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Table 2 Qualitative themes

From: Syringe services program staff and participant perspectives on changing drug consumption behaviors in response to xylazine adulteration

Guiding Question 1: How did information about xylazine adulteration spread?

Theme 1: Clients initially identified a tranquilizer-like adulterant that heightened sedation and withdrawal symptoms and caused wounds.

Theme 2: SSP medical providers identified xylazine by treating new medical cases and through diverse information-sharing networks including professional societies and news sources.

• Medical cases: wounds in non-injection sites, tissue necrosis, challenges alleviating withdrawal symptoms

• Information sharing networks: professional societies, conferences, harm reduction partners, media coverage

Theme 3: SSP frontline staff and clients needed additional educational resources about xylazine and its potential side effects.

• Desired educational materials: staff training, client-facing pamphlets

Guiding Question 2: How did SSP clients respond to seeing xylazine in the drug supply?

Theme 4: Clients began altering their drug consumption routes, reducing drug use, and relying on their peers’ experiences with the drug supply to protect themselves from xylazine.

• Transitioning from injecting to smoking, anal administration

• Using the same seller, ‘street science’ testing methods, sharing safe supplies

Theme 5: Xylazine’s emergence led some individuals to prefer xylazine-adulterated opioids and to increase their drug use.

• Potentially prolonged, intense high, conflicting perceptions of xylazine’s half-life

Theme 6: Seemingly protective behaviors like increasing the use of stimulants, using alone, and conducting ‘human testing’ placed clients in harm’s way.

• Mixing drugs, using alone, ‘human testing’ for potency

  1. Note: SSP = syringe services program.
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Harm Reduction Journal

ISSN: 1477-7517