Cumberland County Department of Public Health and Fayetteville State University are partnering in a research project called Understanding the Role of Xylazine in the Opioid Crisis. According to the project description, xylazine is a non-opioid FDA-approved sedative for animals that is not approved for human use, but is increasingly found in illicit street drugs and may have devastating public health repercussions.
The DPH and FSU were awarded a $200,000 grant to fund the project.
“We want to clarify the role of xylazine in this huge, huge battle we’re fighting right now,” said Shanhong Luo, James B. Hunt Jr. Distinguished Professor of Psychology at Fayetteville State University, who is working as Principal Investigator on the project along with other co-PI’s and several students.
“It's very, very challenging for everybody in healthcare, public health, behavioral health, everyone across the board,” said Greg Berry Project Coordinator with both the Cumberland Fayetteville Opioid Response Team and the North Carolina Harm Reduction Coalition.
Berry and others began noticing patterns that fit xylazine use while working on harm reduction initiatives several years ago. They were seeing wounds not typical of drug use in persons who use drugs (PWUD) and were also reporting altered experiences such as strange tastes and loss of consciousness.
Berry said they reached out to UNC Street Drug Analysis lab in Chapel Hill to obtain test kits.
Those samples confirmed the presence of xylazine in the illicit opioid supply in Cumberland County. Since then, he and others have been working to educate and raise awareness among PWUDs and medical providers about the presence of xylazine in Cumberland County.
According to Luo, they sent out a small, initial survey last summer that confirmed the need for ongoing research and education.
“I’d say more than 50% of the survey-takers weren’t even aware of xylazine,” Luo explained, “I think the community can benefit from a lot more education about this new phenomenon.”
Berry said the medical community is often unaware of the issue and doesn’t screen for xylazine use, sometimes leading to misdiagnosis of the ulcer-like wounds many PWUDs are developing. He described the wounds as “soft tissue necrosis” adding that they don’t heal on their own and worsen over time — especially with continued use of substances containing xylazine. The wounds also present a high risk for secondary infection.
“We've seen people develop serious infections as a result of these wounds that have led to everything from amputations to death,” he said.
They’ve worked with the Southern Regional Area Health Education Center to provide some ongoing professional development and training for healthcare professions, but concluded, “We have not done enough.”
Berry said he’s concerned about the potential impact of xylazine in addiction treatment.
“This drug does have addiction potential, and so there could be complications that people are experiencing while trying to seek care for opioid use treatment.”
Because many PWUDs are unaware that the substances they are using are adulterated with xylazine, many are unaware that they may be withdrawing from xylazine as well as other substances.
Additionally, it’s unclear whether xylazine may play a role in overdose rates. Berry said that while Cumberland County’s overdose rates have been declining over the last 12 months, they’re still problematic.
“I don't want to take away from the tremendous progress that we've made as a community,” he shared. “Those numbers are coming down in a big way. However, even though they're coming down, we are still trending higher than the state average.”
While some research on xylazine is available, according to Berry it is still considered a novel drug, and the research is limited.
“Most of the information and the data that we have is more anecdotal, and there isn't a lot of empirical data, especially in human subjects.”
The project could begin to shed light on unanswered questions.
Luo explained that the project has two major components: survey studies and drug analysis, both of which could eventually help address treatment disparity. The surveys will primarily target PWUDs and health professionals.
According to information provided by Luo, the project will assess the following topics:
(1) Awareness of xylazine including its prevalence and impact on the local community.
(2) Knowledge of xylazine effects.
(3) PWUDs’ experience with using xylazine and health professionals’ experience with treating xylazine.
Some incentives for participation will be made available and PWUDs will be invited to donate drug samples to test for the presence of xylazine. The samples will be sent to the UNC Street Drug Analysis Lab and the results will be uploaded anonymously for donors to see. Survey responses will also remain anonymous.
Luo expressed that the university is enjoying working together with the local government and finds the partnership mutually beneficial.
“It's a very exciting collaboration.” She added that several graduate students are heavily involved in developing study materials and surveys, “They feel like they are learning a lot, not only just from a research perspective but also from the kind of community engagement perspective as well. So they're just very passionate about this project.”
Berry said that if you suspect you or someone you know has been using a substance that contains Xylazine, the C-FORT Recovery Resource Center located at 707 Executive Place Fayetteville can connect you with testing, harm reduction services, and treatment.
“There's help available,” he shared.
“The hope is that this research will make a real, tangible contribution to the knowledge base that we have right now,” Berry expressed. “This is not just local to our area.”