The article, “Xylazine and Adulterants in the Evolving Drug Supply: Urgent Call for Responsive Education Models,” has been published in SAj.
In this commentary, the authors state that novel adulterants and synthetic substances are rapidly infiltrating the US and international drug supply. Efforts to reduce the overprescription of opioids, compounded by increased pressure from law enforcement, have led to shifts in the US drug market and forced people to seek illicit sources which are at risk of adulteration. This shifting drug landscape has resulted in an increasingly dangerous and unregulated supply. Initially an adulterant to heroin, fentanyl, a potent synthetic opioid, has now largely replaced heroin as the dominant illicit opioid in the US. This shift has resulted in an exponential rise in fatal overdoses and other drug-related harms. As the addiction care community continues to navigate the challenges posed by fentanyl, the nation must now adapt to yet another emerging substance, xylazine, contaminating the illicit drug supply.
In the AUTHORS’ OWN WORDS, they relate the importance of their work:
“Public health threats significantly affect population health, and early effective distribution of information is critical to enhance clinical response capabilities. In the context of the evolving supply to date, avenues for timely continuing and interprofessional dissemination of information for those in practice have been limited. Providers can seek opportunities for collaborative learning during annual national conferences that require membership or payment; or self-directed learning using emerging literature that requires practical and contextual translation; or rely on freestanding online resources, webinars, or courses, which may exclude the voice of the harm reduction community. Brief, interactive, didactic-based trainings have been effective and are valuable mechanisms to distribute information and implement practices in this field. In the rapidly evolving space of new psychoactive substances, peer-reviewed statistical and clinical evidence takes time to accrue. A significant body of current working knowledge from those with lived experience and professional exposure is communicated through professional and informal networks, including social media, and can be used to address urgent and novel substance-related harms. We describe our experience and lessons learned leveraging a robust existing training and technical assistance (TTA) model to disseminate education and information about xylazine as an emerging threat in the absence of robust clinical guidelines and a peer-reviewed evidence base.”
“Our responsive educational training on xylazine had broad reach and impact allowing for timely dissemination of information. By leveraging a flexible TTA model, our team was able to provide accessible education with free CEC to a diverse group of professionals and community members. Post-training participant feedback was critical to facilitate adaptation of content and aid development of needed resources for the field. By pairing information gathered from literature and nontraditional sources with established clinical protocols and harm reduction strategies from the field, we were able to provide tangible education. The added benefit of working with a robust TTA team allowed us to proactively update information in real time that participants could consider implementing in their own practices—all before literature and official public health guidance became accessible.”