{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,8]],"date-time":"2026-11-08T03:34:30Z","timestamp":1794108870415,"version":"4.8.0"},"reference-count":36,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T00:00:00Z","timestamp":1708387200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000026","name":"national institute on drug abuse","doi-asserted-by":"publisher","award":["NIDA K12DA050607"],"award-info":[{"award-number":["NIDA K12DA050607"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"name":"MA Department of Public Health Bureau of Substance Addiction Services","award":["INTF2330M04500824223"],"award-info":[{"award-number":["INTF2330M04500824223"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Use &amp;amp; Addiction Journal"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:p>Novel adulterants and synthetic substances are rapidly infiltrating the US drug supply causing new clinical harms. There is an urgent need for responsive education and training to address these evolving harms and mitigate new risks. Since 2020, xylazine, a veterinary tranquilizer, has become increasingly common in the illicit opioid supply, especially alongside fentanyl. Training and technical assistance (TTA) programs employing an adaptive model can quickly disseminate emerging information and provide the tools to respond effectively. We describe our TTA program\u2019s experience developing and delivering virtual instructor-led xylazine training to a diverse group of addiction care professionals. The training objectives included the following: (1) introducing epidemiologic trends, pharmacology, and existing literature related to xylazine; (2) reviewing xylazine-associated harms and management; and (3) discussing harm reduction strategies related to xylazine use. We conducted 14 training sessions between October 2022 and July 2023, which were attended by over 2000 individuals across 49 states. We review our experience developing innovative training content and managing flexible training logistics and highlight our lessons learned, including targeting multidisciplinary professionals, leveraging online synchronous delivery methods, and a need for sustainable funding for TTA programs.<\/jats:p>","DOI":"10.1177\/29767342241231114","type":"journal-article","created":{"date-parts":[[2024,2,20]],"date-time":"2024-02-20T04:47:15Z","timestamp":1708404435000},"page":"168-175","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Xylazine and Adulterants in the Evolving Drug Supply: Urgent Call for Responsive Education Models"],"prefix":"10.1177","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6420-5385","authenticated-orcid":false,"given":"Raagini","family":"Jawa","sequence":"first","affiliation":[{"name":"Center for Research on Healthcare, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA"},{"name":"Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Murray","sequence":"additional","affiliation":[{"name":"Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Blakemore","sequence":"additional","affiliation":[{"name":"Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicia S.","family":"Ventura","sequence":"additional","affiliation":[{"name":"Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tavita","family":"Hristova","sequence":"additional","affiliation":[{"name":"Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexa","family":"Wilder","sequence":"additional","affiliation":[{"name":"Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Shang","sequence":"additional","affiliation":[{"name":"Center for Research on Healthcare, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen","family":"LaBelle","sequence":"additional","affiliation":[{"name":"Grayken Center for Addiction Training and Technical Assistance, Boston Medical Center, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,2,20]]},"reference":[{"key":"bibr1-29767342241231114","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2017.05.050"},{"key":"bibr2-29767342241231114","doi-asserted-by":"publisher","DOI":"10.1186\/s13033-023-00601-x"},{"key":"bibr3-29767342241231114","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2017.05.023"},{"key":"bibr4-29767342241231114","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2017.06.010"},{"key":"bibr5-29767342241231114","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000000606"},{"key":"bibr6-29767342241231114","doi-asserted-by":"publisher","DOI":"10.1186\/1747-597X-6-7"},{"key":"bibr7-29767342241231114","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-011-9662-6"},{"key":"bibr8-29767342241231114","doi-asserted-by":"publisher","DOI":"10.1111\/j.1556-4029.2007.00648.x"},{"key":"bibr9-29767342241231114","unstructured":"United States Drug Enforcement Administration. The growing threat of xylazine and its mixture with illicit drugs. 2022. Accessed October 8, 2023. https:\/\/www.dea.gov\/documents\/2022\/2022-12\/2022-12-21\/growing-threat-xylazine-and-its-mixture-illicit-drugs"},{"key":"bibr10-29767342241231114","unstructured":"Bettigole C, Best A, da Silva DT. Health update: xylazine (tranq) exposure among people who use substances in Philadelphia. Substance Use Prevention and Harm Reduction. 2022. Accessed September 9, 2023. https:\/\/hip.phila.gov\/document\/3154\/PDPH-HAN_Update_13_Xylazine_12.08.2022.pdf\/"},{"key":"bibr11-29767342241231114","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7226a4"},{"key":"bibr12-29767342241231114","unstructured":"The White House Office of National Drug Control Policy. Biden-Harris administration designates fentanyl combined with xylazine as an emerging threat to the United States. 2023. 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Characterization of xylazine test strips for use in drug checking. 2022. Accessed September 9, 2023. https:\/\/www.cfsre.org\/images\/content\/reports\/drug_checking\/CFSRE_Xylazine_Report-Rev-1-18-23.pdf"},{"key":"bibr26-29767342241231114","unstructured":"Center for Addiction Medicine and Policy. Best practices for management of xylazine withdrawal and xylazine-related overdose. 2023. Accessed September 09, 2023. https:\/\/penncamp.org\/wp-content\/uploads\/2023\/05\/CAMP-Xylazine-Best-Practices-1.pdf"},{"key":"bibr27-29767342241231114","unstructured":"Pennsylvania Department of Health. Xylazine and wound care for healthcare providers. 2023. Accessed September 09, 2023. https:\/\/www.health.pa.gov\/topics\/Documents\/Opioids\/Xylazine%20Provider%20Info.pdf"},{"key":"bibr28-29767342241231114","unstructured":"Canning P. Xylazine hysteria. Streetwatch: Notes of a Paramedic. 2023. 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