Grant: Project Grant

The primary objective of this sequential explanatory mixed-methods study is to comprehensively investigate the impact of fentanyl adulterated with non-medical benzodiazepines (NMBs) and xylazine on individuals who use drugs in Ontario. The majority of overdoses are attributed to a combination of unregulated fentanyl, NMBs and xylazine, which have unique and synergistic qualities. It is well known that the addition of NMBs and xylazine makes reversing opioid overdoses with naloxone more difficult. However, there has been little research about these adulterants from the perspective of people who use drugs (PWUD), healthcare providers (e.g., physicians and nurses) and harm reduction providers. For example, while xylazine is linked with necrotic wounds, little research has explored the lived experience of managing these wounds in healthcare settings. Our study uses a sequential explanatory mixed-methods design with survey data used to inform semi-structured interviews. Survey methods and urine drug screening will be used to estimate the prevalence of NMBs/xylazine exposure, document wounds believed to be from NMBs/xylazine exposure, and explore correlates of both. Semi-structured interviews will be used to explore experiences and beliefs in greater depth with PWUD and healthcare and harm reduction providers. The survey will be accompanied by biological samples in the form of urine drug screens, which will be checked against self-reported data. This study aims to gain insights into the experiences, perceptions, and health outcomes of the toxic drug supply to improve care and programming.