Xylazine, Pregnancy, and Access to Care - PROJECT ABSTRACT In the past decade, the animal tranquilizer xylazine has been rapidly spreading across the United States, with all four census regions reporting a rise between 2020 and 2021. Although xylazine prevalence and related overdoses remain primarily concentrated in the Northeast U.S., other regions have seen alarming rises; in one year, xylazine-positive overdoses increased by over 1000% in the South and 750% in the West region. In 2023, 98.9% of Philadelphia fentanyl samples contained xylazine, with xylazine as the principal drug component in the latter half of that year. The intense and rapid-onset withdrawal from xylazine prevents patients from attending medical appointments, and patients using xylazine with related wounds often avoid hospital care due to stigma and difficulties with medical clearance. Moreover, the sedating effects of the drug likely places women who use opioids at increased risk of sexual assault. Pregnant women who use opioids (PWUO) are a particularly vulnerable population, affected by high variability in care access and compounded stigma at various levels. Substance use is a growing issue for pregnant women, with a nationwide study from 2017-2020 finding almost 1-in-6 pregnancy deaths to be overdose-related and a large increase in fentanyl- related deaths. Xylazine has undoubtedly already reached the pregnant population, with one maternity ward in St. Louis reporting a jump from 0 to 100% xylazine-positive samples in opioid-dependent patients from 2022 to 2023. Thus far, there is a profound lack of knowledge regarding the effects of xylazine on pregnancy and care for peripartum women. Our long-term goal is to advance understanding of how xylazine has impacted PWUO. Our objective is to generate data about how to promote evidence-based approaches to treatment for PWUO. Our central hypothesis is that xylazine has complicated prenatal care, entry into treatment for opioid use disorder, postpartum care, and other health care access. Our rationale for this study is that understanding the ramifications of xylazine on these outcomes can inform interventions locally and in other areas of the United States. We will do this through implementing an integrated stakeholder engagement process, including training community researchers with living experiences of opioid use and pregnancy, to collect data and interpret results with the study team; describe how the intrusion of xylazine into the fentanyl supply has impacted PWUO; and describe ongoing barriers to care for PWUO to identify methods to improve clinical care. The proposed work is expected to significantly contribute to informing best practices that improve healthcare access for pregnant women who use opioids adulterated with xylazine. It is urgent and timely, given the growing number of pregnancy-related overdoses and rapid spread of xylazine across the country.
