Trainings and Resources

Background: 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. Methods: 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

Immediately after experiencing a non-fatal overdose, many people who inject drugs (PWID) engage in harm-minimizing behavior change, including engagement in drug treatment. To inform the implementation of tailored interventions designed to facilitate drug treatment engagement in rural communities, we sought to identify correlates of starting any form of drug treatment after their most recent overdose among PWID who reside in a rural county in West Virginia.

The United States is in the midst of an unprecedented opioid epidemic. In order to implement effective population-level response strategies to this epidemic, health departments and community-based organizations must understand both the size and characteristics of the local population affected. Local data regarding the opioid epidemic are sparse and don’t fully characterize the population of those most affected, such as people who inject drugs (PWID). Without these data, it is difficult to know which epidemic response strategies are meeting the most pressing community needs and whether services are delivered at the appropriate scale. For these reasons, we developed this toolkit for population size estimation with specific emphasis on applying population estimation methods among PWID in rural communities.

Over the past decade, attempts to address the overdose crisis in the U.S. have resulted in more restrictive opioid prescribing policies—which, because they have reduced the overall availability of prescription opioids, have inadvertently led to a surge in the use of illicit drugs such as heroin. To reduce the risks posed by the use or sharing of unsterile equipment (disease and infection), state governments should consider facilitating the use of syringe services programs (SSPs), which distribute free, new, sterile syringes to PWID. Such programs also often offer other services, such as vaccinations and education on preventing overdoses, and have also been shown to improve the odds that PWID will seek and engage with treatment.

West Virginia leads the nation in overdose death rate and both counties where participants were interviewed for this study were considered to be at risk for an HIV outbreak among people who inject drugs. This study asked the question ‘What on-the-ground environmental factors among PWIH could be contributing to this overdose rate?

This letter to the editor in The New England Journal of Medicine evaluates the use of an undisclosed, unsanctioned safe consumption site in the United States. The letter begins by discussing the positive outcomes seen through sanctioned safe consumption injection sites in other countries.