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Xylazine: What Health Agencies Need to Know astho, association of state and territorial health officials, xylazine trend, xylazine, overdose epidemic, overdose deaths, harm reduction, drug overdose deaths, drug related harm, blood pressure, respiratory depression, medical examiners, mental health, reducing the harms, substance use disorder, harm reduction services, drug overdose, people who use drugs, drug overdose epidemic, skin ulcers, puerto rico, overdose prevention, early 2000s, harm reduction programs, synthetic opioids, overdose deaths involve, prescription opioids Stephanie Swanson, Richa Ranade ASTHO | How health agencies are handling the rise of xylazine in the illicit drug supply. Communities across the United States are facing an evolving and complex overdose epidemic, which claimed more than 100,000 lives in 2022. Recent increases in overdose deaths have largely been attributed to illicit fentanyl, which has increasingly been combined with both opioid and stimulant drugs and used to lace counterfeit pills.     Federal agencies have been warning that xylazine, a non-opioid tranquilizer used in veterinary medicine, is infiltrating the drug supply and being mixed with other illicit substances—most commonly heroin and fentanyl. Xylazine threatens to worsen outcomes for people who use drugs and complicate the overdose prevention landscape across the country.  Xylazine is approved for veterinary use in the United States but is not approved by FDA for human medicine. The drug, which is not currently controlled under the Controlled Substances Act, first appeared in the Philadelphia drug supply in the mid-to-late 2010s, but has since spread throughout the northeast and westward. The Philadelphia Department of Public Health reported that more than 90% of opioid samples tested in the city in 2021 tested positive for xylazine. Heroin or fentanyl cut with xylazine is often referred to as "tranq" or "tranq dope." Substances containing xylazine can be ingested orally, snorted, sniffed, or—mostly commonly—injected intravenously. Leading Concerns  People may not know whether they are exposed to xylazine when using other substances, which may place people who encounter it at greater risk for harm. Xylazine is a central nervous system depressant, causing drowsiness, slowed breathing, reduced heart rate, and hypotension, which may increase the risk of a fatal overdose.   The symptoms of xylazine use and opioid use are similar, making it difficult to differentiate whether an individual has used both substances. Xylazine use is associated with skin ulcers, lesions, and abscesses. Individuals who develop a physical dependency on xylazine may develop severe withdrawal symptoms. What Steps are Health Agencies Taking? State and territorial health agencies can take several steps to prevent harm related to xylazine. Agencies can partner with harm reduction organizations, hospitals, substance use treatment providers, High Intensity Drug Trafficking Areas, and medicolegal death investigators to understand whether xylazine is present in the local drug supply.  Connecticut conducted a pilot project with hospitals to collect urine samples from patients who experienced nonfatal overdoses. The Connecticut State Public Health Lab tested the samples between 2021 and 2022, and found that 13% contained a combination of fentanyl and xylazine.  During a presentation about xylazine to medicolegal death investigators in January, 2023, Shobha Thangada, a specialist at the Connecticut Department of Public Health, said, "In cases of fatal overdose, we cannot communicate with those people. However, when patients with a non-fatal overdose come to the hospital setting, we can inform them to watch their drugs and know what is in what they are using." In areas where xylazine is detected, raising community awareness of risks associated with xylazine is critical. Philadelphia, New York City, Connecticut, Massachusetts, and Rhode Island have developed campaigns and awareness materials to alert people about the risks of xylazine and to inform them of ways to prevent xylazine-related overdose. Philadelphia also plans to utilize opioid settlement funding to implement wound care sites for those affected by xylazine.  Those responding to a suspected xylazine overdose are advised to administer naloxone. Though xylazine is not an opioid and does not respond to naloxone, xylazine is commonly mixed with opioids. If an overdose is not responsive to naloxone, providers are encouraged to provide supportive measures.   article yes

Celebrating Black HER-STORY astho, association of state and territorial health officials, black history month, her stories, black history, african american women, president gerald ford, american life and history, frederick douglass, african american woman, united states, carter g woodson, american women, african american history, celebrate black history, washington dc, african american life, virginia hamilton, black history month celebration, african american, study of african american, history month, civil war, black women, black people, rosa parks, harriet tubman, mae jemison, Phillis Wheatley, Shirley Chisholm Kimberlee Wyche Etheridge Celebrating Black Women's Historic Contributions. I grew up proud to know that I am the product of generations of planning, sacrifice and prayers, and that I represent the wildest dreams of my ancestors.  I look at the world from the shoulders of all of generations of women who walked this earth for centuries before me. Their stories, their trials and tribulations were not in the history books I was given in school. Instead, their words have been passed down from generation to generation through their stories—her stories. The word "history" can be broken down into two parts: His and Story. History is said to be written often from the viewpoint of the powerful who control the pen, and the narrative. Stories are often scribed from the author’s viewpoint and crafted in a way to make the protagonists look good, sometimes at all costs. When we study history, it is important to read between the lines to get the full story and to learn what we may not be taught, or what we are sometimes taught misleadingly.    With roots dating back to 1915, author and historian Dr. Carter G. Woodson founded the Association for the Study of Negro Life and History, setting the foundation for Black History month. Nationally we look to February as a time dedicated to focusing on uplifting Black history and encouraging all to learn and celebrate the many important contributions made by African Americans that have shaped this country. This year, 2023, I want to focus not just on Black history, but on Black Her-Story, highlighting five of the many impactful contributions made by African American women that have changed the course of America and sculped my life. Sadly, too many of us do not know their names. In most cases, they live in the margins of our history books, and if we take the time to learn we will see how Her Stories have truly shaped our collective History.   Harriet Tubman (Born: 1882, Died: March 20, 1913). Enslaved from birth in Maryland, she escaped to freedom, but returned nearly 20 times to free family members and others.  She never gave up and she never lost a single person.  Harriet Tubman taught me to always reach back to bring others forward. Through mentorship programs, teaching medical students, and pipelining initiatives, the term, “play it forward” is a mantra that I live by.   Phillis Wheatley (Born: May 8, 1753, Died: Dec. 5, 1784). Born in West Africa and enslaved at the age of eight, young Phillis was privileged to learn to read and write, accomplishing something for which many had lost their lives. Her intellect and passion for her studies, lead her to poetry and in 1773, she became one of the first African American women publish a poetry volume in both the United States and the United Kingdom. Phillis Wheatly taught me the power of words and what a coveted privilege it was then—and is now becoming again—to be free to pick up a book and read. Many science fiction books describe societies where knowledge is limited and controlled, hiding history and sometimes the truth of the present.  Studying Phillis Wheatley’s poetry, helped to teach me to read between the lines. Mae Jemison (Born: October 17, 1956). Known by some as the first Black American woman astronaut, a physician, a leading scientist, and an advocate for girls' education in the United States, Mae Jemison joined NASA in 1987, and served aboard the space shuttle Endeavor in 1992. Her story taught me that the sky is not the limit, and to never let anyone “put you in a box.” As a fellow medical doctor, my work in the creation of an annual Girls Powered by S.T.E.A.M. (Science Technology Engineering Art and Math) event has changed the trajectory of many middle school girls of color who had never been shown their potential.     Shirley Chisholm (Born: Nov 30, 1924, Died: Jan. 1, 2005). In 1972, she was the first Black woman to run to win the bid for presidential nomination in any major party.  An activist in her home state of New York, she was also the first Black woman to serve in Congress. Shirley Chisholm taught me that my voice counts, and if you do not like something, advocate to change it. I added a public health degree to my medical degree because I did not like the health outcomes I was seeing as a physician, and I had a responsibility to use my voice to change the health trajectory of others whose voices had been silenced by bias, prejudice and racism. Rosa Parks (Born: Feb 4, 1913, Died: Oct. 24, 2005). Well trained and well prepared, in 1955, Rosa Parks did not get up. An activist during the Alabama civil rights movement in the 1930’s, she was involved in the planning of the famous bus boycott. Her planned actions started the 381-day Montgomery Bus Boycott, which eventually desegregated that city's public transit. Ms. Parks taught me to hold firm.  Knowing she was going to get arrested; she did not waver in her determination to bring to light the injustices she had been working to end. The boycott did not end in a week or a month.  It lasted over a year. We have adopted a now or never mentality.  Change takes time and patience can be a true virtue. Sometimes you must keep your eyes on the prize to experience success.  We have not achieved health equity yet, and I know my job is not done. I do not know if it will take another year, or another decade, but believing in the outcome sets the path for success.   Each day, additional women teach and inspire me. There is no job description of who one may learn from, no pedigree of worthiness to be a Her-story maker. Today is tomorrow’s history. I have no idea how my actions now may influence someone in the future. Celebrate the past, embrace the present and dream for those who will follow in your footsteps. Happy Black Her-Story month. Black history is American history. Make sure your read between the lines and check out what is hidden in the margins.  Not just for 28 days, but every day. Knowledge knows no calendar. article yes

Looking to the future, states are improving access to care, providing subsidies for tuition costs, expanding hours of licensed facilities, increasing access, and meeting the needs of both parents and children.

Here are some things health officials should consider when developing a strategy to improve trust between health departments and their audiences.

This post highlights three strategies health department leaders can explore to reduce staff stress and burnout in the office: quiet spaces, art on display, and allowing pets in the office.

Two DELPH scholars from cohort one reflect on their completion of the 10-month program and discuss how learning about one’s own leadership style is critical for success.

After years of advocacy, ASTHO and our partners are celebrating the recently signed Consolidated Appropriations Act.

Four DELPH participants answer the question, “Which is more important for leadership in health equity: to influence the community to follow the leader’s vision or to influence the community to follow their own vision?”

Supporting policies that reduce HIV stigma and promote health equity is an important public health issue.

As part of ASTHO’s Public Health - Hope, Equity, Resilience, and Opportunity initiative, we are using this post to highlight some acts of thanks for organization leaders and supervisors to consider.

Following a hurricane, the risk of exposure to infectious disease increases due, in part, to the presence of floodwater and debris. Hurricanes may contribute to population displacement and overcrowding—further heightening risk factors for respiratory diseases—as well as cause damage to healthcare facilities. In this post, see how jurisdictions respond to the biggest post-hurricane threats, from water-borne diseases to severe disruptions in the healthcare system.

Tips for public health leaders to improve crisis communications.

Reflections on ASTHO's time at the National Menthol Conference.

Learn about the role and impact of State offices of Rural Health in a Q&A with Alisa Druzba.

Adopting a public health approach to substance use by implementing harm reduction policies across all levels of government can help communities address the overdose crisis. This post analyzes e

Public health agencies are working to reduce dementia risk and to optimize the health and well-being of people living with dementia and their caregivers.

After a year and a half of work as embedded disability specialists, 5 program participants share their reflections on important lessons learned and why disability inclusion is critical to the future of emergency preparedness.

Partnering with Community Action Agencies Can Improve Trust in Vaccines astho, association of state and territorial health officials, association of state and territorial health officials astho, state health official, public health official, territorial health official, island jurisdictions, state health, health department, public health, state and territorial health, social determinants of health, johns hopkins, advance health equity, socially determined, health inequities, race ethnicity, covid-19 vaccines, health disparities, vaccine supply, high income countries, vaccine equity, vaccine distribution, vaccine hesitancy, immunization, centers for disease control, community action agencies, covid19 pandemic, at-risk populations, healthy equity Geetika Nadkarni Learn how community action teams are working to improve COVID-19 vaccine acceptance and uptake in their own communities. In the current climate surrounding vaccinations and other large-scale public health measures, it’s more important than ever for public health to engage communities. One way to do this is through working with community action agencies (CAAs), local entities that work to reduce poverty and reduce disparities among the populations they serve. Funded through the Community Services Block Grant (CSBG), CAAs are an ideal complement to public health’s mission to address the social determinants of health and achieve greater equity. With support from CDC, ASTHO is working with the National Community Action Partnership and five CAAs in the Partnering for Vaccine Equity project, which aims to increase acceptance and uptake of vaccines among racial and ethnic minority groups and in rural communities. ASTHO chose to partner with CAAs as trusted community agents for this project because of their existing relationships within communities through programs such as Head Start, food banks, federal nutrition programs, and employment and housing assistance. Through their internal and external partnerships, they can reach people who may be concerned about vaccine safety and/or lack access to vaccination sites. Through this project, CAAs are partnering with residents, faith-based organizations, local schools and universities, state and local public health departments, and non-profits active in the community. They are also engaging a range of local providers, such as federally qualified health centers (FQHCs), physicians, community health workers, medical and nursing students, and emergency medical technicians (EMTs). These community action teams are working together to improve vaccine acceptance and uptake and to customize evidence-based strategies to their own communities and neighborhoods. article yes

In an effort to help meet demand, some states and territories have joined interjurisdictional licensing compacts that allow a mental health care provider licensed in one state to provide care in another state—without needing to gain licensure in multiple states. These agreements also offer guidance on patient privacy for services rendered remotely or from out-of-state.

This Q&A highlights Tennessee’s success in expanding opioid use disorder treatment in maternal health.