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

项目摘要 使用来自不受管制的药物市场的阿片类药物（PWUO）的人几乎无法控制 他们获得的药物产品中不需要的物质。赛拉嗪是一种动物镇静剂， 在整个美国东部、波多黎各和加拿大的阿片类药物中检测到越来越多。甲苯噻嗪 产生比单独的海洛因更有效的高，增强和抑制阿片类药物的作用，并可能 增加阿片类药物过量或死亡的风险。赛拉嗪减少兴奋性 中枢神经系统（CNS）中的神经递质和外周作为血管收缩剂。这可以 导致镇静、肌肉松弛、呼吸抑制和低血压。此外，长期，镇静 药物的影响使PWUO遭受性侵犯的风险增加。赛拉嗪也与 注射和非注射部位的严重感染性溃疡性皮肤病变。令人担忧的是，赛拉嗪迅速 在美国各地蔓延，2020年全国过量死亡人数将增加五倍 与2015年相比。在该国东部和东北部地区蔓延尤其迅速。到 迄今为止，美国对甲苯噻嗪缺乏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， 在国内其他地区的市场，迫切需要快速反应，以防止不利的 在全国范围内，PWUO的成果。为了应对费城甲苯噻嗪的快速增长，PWUO已经 寻求减轻甲苯噻嗪危害的策略。到目前为止，这些都没有得到严格的探索， 传播。我们的研究表明，费城的PWUO希望有针对性的减少伤害策略， 避免甲苯噻嗪。本提案的目的是利用PWUO的知识和经验， 费城，甲苯噻嗪出现的早期地点，与国家内容专家一起开发和测试 以人为本的方法，以减轻甲苯噻嗪的影响，因为它在其他市场上作为一种掺杂物出现 全国范围内。我们将通过以下方式做到这一点：1）聘请PWUO和其他内容专家， 甲苯噻嗪掺假的经验，2）制定可行的干预措施，以解决新出现的甲苯噻嗪 掺假，以及3）在马萨诸塞州新兴的甲苯噻嗪市场上展示这些干预措施草案， 反馈的目的，并告知改进。我们的长期目标是将PWUO需求转化为PWUO- 以干预措施为中心，创建关键的减少危害信息，以减轻甲苯噻嗪的公共卫生危害 在费城发现的掺假预计拟议的工作将大大有助于向 最佳的危害减少干预措施，以减轻与甲苯噻嗪掺假相关的危害， 切实贯彻这是紧急和及时的，因为甲苯噻嗪目前正在全国迅速蔓延，因此， 迫切需要这些干预措施，以防止不必要的伤害。

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.