Community-informed approaches to the escalating presence of xylazine in opioids

针对阿片类药物中甲苯噻嗪含量不断增加的社区知情方法

• 批准号: 10701304
• 负责人: Megan Reed
• 金额: $ 21.02万
• 依托单位: THOMAS JEFFERSON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10701304
• 关键词: Address; Adrenergic Agonists; Amputation; Animals; Bradycardia; Canada; Care given by nurses; Central Nervous System; Cessation of life; Cities; Communities; Country; Data; Development; Dopamine; Drug abuse; Feedback; Fentanyl; Goals; Harm Reduction; Health; Heroin; Hospitals; Hypotension; Injections; Intervention; Knowledge; Learning; Link; Marketing; Massachusetts; Muscle relaxation phase; Neurotransmitters; Norepinephrine; Opioid; Outcome; Pain; Peripheral; Persons; Pharmaceutical Preparations; Philadelphia; Positioning Attribute; Public Health; Puerto Rico; Research; Research Personnel; Research Support; Risk; Sampling; Sedation procedure; Services; Site; Stimulus; Testing; Time; Toxicology; Tranquilizing Agents; Translating; United States; Vasoconstrictor Agents; Ventilatory Depression; Work; Xylazine; acceptability and feasibility; adverse outcome; design; drug market; evidence base; experience; intervention refinement; opioid overdose; opioid user; overdose death; patient oriented; person centered; prevent; response; rural area; screening; sexual assault; skin lesion; symposium; therapy design; webinar; wound care

PROJECT ABSTRACT People who use opioids (PWUO) from the unregulated drug market have little control over the presence of unwanted substances within the drug products they obtain. Xylazine, an animal tranquilizer, has been increasingly detected in opioids throughout the eastern United States, Puerto Rico, and Canada. Xylazine produces a more potent high than heroin alone, potentiates and prolongs the effects of opioids, and may increase the risk of opioid-related overdose or death. Xylazine decreases the release of excitatory neurotransmitters in the central nervous system (CNS) and peripherally acts as a vasoconstrictor. This can lead to sedation, muscle relaxation, respiratory depression, and hypotension. Moreover, the long, sedating effects of the drug places PWUO at increased risk of sexual assault. Xylazine is also linked to development of severe infected ulcerating skin lesions in both injection and non-injection sites. Of concern, xylazine is rapidly spreading across the United States, with a five times higher presence in national overdose deaths in 2020 compared with 2015. Spread has been particularly rapid in the Eastern and Northeast parts of the country. To date, the United States lacks a robust national public health response to xylazine. As xylazine emerges in drug markets in other parts of the country, there is an urgent need for a rapid response to prevent adverse outcomes for PWUO nationally. In response to this rapid rise of xylazine in Philadelphia, PWUO have been seeking strategies to mitigate xylazine harms. To date, these have not been rigorously explored nor disseminated. Our research indicates that PWUO in Philadelphia desire tailored harm reduction strategies to avoid xylazine. The objective of this proposal is to leverage the knowledge and experiences of PWUO in Philadelphia, an early locus of xylazine emergence, alongside national content experts to develop and test person-centered approaches to mitigate the impact of xylazine as it emerges as an adulterant in other markets nationally. We will do this through 1) engaging PWUO and other content experts to explore current experiences with xylazine adulteration, 2) developing actionable interventions to address emerging xylazine adulterations, and 3) presenting these draft interventions in emerging xylazine markets in Massachusetts for purposes of feedback and to inform refinement. Our long-term goal is to translate PWUO needs into PWUO- centered interventions, creating key harm reduction messaging to mitigate the public health harms of xylazine adulteration observed in Philadelphia. The proposed work is expected to significantly contribute to informing optimal harm reduction interventions to mitigate harms associated with xylazine adulteration that can be rapidly implemented. It is urgent and timely, as xylazine is currently rapidly spreading across the country, and thus these interventions are imminently needed to prevent unnecessary harm.

项目摘要 使用不受监管的药物市场使用阿片类药物（PWUO）的人几乎没有控制 他们获得的药品中的不需要物质。木嗪是一种动物镇静剂，已经 在美国东部，波多黎各和加拿大的阿片类药物中越来越多地发现。撒嗪 单独产生的比海洛因更有效，增强并延长阿片类药物的影响，可能 增加阿片类药物相关的过量或死亡的风险。撒嗪减少兴奋性的释放 中枢神经系统（CNS）中的神经递质和外周充当血管收缩剂。这可以 导致镇静，肌肉松弛，呼吸道抑郁和低血压。而且，长而镇静 毒品场所的影响PWUO对性侵犯的风险增加。撒嗪也与 注射和非注入部位中严重感染的溃疡皮肤病变。令人担忧的是，撒甲嗪迅速 遍布美国，在2020年全国过量死亡中的存在五倍 与2015年相比，该国东部和东北部的差异特别迅速。到 日期，美国缺乏对木马的强大的国家公共卫生反应。当甲基嗪在药物中出现 该国其他地区的市场迫切需要快速反应以防止不利 全国PWUO的成果。为了回应费城木马嗪的这种快速兴起，Pwuo一直是 寻求减轻甲基嗪危害的策略。迄今为止，这些尚未经过严格探索或 传播。我们的研究表明，费城的PWUO渴望为减少伤害策略定制 避免甲基嗪。该提议的目的是利用Pwuo的知识和经验 费城是撒甲嗪出现的早期基因座，与国家内容专家一起开发和测试 以人为中心的方法来减轻木马的影响，因为它在其他市场中成为掺假者 全国。我们将通过1）吸引PWUO和其他内容专家来探索当前 甲基嗪掺假的经历，2）制定可行的干预措施，以解决新兴的撒甲嗪 掺假和3）在马萨诸塞州新兴的撒甲苯市场中提出这些草案干预措施 反馈的目的并告知完善。我们的长期目标是将PWUO需求转化为Pwuo- 集中的干预措施，创建关键的减少危害消息传递，以减轻木马的公共卫生危害 在费城观察到的掺假。预计拟议的工作将有助于通知 最佳的危害减少干预措施以减轻与撒甲嗪掺假相关的危害，这可以迅速 实施的。这是紧迫而及时的，因为木马嗪目前正在迅速蔓延到全国，因此 这些干预措施是必需的，以防止不必要的伤害。