Community Mitigation Against Xylazine

Research Triangle Institute, Durham NC

Investigators

Abstract

We propose to examine the feasibility and acceptability of a drug checking program operating through an overdose prevention program to collect information about the presence of xylazine in the illicit drug supply in Minnesota. Xylazine is a dangerous adulterant not approved for use in humans; administrative datasets that detect xylazine are too delayed and removed from end users to provide actionable understanding into intervention strategies or changes in use patterns. Drug checking has the potential to identify emerging substances like xylazine in real-time and serve as point of care to provide information along with actionable responses and referrals to treatment and services. However, there is limited information on the feasibility and acceptability of drug checking in the research literature and nothing in less densely populated regions. The proposed R21, Community Mitigation Against Xylazine, will address this and is ideally situated for the NOT-DA-24-012. Minnesota legalized all drug paraphernalia in 2023, and the state provided funding to overdose prevention programs to purchase a Fourier-transform infrared spectroscopy technology (the gold standard for mobile CBDC programs), xylazine testing strips, and wound care kits. As part of this exploratory R21, we build on a collaboration with an overdose prevention program that established the first drug checking in the state—with delivery to low-population-density areas—to examine the feasibility and acceptability of this service. As part of a 24-month mixed-methods study, we will examine feasibility (use and sustained programming) and acceptability (participant attitudes) of the program to detect xylazine (Aim 1) through longitudinal surveys with program participants (N=60), with those whose drugs test positive for xylazine recruited to complete a qualitative interview on use and health effects (N=25). To demonstrate feasibility and acceptability, we will calculate the prevalence of xylazine among samples tested by the drug checking program (N=500) (Aim 2). By developing a centralized database, we will be able to examine prevalence of xylazine over time and across settings and will prioritize dissemination to public health stakeholders. The proposed study has strong public health potential to mitigate harms from xylazine and future cutting agents. Our study proposes examining drug checking where legal barriers have been removed and with a population that is lacking in existing research. The investigation team has experience examining overdose prevention strategies and future R01 implementation science grants will further examine strategies that improve the benefits of drug checking as an emerging strategy.