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

基本信息

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
项目类别：
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

项目摘要

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.

项目摘要使用来自不受监管的药品市场的阿片类药物 (PWUO) 的人几乎无法控制阿片类药物的存在他们获得的药品中含有不需要的物质。 Xylazine 是一种动物镇静剂在美国东部、波多黎各和加拿大，阿片类药物的检出率越来越高。甲苯噻嗪产生比单独使用海洛因更有效的兴奋剂，增强并延长阿片类药物的作用，并可能增加阿片类药物相关过量或死亡的风险。赛拉嗪减少兴奋性物质的释放中枢神经系统 (CNS) 中的神经递质和外周血管收缩剂。这个可以导致镇静、肌肉松弛、呼吸抑制和低血压。此外，长时间的、镇静的该药物的作用使 PWUO 遭受性侵犯的风险增加。赛拉嗪还与注射部位和非注射部位出现严重感染、溃疡性皮肤损伤。值得关注的是，甲苯噻嗪正在迅速蔓延至美国各地，2020 年全国服药过量死亡人数增加了五倍与2015年相比，该国东部和东北部地区的传播速度尤其迅速。到迄今为止，美国缺乏针对甲苯噻嗪的强有力的国家公共卫生应对措施。随着甲苯噻嗪出现在药物中国内其他地区的市场，迫切需要快速反应，防止不利影响 PWUO 在全国范围内取得的成果。为了应对费城甲苯噻嗪的迅速增加，PWUO 已寻求减轻甲苯噻嗪危害的策略。迄今为止，这些还没有经过严格的探索，也没有传播。我们的研究表明，费城的 PWUO 希望制定量身定制的减少伤害策略避免使用甲苯噻嗪。该提案的目的是利用 PWUO 的知识和经验费城，甲苯噻嗪出现的早期所在地，与国家内容专家一起开发和测试当赛拉嗪作为掺假物出现在其他市场时，采取以人为本的方法来减轻其影响全国范围内。我们将通过以下方式做到这一点： 1) 让 PWUO 和其他内容专家参与探索当前的赛拉嗪掺假的经验，2) 制定可行的干预措施来解决新出现的赛拉嗪问题掺假，以及 3) 在马萨诸塞州新兴甲苯噻嗪市场提出这些干预措施草案反馈的目的并为改进提供信息。我们的长期目标是将 PWUO 需求转化为 PWUO- 集中干预，创建关键的减害信息，以减轻赛拉嗪对公众健康的危害费城观察到掺假现象。拟议的工作预计将大大有助于信息最佳减少危害干预措施，以减轻与赛拉嗪掺假相关的危害，这种危害可以迅速得到解决实施的。这是紧急和及时的，因为甲苯噻嗪目前正在全国迅速蔓延，因此迫切需要采取这些干预措施来防止不必要的伤害。