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Xylazine (or “tranq”) is a non-opioid sedative and tranquilizer only approved for use in veterinary medicine. However, over the past several years, human consumption of xylazine has begun rapidly increasing. Although initially only identified in illicit drug supplies in limited areas, xylazine has been found in 48 states as of April 2023. Xylazine is frequently, though not exclusively, used in conjunction with opioids, particularly fentanyl—due to xylazine’s ability to prolong their effects. Xylazine use presents many potential dangers to people, including an increased risk of overdose and the development of necrotizing tissue damage. This factsheet details key concerns, overdose responses, harm reduction techniques, and more.
To download the factsheet in English, please click the "Understanding Xylazine" button on the right side of the page.
This factsheet is now available in Spanish. Translation services by the National Hispanic and Latino Behavioral Health Center of Excellence. Traducido por:
To download the full version of the Spanish factsheet, please click the "Comprender la xilacina" button on the right side of the page.
eNewsletter or Blog
Dr. Nora Volkow is the Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health. Her research sheds light on one of the most important indicators that someone will or will not reach out for support for their substance use: stigma.[1] She states that:
"The words we use to describe mental illnesses and substance use disorders (addiction to alcohol and other legal and illegal drugs) can impact the likelihood that people will seek help and the quality of the help they receive. Research indicates that stigma—negative attitudes toward people based on distinguishing characteristics—contributes in multiple ways to poorer health outcomes; consequently, it has been identified as a critical focus for research and interventions."[2]
Addiction, along with mental health challenges, have long been some of the most stigmatized conditions. Countless research studies show that when there are stigmatizing attitudes, fewer people reach out for help. This is especially concerning considering the percentages of people who don’t receive the treatment they need (nearly 90% of the people who need support for their substance use challenges or addiction do not get it).[3]
The Words We Use Matter
How we talk about addiction and recovery matters. Not just because of the words we say, but because of the words we hear—and what our loved ones hear and in turn, can internalize. Research from 2019 shows that nearly 20% of people who needed help didn’t get it because they were concerned about what their neighbors or community would think.[4]
There are things that we can do as loved ones to learn how to talk about addiction and also why this matters—and how it can help end addiction stigma.
Understanding the science of addiction and recovery is a first step. You may be like me (not a neuroscientist) and that’s okay. There’s a way to understand what happens on a physical level when we experience substance use disorder or substance misuse challenges.
Flo Hilliard, MSH, founding member of Faces & Voices of Recovery and expert in the field of addiction science explains it this way:
"Many medical conditions, like Type 2 Diabetes and Cardiovascular disease, are linked to not only a genetic predisposition but also to patterns or habits that can lead to "turning on" the gene for that condition. Substance use disorders often follow the same pattern, yet there is often stigma and shame attached to the normal progression of the medical condition. Understanding the basic brain science of addiction and recovery is a fundamental step in eliminating stigma and treating those suffering from this disorder as respected human beings. Research shows that with the proper treatment and support people can and do recover from addiction to alcohol and other drugs to have successful professional and personal lives."
When we understand that addiction is a normal part of the human experience, it loses its ability to be framed as something requiring punitive measures. Something that causes shame. It lacks the power to divide into “us vs. them.” Addiction or substance use disorders are worthy of our understanding and compassion.
There are some excellent resources out there, including ones through the ATTC network, including their Addiction Science Made Easy Series, that share information about the science of addiction and recovery so we not only understand it but understand how to talk about it.
How We Talk About Addiction Recovery Matters
There are simple ways that you can talk about addiction and recovery that decrease stigma. The National Institute on Drug Abuse or NIDA shares these helpful ways to talk about addiction recovery:[5],[6]
Use person-first language
Promote community education about addiction
Share recovery stories
Education programs for folks who work with those of us in or seeking recovery like doctors, nurses, treatment providers, counselors, and church leaders
Here is another helpful resource from SAMHSA: Overcoming Stigma Ending Discrimination.
Check out this helpful chart from NIDA: Words Matter - Terms to Use and Avoid When Talking About Addiction.
Women and Addiction Stigma
Stigma is even more prevalent for women, especially mothers, and women of color, and this has been known for decades.[7]
It's part of why I founded and host the annual event with the SHE RECOVERS foundation that highlights and celebrates women’s recovery during Women’s History Month on International Women’s Day every year. This year, we are focusing on highlighting the next generation and why it’s important to not only share stories of recovery but also share what works in terms of recovery support services.
Gathering as a global community of supporters of recovery is not only an incredible experience, it has a purpose: to help reduce the addiction recovery stigma that women face.[8] Since women, especially from under-resourced and underserved communities, experience higher levels of addiction stigma and are thus, less likely to seek support, we all must work to address this issue that impacts millions.
When we share our stories of recovery in the light, it can illuminate hope for others and show that recovery is possible. When we use supportive and hope-filled language, we can be a part of eradicating the stigma and discrimination that has no place in our recovery-oriented world today.
Join us this March and celebrate.
For more information and to register for free visit: https://sherecovers.org/international-womens-day-2024/
Time and date don’t work for you? No problem! Register for a link to watch on demand any time or plan your own watch party.
Caroline Beidler, MSW is an author, recovery advocate, and founder of the storytelling platform Circle of Chairs. With almost 20 years in leadership within social work and ministry, she is currently a consultant with JBS International, along with the founder and host of the annual International Women’s Day Global Recovery Event presented by the SHE RECOVERS Foundation.
Connect with her @carolinebeidler_official and https://www.facebook.com/carolinebeidlermsw
[1] Volkow, N.D., Gordon, J.A. & Koob, G.F. Choosing appropriate language to reduce the stigma around mental illness and substance use disorders. Neuropsychopharmacol. 46, 2230–2232 (2021). https://doi.org/10.1038/s41386-021-01069-4
[2] National Academies of Sciences, Engineering, and Medicine. Ending Discrimination Against People with Mental and Substance Use Disorders: the Evidence for Stigma Change. Washington, DC: The National Academies Press; 2016. https://doi.org/10.17226/23442.
[3] Hammarlund R, Crapanzano KA, Luce L, Mulligan L, Ward KM. Review of the effects of self-stigma and perceived social stigma on the treatment-seeking decisions of individuals with drug- and alcohol-use disorders. Subst Abus Rehabil. 2018;9:115–36. https://doi.org/10.2147/SAR.S183256. Published 2018 Nov 23.
[4] Han B. Key substance use and mental health indicators in the United States: results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration; 2020.
[5] Volkow, N.D., Gordon, J.A. & Koob, G.F. Choosing appropriate language to reduce the stigma around mental illness and substance use disorders. Neuropsychopharmacol. 46, 2230–2232 (2021). https://doi.org/10.1038/s41386-021-01069-4
[6] Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction (Abingdon, England), 107(1), 39–50. https://doi.org/10.1111/j.1360-0443.2011.03601.x
[7] Radcliffe P. Motherhood, Pregnancy, and the Negotiation of Identity: The Moral Career of Drug Treatment. Social Science & Medicine. 2011;72:984–991.
[8] Page, S., Fedorowicz, S., McCormack, F., Whitehead, S. (2024). Women, Addictions, Mental Health, Dishonesty, and Crime Stigma: Solutions to Reduce the Social Harms of Stigma. International Journal of Environmental Research and Public Health, 21(1):63. https://doi.org/10.3390/ijerph21010063
eNewsletter or Blog
by Raymond Crowel, PsyD, Clinical Director, The Danya Institute
In March 2020, COVID-19 made its presence felt literally around the world. Within weeks, our lives were upended, as businesses shuttered their doors, schools closed, and our social connections were severed. The same was true for substance use and recovery programs when outpatient addiction treatment, medication-assisted treatment, and residential treatment programs closed. In the early months, both face-to-face services and AA/NA support networks were nonexistent.
Successful substance use recovery requires access to treatment, connection to people, and a strong community that supports recovery. Limited access to treatment and services, paired with isolation, anxiety, and depression caused by the pandemic, proved to be devastating for many people in recovery. Relapse and overdose rates jumped in the first year of the pandemic, destroying the progress that was beginning to be made in combating the opioid abuse epidemic. In addition, many vulnerable people turned to drugs and alcohol to cope with the chronic stress, loneliness, loss of work, and grief. Lastly, the drug trade in fentanyl exploded. The result was a dramatic spike in overdoses and substance use-related emergency department visits.
While the COVID-19 pandemic has become less deadly, substance abuse has not. The ongoing trauma from the pandemic, untreated relapses in recovery, limited treatment capacity, and increasing potency and availability of illegal drugs contributed to more than 100,000 deaths in 2022 (NIDA).
The pandemic forced substance use treatment systems to think of creative ways to continue to support recovery. Peer Recovery Specialists, trained in outreach and connecting with persons ready to begin their recovery process, shifted to disposable cell phones and virtual support services and support groups. Flexible Federal and state government policies allowed medication-assisted treatment programs to provide more walk-up and take-home dosing. The entire substance abuse and mental health service system migrated to telehealth services to provide safe access to ongoing treatment.
Online networks and virtual referral processes made identifying and matching treatment providers with those seeking treatment easier. As residential programs reopened, providers implemented masking, testing, safe distancing, and sanitation processes to protect residents and staff from COVID-19. Many such practices put into place during the height of the pandemic have remained in place, permanently altering how services are delivered. Sadly, our rates of addiction, overdose, and death by overdose remain high. Although education, prevention, and treatment efforts are back to near pre-pandemic levels, still more needs to be done to save the lives of the many still struggling with addiction.
At a minimum, we need:
More treatment professionals, including Peer Recovery Specialists and credentialed foreign-trained professionals.
Integrated approaches to healthcare that consider both mental health and substance, along with social determinants of health.
Increased adoption of harm reduction efforts, including the widespread distribution of Naloxone, needle exchanges, and fentanyl test kits, as well as supervised consumption sites.
COVID-19’s legacy is one of suffering and rising to the challenge. We are hopeful that the enduring legacy will be a stronger system of care for behavioral health, built with the same determination brought to combatting COVID-19.