Xylazine in the Unregulated Drug Market: An Integrative Review of Its Prevalence, Health Impacts, and Detection and Intervention Challenges in the United States

Integrating Nursing Practice and Policy in Opioid Overdose Prevention: Analysis of the Opioid-Overdose Reduction Continuum of Care Approach Practice Guide

AIM

To present a comprehensive analysis of the Opioid-Overdose Reduction Continuum of Care Approach (ORCCA) Practice Guide 2023, evaluating its alignment with Russell and Fawcett's conceptual model of nursing and health policy and highlighting the implications for nursing practice and policy.

DESIGN

This paper employs a policy analysis framework to evaluate the ORCCA Practice Guide, using Russell and Fawcett's conceptual model as a lens to assess the policy's structure and implementation.

METHODS

The analysis is framed by Russell and Fawcett's conceptual model, focusing on the dimensions of efficacy, effectiveness, equity and justice. This framework assesses how well the ORCCA's strategies align with these dimensions in the context of nursing and health policy.

RESULTS

Key findings indicate that the ORCCA's strategies are integral to nursing practice, particularly in frontline interventions such as education, naloxone distribution and Medication for Opioid Use Disorder (MOUD) delivery. The integration of these strategies demonstrates a significant impact on the opioid crisis, enhancing the roles nurses play in opioid overdose prevention.

CONCLUSION

The ORCCA Practice Guide represents a multifaceted approach to addressing the opioid crisis, with strong alignment to the conceptual model used for analysis. It underscores the essential role of nurses in implementing and refining opioid overdose reduction strategies.

IMPLICATIONS

The study highlights the critical need for nursing involvement in policy formation and practice implementation, suggesting that nurses are key to advancing comprehensive opioid overdose prevention measures.

IMPACT

This study addresses the problem of opioid overdoses and the need for effective interventions. The main findings show the importance of nurse-driven strategies in opioid crisis management. The research impacts public health policy and practice, particularly influencing how nursing approaches are integrated into overall health strategies for overdose prevention.

NO PATIENT OR PUBLIC CONTRIBUTION

No patients, caregivers, or members of the public were involved in conducting this analysis.

Wound-associated agents in the unregulated drug supply: Evidence from a statewide drug checking program

BACKGROUND

While the unregulated drug market has seen dramatic increases in fentanyl adulteration in the past decade, other adulterants have impacted the recent volatility of the drug supply. There has been recent documentation related to the presence of wound-associated substances; however, there is a lack of data showing the prevalence of these substances across unregulated drug market samples over time. The aim of this paper is to examine known and potential wound-associated agents' (xylazine, levamisole, medetomidine) prevalence in Maryland's unregulated drug supply.

METHODS

Using data from Maryland's statewide drug checking program, Rapid Analysis of Drugs (RAD), this paper discusses samples that were voluntarily provided at participating syringe service programs and analyzed at the National Institute of Standards and Technology between October 2021 and October 2023 (N= 2,210). We calculated prevalence and chi-square significance to assess co-occurrence of wound-associated agents and other substances and evaluated xylazine's prevalence over time.

RESULTS

Xylazine was detected in 33.4 % of samples and primarily co-occurred with fentanyl; heroin and related compounds; and other opioids, stimulants, and anesthetics. Xylazine's prevalence decreased over time and varied geographically. Levamisole and medetomidine occurred in 1.9 % and 0.7 % of samples respectively with no significant co-occurrence.

CONCLUSION

These findings emphasize the importance of statewide monitoring amid an evolving drug market, especially regarding wound-associated agents. Drug checking, safer supply, overdose prevention, and non-stigmatizing wound care services for people who use drugs are instrumental in mitigating the health consequences of the unregulated drug supply.

Empowering Communities and Enhancing Public Safety: Stakeholders' Perspectives on Opioid Overdose Prevention Strategies in Boston

The opioid crisis in Boston necessitated multifaceted prevention strategies. This qualitative descriptive study engaged stakeholders' perspectives to explore the role of community empowerment and educational strategies in opioid overdose prevention. Fifteen officials from law enforcement, healthcare, policy, and community organizations participated in semi-structured interviews conducted from January to March 2024. Thematic analysis using Braun and Clarke's approach, facilitated by MAXQDA software, revealed three themes: Perceived Role of Community Empowerment in Opioid Overdose Prevention, highlighting the importance of local leadership, personal recovery, and grassroots initiatives; Effectiveness of Educational Strategies in Opioid Overdose Prevention, focusing on awareness, harm reduction, and bridging gaps post-incarceration; and Challenges and Innovations in Empowering Communities and Enhancing Public Safety, emphasizing the integration of law enforcement with technological solutions and community collaboration. The study underscores the importance of integrating public health approaches with enhanced law enforcement strategies and community-driven solutions to balance immediate intervention with long-term community resilience.