Academic Journal
Crack/cocaine use to manage xylazine exposure in fentanyl in Connecticut: findings from a convergent mixed methods study.
| Τίτλος: | Crack/cocaine use to manage xylazine exposure in fentanyl in Connecticut: findings from a convergent mixed methods study. |
|---|---|
| Συγγραφείς: | Hill K; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA. k.hill@yale.edu., Biegacki ET; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA.; Department of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA., Bogut G; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA., Znamierowski E; Department of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA.; New Haven Syringe Services Program, New Haven, CT, USA.; Infectious Diseases, Internal Medicine, Yale School of Medicine, New Haven, CT, USA., Breen C; Liberation Programs, Bridgeport, CT, USA., Rose R; Connecticut Harm Reduction Alliance, Hartford, CT, USA., Zhang C; Alliance for Living, New London, CT, USA., Grau LE; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA., Butner JL; Department of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA., Heimer R; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA., Sue KL; Yale Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, USA.; Department of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA. |
| Πηγή: | Harm reduction journal [Harm Reduct J] 2026 May 02; Vol. 23 (1). Date of Electronic Publication: 2026 May 02. |
| Τύπος έκδοσης: | Journal Article; Research Support, Non-U.S. Gov't |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: BioMed Central Country of Publication: England NLM ID: 101153624 Publication Model: Electronic Cited Medium: Internet ISSN: 1477-7517 (Electronic) Linking ISSN: 14777517 NLM ISO Abbreviation: Harm Reduct J Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [London] : BioMed Central, c2004- |
| Ιατρικοί όροι (MeSH): | Xylazine*/analysis , Fentanyl*/poisoning , Drug Overdose*/mortality , Drug Overdose*/epidemiology , Cocaine-Related Disorders*/epidemiology , Opioid-Related Disorders*/epidemiology , Crack Cocaine*, Connecticut/epidemiology ; Humans ; Female ; Adult ; Male ; Middle Aged ; Analgesics, Opioid ; Young Adult |
| Περίληψη: | Background: In the context of the fourth wave of the opioid overdose crisis, defined by fentanyl and stimulant co-use, we aimed to explore if there might be a relationship between exposure to xylazine in the fentanyl supply and patterns of crack/cocaine use. Methods: This mixed methods study used data from four Connecticut-based sources: (1) the Office of the Chief Medical Examiner for fatal overdoses, 2019-2023, (2) community-based drug checking data, 2023-2024, (3) a structured survey of people who use drugs, 2024, and (4) one-on-one in-depth interviews, 2024. Results: Xylazine was detected in 19.2% of overdose fatalities involving fentanyl or a fentanyl analog (n = 5,849). Those with xylazine detected had a higher proportion of cocaine simultaneously detected, though this was not statistically significant (54.0% vs. 51.1%, p = 0.085). Cocaine detection rose over time in the fatality data, regardless of xylazine detection. There were 1,048 drug samples submitted to harm reduction organizations for drug checking. Using Fourier Transform Infrared Spectroscopy, 573 of the samples submitted tested positive for fentanyl or a fentanyl analog; 45.2% of these also tested positive for xylazine. Of 1048 samples, 276 tested positive for cocaine. Among the survey sample (n = 88), 62.5% of participants self-reported xylazine exposure. Those who reported lifetime xylazine exposure also reported higher past-year crack/cocaine use, though this was not statistically significant (89.1% vs. 81.8%, p = 0.336). Among our interview sample (n = 31), three themes emerged: (1) participants felt there was an inevitability of polysubstance use due to an increasingly volatile drug supply, (2) participants increased their crack/cocaine use in response to perceived exposure to xylazine in their fentanyl supply, and (3) participants' drug patterning changed due to xylazine's presence (e.g., timing, drug sequencing, etc.). Two meta-inferences were identified: (1) overdose fatality data likely underestimate the "true" prevalence of xylazine in the street supply, and (2) people who use drugs are using crack/cocaine in response to xylazine in their local fentanyl supply. Conclusions: Xylazine exposure has likely contributed to an adaptive and increasing use of crack/cocaine among people who use drugs in Connecticut. It is imperative that practitioners and policymakers are prepared to manage this triad of opioid-stimulant-sedative polysubstance use. (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Ethics approval: Access to the opioid-detected fatality data was approved by the Connecticut Office of the Chief Medical Examiner (OCME), and the data collected was part of a study that the Yale University Institutional Review Board deemed exempt from review. This overall research project has been reviewed by and approved by Yale Human Research Protections Program (Protocol #2000036264), in accordance with the Belmont Rule. consent for publication: Not applicable. Competing interests: The authors have no conflicts of interest to declare. |
| References: | Subst Use Misuse. 2017 Jul 3;52(8):1051-1058. (PMID: 28323507) J Gen Intern Med. 2022 Sep;37(12):3174-3175. (PMID: 35112282) Addiction. 2024 Apr;119(4):606-608. (PMID: 37939387) Int J Drug Policy. 2023 Aug;118:104118. (PMID: 37422985) Soc Sci Med. 2022 Feb;294:114696. (PMID: 34995988) Curr Opin Psychiatry. 2021 Jul 1;34(4):344-350. (PMID: 33965972) Cureus. 2023 Mar 29;15(3):e36864. (PMID: 37009344) Harm Reduct J. 2017 Jul 31;14(1):52. (PMID: 28760153) Int J Environ Res Public Health. 2019 May 17;16(10):. (PMID: 31108963) J Public Health Manag Pract. 2022 Nov-Dec 01;28(Suppl 6):S347-S354. (PMID: 36194805) Subst Use Misuse. 2026;61(2):217-226. (PMID: 40888200) Clin Toxicol (Phila). 2023 Mar;61(3):173-180. (PMID: 37014353) Int J Drug Policy. 2022 Sep;107:103791. (PMID: 35830749) Can J Nurs Res. 2025 Jun;57(2):324-329. (PMID: 39865880) Am J Forensic Med Pathol. 2021 Mar 1;42(1):9-11. (PMID: 33031124) MMWR Morb Mortal Wkly Rep. 2024 Feb 15;73(6):124-130. (PMID: 38358969) J Anal Toxicol. 2022 Oct 14;46(8):911-917. (PMID: 35770859) Adv Clin Chem. 2023;116:1-30. (PMID: 37852717) Int J Drug Policy. 2020 Nov;85:102934. (PMID: 32911318) MMWR Morb Mortal Wkly Rep. 2025 Aug 28;74(32):491-499. (PMID: 40875496) BMC Med Res Methodol. 2025 Jan 24;25(1):18. (PMID: 39856568) Postgrad Med J. 1990 Mar;66(773):244-5. (PMID: 2362897) MMWR Morb Mortal Wkly Rep. 2021 Sep 17;70(37):1303-1304. (PMID: 34529638) MMWR Morb Mortal Wkly Rep. 2019 Aug 30;68(34):737-744. (PMID: 31465320) Arch Pharm (Weinheim). 2025 Mar;358(3):e2500041. (PMID: 40091602) Drug Alcohol Depend. 2023 Nov 1;252:110985. (PMID: 37826988) Subst Use Addctn J. 2024 Jul;45(3):328-336. (PMID: 38747578) MMWR Morb Mortal Wkly Rep. 2024 Jul 04;73(26):594-599. (PMID: 38959171) Am J Drug Alcohol Abuse. 2024 Jan 2;50(1):1-7. (PMID: 37734160) J Addict Med. 2024 Mar-Apr 01;18(2):194-200. (PMID: 38289240) Harm Reduct J. 2024 Aug 16;21(1):148. (PMID: 39148036) MMWR Morb Mortal Wkly Rep. 2025 Mar 27;74(10):173-178. (PMID: 40146666) Int J Drug Policy. 2020 Mar;77:102661. (PMID: 31951925) Am J Public Health. 2022 Aug;112(8):1212-1216. (PMID: 35830662) Drug Alcohol Rev. 2025 Nov;44(7):1866-1874. (PMID: 40977066) Drug Alcohol Depend Rep. 2025 Dec 06;18:100403. (PMID: 41488161) J Addict Med. 2023 Nov-Dec 01;17(6):739-741. (PMID: 37934550) Clin Toxicol (Phila). 2022 Aug;60(8):892-901. (PMID: 35442125) Am J Respir Crit Care Med. 2022 Oct 1;206(7):824-837. (PMID: 35612914) J Neuroimmunol. 2001 Feb 1;113(1):19-29. (PMID: 11137573) Drug Alcohol Depend. 2019 Nov 1;204:107592. (PMID: 31586804) Harm Reduct J. 2023 Sep 30;20(1):141. (PMID: 37777769) Harm Reduct J. 2025 Jul 31;22(1):134. (PMID: 40745293) Harm Reduct J. 2022 Feb 4;19(1):9. (PMID: 35120531) BMJ Qual Saf. 2024 Jun 19;33(7):470-478. (PMID: 38575310) Subst Use Misuse. 2026;61(2):209-216. (PMID: 40847818) Psychopharmacology (Berl). 2023 Jul;240(7):1561-1571. (PMID: 37340247) Drug Alcohol Depend. 2021 Oct 1;227:109003. (PMID: 34482046) MMWR Morb Mortal Wkly Rep. 2025 May 01;74(15):266-268. (PMID: 40310762) Drug Alcohol Depend. 2019 Dec 1;205:107671. (PMID: 31706248) Int J Drug Policy. 2023 Aug;118:104102. (PMID: 37343365) Cureus. 2023 Jun 21;15(6):e40736. (PMID: 37485167) Pediatr Emerg Care. 2001 Dec;17(6):447-8. (PMID: 11753193) Ann N Y Acad Sci. 2022 Feb;1508(1):3-22. (PMID: 34561865) MMWR Morb Mortal Wkly Rep. 2023 Jun 30;72(26):721-727. (PMID: 37384558) Addiction. 2004 Sep;99(9):1136-46. (PMID: 15317634) Int J Drug Policy. 2024 Mar;125:104339. (PMID: 38335867) MMWR Morb Mortal Wkly Rep. 2024 Dec 05;73(48):1099-1105. (PMID: 39636782) J Addict Med. 2023 May-Jun 01;17(3):349-352. (PMID: 37267188) Prev Med. 2023 Nov;176:107625. (PMID: 37468073) Qual Quant. 2018;52(4):1893-1907. (PMID: 29937585) Am J Public Health. 2025 May;115(5):646-648. (PMID: 40203259) Health Serv Res. 2013 Dec;48(6 Pt 2):2134-56. (PMID: 24279835) AIDS Behav. 2014 Mar;18(3):452-63. (PMID: 23921583) Ann Am Thorac Soc. 2025 May;22(5):797-801. (PMID: 39928483) Int J Environ Res Public Health. 2022 Oct 19;19(20):. (PMID: 36294127) |
| Contributed Indexing: | Keywords: Cocaine; Crack; Fentanyl; Harm reduction; Stimulants; Xylazine |
| Substance Nomenclature: | 2KFG9TP5V8 (Xylazine) UF599785JZ (Fentanyl) 0 (Crack Cocaine) 0 (Analgesics, Opioid) |
| Entry Date(s): | Date Created: 20260502 Date Completed: 20260623 Latest Revision: 20260813 |
| Update Code: | 20260813 |
| PubMed Central ID: | PMC13289556 |
| DOI: | 10.1186/s12954-026-01459-1 |
| PMID: | 42069615 |
| Βάση Δεδομένων: | MEDLINE |
καταχωρήστε σχόλιο πρώτοι!