occupational access to veterinary sedatives. These data do not support community or recreational spread. Nonetheless, observed cases confirm xylazine's life-threatening potential.

CONCLUSION: This retrospective analysis highlights the rarity of reported xylazine exposures in French poison centre data, strengthened toxicological surveillance and coordination between Poison Control Center and drug-checking networks are needed to detect any shift toward broader use and guide prevention efforts.