Maryland health officials brief subcommittee on xylazine and metatomidine trends as scheduling debate continues

Maryland Department of Health officials told the Public Health and Minority Health Disparities Subcommittee on April 3 that xylazine and a newer veterinary sedative, metatomidine, are being detected repeatedly in the state's illicit fentanyl supply and are complicating clinical care and overdose response.

The briefing, presented by department staff including Dr. Kelly Onarone and Dr. Kalyana Raman, reviewed mortality and near-real-time surveillance and underscored that most xylazine-positive decedents also had illicitly manufactured fentanyl as the cause of death. "We saw a rise last year to 18.4 percent in 2024," Dr. Kelly Onarone said, citing the proportion of decedents who tested positive for xylazine. The department emphasized the preliminary nature of some numbers.

Why it matters: xylazine and metatomidine are veterinary sedatives not authorized for human use and are being mixed into street fentanyl. The drugs can worsen withdrawal, make detoxification and wound care harder, and may increase the severity of nonfatal harms even where total overdose deaths have recently trended down.

Key findings and department actions

- Mortality and surveillance: Dr. Onarone said overall overdose deaths have recently declined from prior peaks, but xylazine-positive decedent proportions rose to 18.4% in 2024 after a lower period in…