PDF(Pubmed)
Abstract：
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.
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.
摘要：
背景：赛拉嗪在美国无管制的阿片类药物供应中越来越普遍。接触这种掺假会导致重大伤害，包括长时间的镇静和坏死伤口。在没有文献描述医疗保健提供者治疗病人谁已经暴露于赛拉嗪的经验，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。
方法：从2023年10月到2024年2月，我们进行了一项连续的解释性混合方法研究，（1）定量调查阶段，利用在康涅狄格州治疗患者的医疗保健提供者的便利抽样，以及（2）定性半结构化访谈阶段，利用有治疗赛拉嗪暴露患者经验的提供者的目的抽样。列出了调查的摘要统计数据；使用主题分析对访谈记录进行了分析。
结果：78名符合条件的医疗保健提供者参与了我们的调查。大多数参与者听说过赛拉嗪（n=69，95.8％），并且对这种掺杂物有所了解；但是，较少报告看到一名或多名患者暴露于赛拉嗪(n=46,59.8%).从这个子群中取样后，我们进行了15次深入采访。这一定性阶段揭示了五个主题：(1)赛拉嗪是新颖的，值得关注的，这不一定是例外的(即，对于使用药物的患者，还有其他新出现的问题）；（2）参与者认为赛拉嗪在药物供应中越来越普遍，即使他们不一定看到更多的患者与赛拉嗪相关的结果（XROs）;（3）患者主要表现为非XROs，这使得很难知道关于赛拉嗪的对话何时是合适的;(4)XRO患者可能会遇到获得医疗保健的问题;(5)提供者和他们的患者正在一起学习如何最大限度地减少XRO并减少面对新掺假者的无助感。
结论：目前，针对医疗保健提供者的赛拉嗪特定教育不足。改善这种教育，以及资源(例如，药物检查技术)和数据(例如，XRO的预防和治疗研究)，对于改善使用药物的患者的护理至关重要。
方法：从2023年10月到2024年2月，我们进行了一项连续的解释性混合方法研究，（1）定量调查阶段，利用在康涅狄格州治疗患者的医疗保健提供者的便利抽样，以及（2）定性半结构化访谈阶段，利用有治疗赛拉嗪暴露患者经验的提供者的目的抽样。列出了调查的摘要统计数据；使用主题分析对访谈记录进行了分析。
结果：78名符合条件的医疗保健提供者参与了我们的调查。大多数参与者听说过赛拉嗪（n=69，95.8％），并且对这种掺杂物有所了解；但是，较少报告看到一名或多名患者暴露于赛拉嗪(n=46,59.8%).从这个子群中取样后，我们进行了15次深入采访。这一定性阶段揭示了五个主题：(1)赛拉嗪是新颖的，值得关注的，这不一定是例外的(即，对于使用药物的患者，还有其他新出现的问题）；（2）参与者认为赛拉嗪在药物供应中越来越普遍，即使他们不一定看到更多的患者与赛拉嗪相关的结果（XROs）;（3）患者主要表现为非XROs，这使得很难知道关于赛拉嗪的对话何时是合适的;(4)XRO患者可能会遇到获得医疗保健的问题;(5)提供者和他们的患者正在一起学习如何最大限度地减少XRO并减少面对新掺假者的无助感。
结论：目前，针对医疗保健提供者的赛拉嗪特定教育不足。改善这种教育，以及资源(例如，药物检查技术)和数据(例如，XRO的预防和治疗研究)，对于改善使用药物的患者的护理至关重要。
