Jennifer S. Love

Introduction: Nitazenes are an emerging class of highly potent synthetic opioids not approved for clinical use. Knowledge of nitazene-associated practices and clinical effects remains limited. Reddit contains nitazene-related discussions describing self-reported experiences. We analyzed nitazene mentions to characterize these experiences. Methods: Nitazene-mentioning posts between 01/2019 and 10/2025 were extracted via natural language processing-based lexical filters, and a random sample of 293 mentions was qualitatively reviewed and annotated for themes consolidated via consensus discussion. Repeated findings more specific than themes were synthesized as subthemes, and a validated GPT-4o-based pipeline was applied to all mentions to forecast the theme distribution. Results: A total of 31,638 mentions were extracted; frequency increased between 2022 and 2024 (mean 584 mentions/month, P <0.01 increase compared with 2019–2021’s mean of 197 mentions/month). Ten themes were curated, with source (31.3%), potency and dose (26.5%), and uncertainty (25.9%) most prevalent in the annotated sample. Across the full dataset, automated characterization predicted that general experience (44.7%), general comment (37.9%), and potency and dose (27.6%) were the most prevalent thematic labels. Nine subthemes included information about counterfeit pills, withdrawal management difficulties, motivating factors for use, benzodiazepine adulteration, and vascular injury associated with intravenous administration. Discussion: Increasing nitazene mentions on Reddit may reflect increasing interest and use. Thematic characterization identified patterns in nitazene use, effects, and distribution relevant to clinical practice and public health. Insights provided by subthemes align with laboratory potency assessments and emerging evidence from case series and health alerts. Conclusion: These findings can inform public health monitoring, overdose prevention, and clinical characterizations of nitazene use.

This study, using natural language processing and manual thematic analysis of Reddit posts, revealed a rapid rise in discussions about tianeptine, with posts frequently reporting dependence, withdrawal, and coingestion with other unregulated substances, highlighting tianeptine as an emerging public health concern.

Background and aims: Xylazine, an alpha‐2 agonist used in veterinary anesthesia, is increasingly detected in the illicit opioid supply but little is known about the patient level factors associated with xylazine in non‐fatal opioid overdose. This study aimed to determine the demographic and clinical factors associated with xylazine detection among emergency department (ED) patients with opioid overdose. Design: Observational study. The Toxicology Investigators Consortium (ToxIC) Fentalog Study is a multicenter, prospective cohort of adult patients with suspected opioid overdose. This analysis included patients enrolled from September 2020 to September 2023. Setting: In this multicenter study, participating sites included 10 institutions across 9 states in 4 regions of the United States (US): Northeast, Southeast, Midwest and West. Participants: Patients were eligible for Fentalog Study inclusion if they were at least 18 years old, had a suspected opioid overdose and had waste blood available for toxicologic analysis. Only patients with qualitative serum detection of illicit opioids and/or xylazine were included in the final cohort. Of 5554 patients screened, 1289 were eligible for Fentalog Study inclusion. Measurements: Based on results of liquid chromatography with a quadrupole time‐of‐flight mass spectrometer (LCQTOF‐MS) and/or liquid chromatography with a triple quadrupole mass spectrometer (LC‐QQQ‐MS), patients were categorized into those with xylazine detected (positive cases) and without xylazine detected (negative controls). To determine clinical variables associated with xylazine detection, the primary outcome of interest was qualitative detection of xylazine on serum sampling by LCQTOF‐MS. Findings: Xylazine was detected in 238 patients. Patients with xylazine were primarily male (78%), white (48%), non‐Hispanic (82%) and located in the Northeast US (75%). Bradycardia on initial ED vital signs was associated with higher likelihood of xylazine detection (adjusted odds ratio = 2.11, 95% confidence interval = 1.06–4.06). Conclusions: Xylazine detection among emergency department opioid overdose patients appears to be more prevalent in the Northeast US and bradycardia appears to be a statistically significant clinical predictor.

Background: Xylazine, a veterinary sedative not approved for human use, is increasingly present, often mixed with fentanyl, in the illicit opioid supply. Its clinical impact in human overdose and methods for reliable detection remain unclear. To inform harm reduction strategies, this study evaluates and compares two rapid urine tests that can detect xylazine. Methods: This prospective observational study included emergency department (ED) patients with suspected opioid overdose at two New York City EDs between April and July 2025. Discarded urine samples from enrolled patients were tested for xylazine using two rapid immunoassays. The threshold of detection for the Instanosis Xylazine Test Strips was 1 ng/ml and for BTNX test strips, 1000 ng/ml. Results: Eleven urine samples were analyzed. Xylazine was detected in seven samples (64%) using the Instanosis Xylazine Test Strip. Only two samples (18%) had xylazine detected using the BTNX strips. Four samples (36%) tested negative using both strips. Conclusion: Preliminary findings highlight variability between test strips and suggest the need for further evaluation before determining clinical utility. These discrepancies may reflect false negatives with BTNX due to its higher detection threshold. Future work will compare xylazine serum testing with urine test strip testing.

Background: Xylazine has been associated with skin wounds. The rising prevalence of xylazine and its debated role in wound causation have sparked concerns among public health professionals, medical experts, and people who use drugs. Objective: This study used a qualitative evaluation of Reddit posts to understand the experiences of people who use drugs concerning xylazine-associated wounds. Methods: This study explored xylazine discussions on Reddit. Data were collected from 930+ drug-related subreddits via the PRAW Python application programming interface, and natural language processing methods were employed to identify posts that mentioned xylazine and wound-related keywords. Retrieved posts were manually coded for thematic analysis, and a term frequency–inverse document frequency analysis was performed per theme to obtain additional insights. Results: The manual classification of 286 posts revealed predominant themes related to the pathophysiology of xylazine, wound locations on the body, and management strategies. The 3 most frequent xylazine wound-related themes were “Mechanisms of xylazine-associated wounds” (84 posts, 29.4%), “Geographic region” (67, 23.4%), and “Location of wounds on the body” (56, 19.6%). The analysis showed xylazine’s presence in the discussions among Reddit’s drug-using communities, with a notable focus on wound management and geographic trends. The term frequency–inverse document frequency analysis revealed prominent lexical markers within each theme. Conclusions: The findings suggest that social media platforms such as Reddit can serve as valuable resources for understanding emerging health issues such as xylazine-associated wounds. The study’s findings highlight patterns of use, the characteristics of wounds on people who use drugs, and discussions about wound management. This study adds to a growing body of literature using social media to understand the consequences of emerging drugs on human health.

Background: The increasing use of social media to share lived and living experiences of substance use presents a unique opportunity to obtain information on side effects, use patterns, and opinions on novel psychoactive substances. However, due to the large volume of data, obtaining useful insights through natural language processing technologies such as large language models is challenging. Objective: This paper aims to develop a retrieval-augmented generation (RAG) architecture for medical question answering pertaining to clinicians’ queries on emerging issues associated with health-related topics, using user-generated medical information on social media. Methods: We proposed a two-layer RAG framework for query-focused answer generation and evaluated a proof of concept for the framework in the context of query-focused summary generation from social media forums, focusing on emerging drug-related information. Our modular framework generates individual summaries followed by an aggregated summary to answer medical queries from large amounts of user-generated social media data in an efficient manner. We compared the performance of a quantized large language model (Nous-Hermes-2-7B-DPO), deployable in low-resource settings, with GPT-4. For this proof-of-concept study, we used user-generated data from Reddit to answer clinicians’ questions on the use of xylazine and ketamine. Results: Our framework achieves comparable median scores in terms of relevance, length, hallucination, coverage, and coherence when evaluated using GPT-4 and Nous-Hermes-2-7B-DPO, evaluated for 20 queries with 76 samples. There was no statistically significant difference between GPT-4 and Nous-Hermes-2-7B-DPO for coverage (Mann-Whitney U=733.0; n1=37; n2=39; P=.89 two-tailed), coherence (U=670.0; n1=37; n2=39; P=.49 two-tailed), relevance (U=662.0; n1=37; n2=39; P=.15 two-tailed), length (U=672.0; n1=37; n2=39; P=.55 two-tailed), and hallucination (U=859.0; n1=37; n2=39; P=.01 two-tailed). A statistically significant difference was noted for the Coleman-Liau Index (U=307.5; n1=20; n2=16; P<.001 two-tailed). Conclusions: Our RAG framework can effectively answer medical questions about targeted topics and can be deployed in resource-constrained settings.

Background Gender diversity in both emergency medicine and medical toxicology has grown over the last decade. However, disparities in promotion, awards, and speakership still exist. No studies have examined gender disparities in authorship in medical toxicology journals. Research Questions Does the proportion of female first authors and female senior authors in medical toxicology publications increase over time? What factors predict female authorship in the first author or last author positions in two major medical toxicology journals? Methods We performed a retrospective review of all non-abstract publications in two medical toxicology journals, Clinical Toxicology and Journal of Medical Toxicology, between 2011 and 2020. We collected author names, number of authors, publication type, and publication year. Author names were used to identify author gender using Gender-API integrative tool. Data on the percentages of female medical toxicology fellows and medical toxicologists was provided by the American Board of Emergency Medicine (ABEM). Results A total of 2212 publications were reviewed and 2171 (97.9%) were included in the dataset. Overall, 31.7% of first authors were identified as female and 67.0% were identified as male by the Gender-API tool. There were 46.8% male-male author dyads, 24.2% female-male author dyads, 12.1% male-female author dyads, and 5.7% female-female author dyads. Predictors of female first authorship included research and case report articles, and percentage of ABEM female toxicologists. Predictors of female senior authorship included number of authors and percentage of ABEM female toxicologists. The proportion of female authorship in both categories increased over the study period. Conclusions The frequency of female authorship in the first author position has grown over the last decade and is associated with increasing female representation in medical toxicology and specific manuscript subtypes, specifically research manuscripts.

Objectives Xylazine is an alpha-2 agonist increasingly prevalent in the illicit drug supply. Our objectives were to curate information about xylazine through social media from People Who Use Drugs (PWUDs). Specifically, we sought to answer the following: 1) what are the demographics of Reddit subscribers reporting exposure to xylazine? 2) is xylazine a desired additive? and 3) what adverse effects of xylazine are PWUDs experiencing? Methods Natural Language Processing (NLP) was used to identify mentions of “xylazine” from posts by Reddit subscribers who also posted on drug-related subreddits. Posts were qualitatively evaluated for xylazine-related themes. A survey was developed to gather additional information about the Reddit subscribers. This survey was posted on subreddits that were identified by NLP to contain xylazine-related discussions from March 2022 to October 2022. Results 76 posts mentioning xylazine were extracted via NLP from 765,616 posts by 16,131 Reddit subscribers (January 2018 to August 2021). People on Reddit described xylazine as an unwanted adulterant in their opioid supply. 61 participants completed the survey. Of those that disclosed their location, 25/50 (50%) participants reported locations in the Northeastern United States. The most common eoute of xylazine use was intranasal use (57%). 31/59 (53%) reported experiencing xylazine withdrawal. Frequent adverse events reported were prolonged sedation (81%) and increased skin wounds (43%). Conclusions Among respondents on these Reddit forums, xylazine appears to be an unwanted adulterant. PWUDs may be experiencing adverse effects such as prolonged sedation and xylazine withdrawal. This appeared to be more common in the Northeast.

Illicit opioids, consisting largely of fentanyl, novel synthetic opioids, and adulterants, are the primary cause of drug overdose fatality in the United States. Xylazine, an alpha-2 adrenergic agon...