Friedman Joseph, Montero Fernando, Bourgois Phillippe, Wahbi Rafik, Dye Daniel, Goodman-Meza David, Shover Chelsea
Center for Social Medicine and Humanities, University of California, Los Angeles, CA, USA; Medical Informatics Home Area, University of California, Los Angeles, CA, USA.
Department of Anthropology, Columbia University, New York, NY, USA.
Drug Alcohol Depend. 2022 Apr 1;233:109380. doi: 10.1016/j.drugalcdep.2022.109380. Epub 2022 Feb 26.
Sharp exacerbations of the US overdose crisis are linked to polysubstance use of synthetic compounds. Xylazine is a veterinary tranquilizer, long noted in the street opioid supply of Puerto Rico, and more recently Philadelphia. Yet its national trends, geographic distribution, and health risks are poorly characterized.
In this sequential mixed-methods study, xylazine was increasingly observed by ethnographers in Philadelphia among drug-sellers and people who inject drugs (PWID). Subsequently, we systematically searched for records describing xylazine-present overdose mortality across the US and assessed time trends and overlap with other drugs.
In 10 jurisdictions - representing all four US Census Regions - xylazine was increasingly present in overdose deaths, rising from 0.36% of deaths in 015m 6.7% in 2020. The highest xylazine prevalence data was observed in Philadelphia, (25.8% of deaths), followed by Maryland (19.3%) and Connecticut (10.2%). Illicitly-manufactured-fentanyls were present in 98.4% of xylazine-present-overdose-deaths - suggesting a strong ecological link - as well as cocaine (45.4%), benzodiazepines (28.4%), heroin (23.3%), and alcohol (19.7%). PWID in Philadelphia described xylazine as a sought-after adulterant that lengthens the short duration of fentanyl injections. They also linked it to increased risk of soft tissue infection and naloxone-resistant overdose.
Xylazine is increasingly present in overdose deaths, linked to the proliferation of illicitly-manufactured-fentanyls. Ethnographic accounts associate it with profound risks for PWID. Nevertheless, many jurisdictions do not routinely test for xylazine, and it is not comprehensively tracked nationally. Further efforts are needed to provide PWID with services that can help minimize additional risks associated with a shifting drug supply.
美国过量用药危机的急剧加剧与合成化合物的多药合用有关。赛拉嗪是一种兽用镇静剂，长期以来在波多黎各的街头阿片类药物供应中被发现，最近在费城也有出现。然而，其全国趋势、地理分布和健康风险仍未得到充分描述。
在这项序贯混合方法研究中，人种志学者在费城越来越多地观察到赛拉嗪出现在毒贩和注射吸毒者（PWID）中。随后，我们系统地搜索了描述美国各地出现赛拉嗪的过量用药死亡记录，并评估了时间趋势以及与其他药物的重叠情况。
在代表美国所有四个普查区域的10个司法管辖区，赛拉嗪在过量用药死亡中越来越常见，从2015年占死亡人数的0.36%上升到2020年的6.7%。赛拉嗪患病率最高的数据出现在费城（占死亡人数的25.8%），其次是马里兰州（19.3%）和康涅狄格州（10.2%）。在出现赛拉嗪的过量用药死亡案例中，98.4%含有非法制造的芬太尼——这表明存在很强的生态联系——还有可卡因（45.4%）、苯二氮卓类药物（28.4%）、海洛因（23.3%）和酒精（19.7%）。费城的注射吸毒者将赛拉嗪描述为一种受欢迎的掺杂物，它能延长芬太尼注射的短暂效果。他们还将其与软组织感染风险增加和对纳洛酮耐药的过量用药联系起来。
赛拉嗪在过量用药死亡中越来越常见，与非法制造的芬太尼的扩散有关。人种志记录表明它给注射吸毒者带来了巨大风险。然而，许多司法管辖区并未常规检测赛拉嗪，而且全国也没有对其进行全面追踪。需要进一步努力为注射吸毒者提供服务，以帮助将与不断变化的毒品供应相关的额外风险降至最低。
