A brick to a bundle: A qualitative study of behavioral responses to xylazine adulteration

Findings suggest that people who use drugs are adapting consumption patterns and adopting harm reduction practices as coping responses to xylazine's adverse effects. Unlike previous major opioid market transitions that primarily differed in pharmacokinetics, xylazine introduces new risks while replacing desired psychoactive effects with undesirable ones. The widespread dissatisfaction with xylazine represents a unique opportunity to expand harm reduction interventions and explore safe supply policies while risk salience is high and user motivation for safer practices aligns with public health goals.