False claims circulate that naloxone encourages drug use

Plus, discussions online perpetuated stigma toward people who use xylazine and other drugs.

This past week, an article about vending machines that provide free harm reduction tools like naloxone generated conversation about opioids, with some posts repeating the false claim that harm reduction promotes drug use. A recent study about managing withdrawal symptoms from xylazine—a non-opioid tranquilizer—and fentanyl also sparked discussion, and several posts expressed stigmatizing attitudes toward people who use drugs.

In response, public health communicators may reiterate that harm reduction tools do not increase drug use and share information about xylazine and fentanyl.

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What’s trending nationally in conversations about opioids

On November 14, NPR published an article about vending machines providing free harm reduction tools like naloxone and sterile syringes and explained how these tools prevent overdose deaths and reduce the spread of infectious diseases. NPR shared the article on Facebook, where some comments suggested that offering free harm reduction tools is “counter-productive” and falsely claimed that harm reduction promotes drug use. Others, however, celebrated these initiatives and correctly stated that harm reduction programs save lives.

A recent study examined withdrawal symptoms from xylazine and fentanyl, which were found to be “unprecedented” in their severity, and outlined potential treatment options in emergency rooms. A combination of short-acting opioids and other medications were found to be effective at reducing withdrawal severity, which may help patients stay in the hospital and receive treatment instead of leaving against medical advice. However, health care providers disagree on whether this treatment is best. A PBS news article about xylazine covered the study, and NPR shared the article on its Facebook page. Most comments expressed stigmatizing attitudes toward people who use drugs and shared false claims about harm reduction. One comment falsely claimed that providing sterile syringes encourages drug use.

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Recommendations for public health professionals

Each week, the Infodemiology.com team will provide messaging recommendations in response to some of the trending narratives outlined above. These helpful tips can be used when creating content, updating web and FAQ pages, and developing strategy for messaging about opioids.

Conversations show persistent confusion about the benefits of harm reduction programs. Messaging may explain that providing free harm reduction tools helps people who use drugs live healthier lives. Messaging may emphasize that harm reduction programs like syringe services programs do not increase drug use or crime and that providing naloxone is associated with a reduction in self-reported drug use. Research shows that harm reduction programs reduce the spread of infectious diseases like HIV and hepatitis C and prevent overdose deaths. In fact, experts attribute the recent decline in overdose deaths to the availability of naloxone, which saves lives by reversing the effects of opioids in people who are overdosing. Communicators may also want to share information about local harm reduction programs, including vending machines that offer free harm reduction tools.

Conversations about xylazine and fentanyl provide an opportunity to highlight the effects of these substances and explain how people can reduce the risk of overdose. Messaging may emphasize that xylazine (a non-opioid tranquilizer) and fentanyl (a potent opioid) both increase the risk of overdose, can be unknowingly mixed with other drugs, and may cause dangerous withdrawal symptoms. Test strips help people determine whether their drugs contain xylazine or fentanyl. Drug test strips may be available for free through local harm reduction programs and can also be purchased online. However, they are not legal everywhere, so communicators should stay up to date on local drug checking equipment laws. Messaging may also explain how to use drug test strips and emphasize that the only way to know for sure if a drug contains xylazine or fentanyl is to test the entire batch. 

Communicators may also recirculate materials outlining the signs of an opioid overdose and explain that while naloxone is only effective against opioids and cannot reverse the effects of xylazine, it should be administered any time an overdose is suspected, as xylazine is often mixed with opioids. Additional messaging may emphasize that withdrawing from opioids and other drugs is safest under medical supervision. Sharing information about local harm reduction programs and SAMHSA’s National Helpline, which connects people to treatment, is recommended.