背景:赛拉嗪,一种常用于兽医学的α2-肾上腺素受体激动剂镇静剂,不允许人类使用。然而,近年来,与赛拉嗪有关的过量用药率激增,在北美越来越多的有毒和合成非法药物供应的推动下。
方法:这篇叙述性综述评估了北美赛拉嗪过量的主要流行病学趋势,旨在确定减少伤害的优先事项。使用四个书目数据库(PubMed,Scopus,Embase,和ScienceDirect)和三个预打印服务器(medRxiv,bioRxiv,和欧洲PMC),2023年5月28日,捕获与关键词组合相关的文章,如“xylazine”,\“阿片类药物\”,和“减少伤害”。
结果:赛拉嗪于2001年在波多黎各成为掺假品,可能从兽医用品中转移。到2010年代中期,它开始在不受监管的美国毒品市场扩散,通常与非法制造的芬太尼(IMF)同时发生,显示合群的特征。最初集中在东北地区(例如,费城,康涅狄格州,Maryland),与赛拉嗪有关的过量药物后来扩展到了铁锈地带,南方,和美国西部地区在2010年代末和2020年代初。在此期间,在加拿大,涉及赛拉嗪的过量用药也激增,特别是在西部省份(不列颠哥伦比亚省和艾伯塔省)和安大略省,建立了由国际货币基金组织主导的不受监管的药物市场。
结论:在过去的二十年中,与赛拉嗪有关的过量用药在北美迅速上升,并且几乎没有放缓的迹象,代表了严重的公共卫生流行病。许多因素可能促成了这一点,包括有限的流行病学监测和药物检查赛拉嗪和新出现的新掺假物;进一步,全面的障碍,创伤知情,非污名化的待遇和社会服务也加剧了这一问题。虽然一些流行病学和人种学研究在美国评估了这些因素,在最近出现赛拉嗪的加拿大,证据有限。这强调了需要更多的研究和减少伤害的措施。
结论:迫切需要减少危害的公共卫生指南和计划,以促进更安全的供应,加强医疗保健系统的能力,以预防和应对与赛拉嗪有关的过量用药,并解决健康结果中的社会和结构差异。
Xylazine, an α2-adrenoceptor agonist sedative commonly used in veterinary medicine, is not approved for human use. Nevertheless, xylazine-involved overdose rates have surged in recent years, fueled by an increasingly toxic and synthetic illicit drug supply in North America.
This narrative
review assessed major epidemiological trends in xylazine-involved overdoses in North America, aiming to identify harm reduction priorities. A literature search was conducted using four bibliographic databases (PubMed, Scopus, Embase, and ScienceDirect) and three preprint servers (medRxiv, bioRxiv, and Europe PMC) on May 28, 2023, to capture articles related to combinations of keywords such as \"xylazine\", \"opioid\", and \"harm reduction\".
Xylazine emerged as an adulterant in Puerto Rico in 2001, likely diverted from veterinary supplies. By the mid-2010s, it began proliferating across unregulated US drug markets, often contemporaneously with illicitly manufactured fentanyl (IMF), displaying characteristics of a syndemic. Initially concentrated in Northeastern regions (e.g., Philadelphia, Connecticut, Maryland), xylazine-involved overdoses later extended to the Rust Belt, Southern, and Western regions of the
USA in the late 2010s and early 2020s. During this time, xylazine-involved overdoses also surged in Canada, particularly in Western provinces (British Columbia and Alberta) and Ontario with established IMF-dominated unregulated drug markets.
Over the past two decades, xylazine-involved overdoses have been rapidly rising in North America and exhibit few signs of slowing down, representing a serious public health epidemic. Numerous factors may have contributed to this, including limited epidemiological surveillance and drug checking for xylazine and emerging novel adulterants; further, barriers to comprehensive, trauma-informed, non-stigmatizing treatment and social services have also exacerbated this issue. While several epidemiological and ethnographic studies have assessed these factors in the
USA, limited evidence is available in Canada where xylazine emerged more recently. This underscores the need for additional research and harm reduction measures.
Harm reduction-informed public health guidelines and programs are urgently needed to promote a safer supply, strengthen the healthcare system capacity to prevent and respond to xylazine-involved overdoses, and address social and structural disparities in health outcomes.