Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA.
Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA.
Harm Reduct J. 2024 Aug 16;21(1):148. doi: 10.1186/s12954-024-01052-4.
Xylazine is increasingly prevalent in the unregulated opioid supply in the United States. Exposure to this adulterant can lead to significant harm, including prolonged sedation and necrotic wounds. In the absence of literature describing healthcare providers' experiences with treating patients who have been exposed to xylazine, we aimed to explore what gaps must be addressed to improve healthcare education and best practices.
From October 2023 to February 2024, we conducted a sequential explanatory mixed-methods study, with (1) a quantitative survey phase utilizing convenience sampling of healthcare providers treating patients in Connecticut and (2) a qualitative semi-structured interview phase utilizing purposive sampling of providers with experience treating patients with xylazine exposure. Summary statistics from the survey were tabulated; interview transcripts were analyzed using thematic analysis.
Seventy-eight eligible healthcare providers participated in our survey. Most participants had heard of xylazine (n = 69, 95.8%) and had some knowledge about this adulterant; however, fewer reported seeing one or more patients exposed to xylazine (n = 46, 59.8%). After sampling from this subgroup, we conducted fifteen in-depth interviews. This qualitative phase revealed five themes: (1) while xylazine is novel and of concern, this is not necessarily exceptional (i.e., there are other emerging issues for patients who use drugs); (2) participants perceived that xylazine was increasingly prevalent in the drug supply, even if they were not necessarily seeing more patients with xylazine-related outcomes (XROs); (3) patients primarily presented with non-XROs, making it difficult to know when conversations about xylazine were appropriate; (4) patients with XROs may experience issues accessing healthcare; (5) providers and their patients are learning together about how to minimize XROs and reduce the sense of helplessness in the face of a novel adulterant.
Xylazine-specific education for healthcare providers is currently insufficient. Improving this education, as well as resources (e.g., drug checking technologies) and data (e.g., research on prevention and treatment of XROs), is crucial to improve care for patients who use drugs.
在美国不受监管的阿片类药物供应中，苯环己哌啶（Xylazine）的使用越来越普遍。接触这种掺杂物会导致严重伤害，包括长时间镇静和坏死性伤口。由于没有描述医疗保健提供者治疗接触苯环己哌啶患者的经验的文献，我们旨在探讨必须解决哪些差距，以改善医疗保健教育和最佳实践。
从 2023 年 10 月到 2024 年 2 月，我们进行了一项顺序解释性混合方法研究，包括（1）利用康涅狄格州治疗患者的医疗保健提供者的便利抽样进行定量调查阶段，以及（2）利用有治疗接触苯环己哌啶患者经验的提供者的目的抽样进行定性半结构化访谈阶段。对调查的汇总统计数据进行制表；使用主题分析对访谈记录进行分析。
78 名符合条件的医疗保健提供者参加了我们的调查。大多数参与者听说过苯环己哌啶（n=69，95.8%）并对这种掺杂物有一定的了解；然而，较少的人报告看到一个或多个接触苯环己哌啶的患者（n=46，59.8%）。从这个亚组中抽样后，我们进行了十五次深入访谈。这一定性阶段揭示了五个主题：（1）虽然苯环己哌啶是新颖且令人关注的，但这并不一定是异常的（即，使用毒品的患者还有其他新出现的问题）；（2）参与者认为苯环己哌啶在药物供应中越来越普遍，即使他们不一定看到更多与苯环己哌啶相关结果（XROs）的患者；（3）患者主要表现出非 XROs，使得很难知道何时进行关于苯环己哌啶的对话是合适的；（4）有 XROs 的患者可能在获得医疗保健方面存在问题；（5）提供者及其患者正在共同学习如何最大限度地减少 XROs，并在面对新掺杂物时减少无助感。
目前，针对医疗保健提供者的苯环己哌啶特定教育不足。改善这种教育，以及资源（例如，药物检测技术）和数据（例如，预防和治疗 XROs 的研究），对于改善使用毒品的患者的护理至关重要。
