Xylazine-Adulterated Fentanyl in the U.S. Southwest: Assessing Risks, Behaviors, and Preventive Strategies - PROJECT SUMMARY Xylazine, a non-opioid sedative and analgesic approved only for veterinary use, has emerged as an increasingly common adulterant of illicitly manufactured fentanyl (IMF) in the US. Xylazine in the illicit drug supply may increase the risk of overdose, and its use has been associated with severe skin ulcerations, profound sedation, and withdrawal symptoms. There is a critical lack of data on the spread of xylazine and its risks in the Southwestern region of the US, such as Arizona. Although xylazine test strips (XTS) are available as one of the preventive strategies to help address the xylazine-associated risks, there is limited understanding of their use and acceptability among people who use IMF. This 4-year R01 application builds on an interdisciplinary collaboration between researchers at the Arizona State University, Valleywise Health, and the Montgomery County Coroner’s Office Toxicology Lab. The project will draw upon a Community Advisory Board composed of key community stakeholders in opioid-related intervention and policy development. The overall purpose of the proposed study is to characterize the emerging trends and social, health-related, and behavioral correlates of xylazine-adulterated IMF use, as well as experiences with XTS use. The study will be conducted in the Phoenix metro area, Arizona, a region situated along dynamic and evolving drug trafficking corridors. The proposed study builds on the Social-Ecological Model that was adapted to characterize the opioid crisis in the US through a multidimensional lens of individual, interpersonal, communal and societal factors of risk. Our mixed-methods approach integrates structured and qualitative data on xylazine-related knowledge, experiences, and risks, and urine toxicology analyses to assess xylazine and other drug exposures using onsite and laboratory-based methods of liquid-chromatography-tandem mass spectrometry (LC-MS/MS). The specific aims of the study are: 1) Characterize the social, behavioral, and health-related correlates of xylazine knowledge, and known and unsuspected xylazine exposures through the analysis of survey and urine toxicology data (LC-MS/MS) obtained from the emergency department (n=100) and community-recruited (n=400) cohorts of people who use IMF (fentanyl). 2) Analyze the uptake, acceptability, and behavioral correlates of XTS use among the emergency department (n=100) and community-recruited (n=400) cohorts of people who use IMF through the analysis of data collected at baseline and 3-month follow up. 3) Through qualitative interviews, provide an in-depth understanding of motivations, practices, and circumstances related to xylazine exposures and XTS use among people who use IMF (n=50). The study is highly significant because it will provide actionable data to help address the emerging risks of xylazine adulteration to help improve risk communication, resource allocation, and intervention strategies.
