Fentanyl and xylazine crisis: Crafting coherent strategies for opioid overdose prevention

Abstract

The United States is in the throes of a severe opioid overdose epidemic, primarily fueled by the pervasive use of fentanyl and the emerging threat of xylazine, a veterinary sedative often mixed with fentanyl. The high potency and long duration of fentanyl is compounded by the added risks from xylazine, heightening the lethal danger faced by opioid users. Measures such as enhanced surveillance, public awareness campaigns, and the distribution of fentanyl-xylazine test kits, and naloxone have been undertaken to mitigate this crisis. Fentanyl-related overdose deaths persist despite these efforts, partly due to inconsistent policies across states and resistance towards adopting harm reduction strategies. A multifaceted approach is imperative in effectively combating the opioid overdose epidemic. This approach should include expansion of treatment access, broadening the availability of medications for opioid use disorder, implementation of harm reduction strategies, and enaction of legislative reforms and diminishing stigma associated with opioid use disorder.

Keywords: Fentanyl; Xylazine; Opioid overdose; Epidemic; Opioid use disorder; Buprenorphine; Medications for opioid use disorder

Core Tip: This editorial addresses the escalating opioid overdose crisis in the United States, exacerbated by the use of fentanyl and the emerging threat of xylazine. Despite efforts like enhanced surveillance and distribution of test kits and naloxone, fentanyl-related deaths persist due to inconsistent state policies and resistance towards harm reduction strategies. The paper advocates for a multifaceted approach, including expanded treatment access, wider availability of medications for opioid use disorder, implementation of harm reduction strategies, legislative reforms, and reducing stigma associated with opioid use disorder.