Suggestions from Clinicians and Harm Reduction Specialists to Mitigate the Impact of Xylazine on People Who Use Opioids

BACKGROUND: Xylazine is rapidly spreading across the US and is associated with several adverse outcomes. This work focused on engaging content experts (e.g., harm reduction direct service staff, wound care nurses) to explore experiences with and responses to xylazine adulteration of the opioid supply. MATERIALS AND METHODS: Twenty interviews were conducted with xylazine content experts in Philadelphia, PA and other areas impacted by xylazine between June-July 2023. We explored the challenges of xylazine spread in the region as well as opportunities for intervention. Interviews were analyzed using a content analysis approach. RESULTS: Among 20 participants, the average years of experience working directly with people who use opioids (PWUO) was 11.4 years. Content experts named wounds, withdrawal, and sedation as challenges exacerbated by xylazine alongside several interventions they believed could help address harms associated with xylazine adulteration. These included individual-level (i.e., overdose response, wound care prevention and treatment) and structural-level (i.e., housing, safer supply options) interventions. CONCLUSIONS: Content experts with longitudinal experience with PWUO identified interventions to mitigate impacts of xylazine in the drug supply. However, these interventions will be limited without structural changes to more effectively prevent xylazine related harms.