Utilizing Multi-Methods to Examine the Impact of Xylazine in the Unregulated Drug Supply - PROJECT SUMMARY / ABSTRACT The overdose crisis in the United States (US) has contributed substantially to mortality, decreased life expectancy, and increased healthcare costs. Xylazine, a veterinary tranquilizer not approved for use in humans, has emerged as an adulterant to the unregulated opioid supply. This has created a rising concern amongst public health practitioners, healthcare providers, and harm reductionists alike, as there is evidence that xylazine (a) may be contributing to the rise in opioid overdoses through increased respiratory depression and decreased heart rate and (b) can induce painful skin ulcers that can have extensive necrosis and are vulnerable to infection. However, due to the novelty of this adulterant in the US, people who use drugs (PWUD) and those that provide services to PWUD have very little information about this substance and its related sequelae. Thus, in this proposal I will pursue two multi-methods studies to characterize the impact of xylazine on PWUD. The first study, based in North Carolina, aims to describe the perceptions of and experiences with xylazine and its related complications (i.e., wounds and overdoses) among PWUD. I will collaborate with North Carolina Survivors Union to recruit participants and use both survey and interview methodologies to ascertain how xylazine is impacting PWUD’s drug use behavior, health outcomes, and healthcare seeking/access. My second study is based in Maine and aims to both (a) elucidate the feasibility and acceptability of a community-based drug checking program that allows PWUD to test their drugs for xylazine and (b) qualitatively and quantitatively describe drug supply changes over time. To assess feasibility and acceptability of a drug checking intervention, we will conduct focus groups amongst PWUD, staff of syringe service programs implementing drug checking, and medical care providers. To describe drug supply changes over time, we will analyze chemical analysis samples of drugs provided to three syringe service programs in Maine. Drug checking, from both Fourier-transform infrared (FTIR) spectroscopy tests in the field and confirmatory gas chromatography–mass spectrometry (GC-MS) conducted in an academic laboratory, will help improve epidemiological surveillance of the volatile drug supply in Maine. Through rigorous scientific evidence, our study is designed to identify key strategies for reducing the harms associated with xylazine among PWUD. This multi-methods proposal ultimately hopes to inform both medical care and harm reduction best practices.
