Xylazine test strip utilization among pregnant and postpartum women with opioid use disorder: A pilot study

The emergence of xylazine, a veterinary alpha-2 and kappa opioid receptor agonist, as an adulterant in illicitly manufactured fentanyl has created new challenges and risks for pregnant people who use unregulated opioids. Xylazine test strips (XTSs) have been proposed as a harm reduction strategy, but their use has not been studied among pregnant and postpartum populations. The goals of this study were to assess the feasibility, acceptability, and efficacy of a novel Perinatal XTS intervention aimed at reducing xylazine exposure and associated harms.

Pregnant and postpartum women with opioid use disorder and high risk of ongoing unregulated opioid use were recruited from inpatient units of a high-volume maternity hospital in western Pennsylvania. Participants engaged in a standardized educational session about xylazine and XTS and then were given five XTS kits. Over a 2-month period, participants were asked to complete a real-time survey when they used an XTS to report test results and any associated drug use behavior change. All participants were asked to participate in an end-of-study survey and a semi-structured interview about their experiences with Perinatal XTS.

A total of 50 participants were enrolled, completed the education session, and accepted the XTS kits. Most participants were concerned about the potential impacts of xylazine on pregnancy and neonatal outcomes. Seventeen participants submitted a total of 71 real-time surveys after using XTS to test drug samples. In the majority of cases, a positive result prompted behavioral change. Qualitative interviews with participants revealed six major themes: (1) Xylazine and XTS education was highly acceptable. (2) Desire for additional education related to xylazine. (3) XTS distribution and use were highly acceptable. (4) Impact of XTS on behavior change varied based on participant circumstances. (5) Concerns related to xylazine's impact on maternal health and treatment. (6) Concerns related to xylazine's impact on fetal and neonatal health.

Findings from this pilot study demonstrate that Perinatal XTS, a harm-reduction intervention combining xylazine and XTS education and XTS kit distribution, is highly feasible to deliver, is acceptable among pregnant and postpartum women cared for in an obstetric healthcare setting, and has the potential to reduce risk-related behaviors.