Trends in Opioid Use and Overdose Risks in Recent Studies

Significant Increase in Opioid-Related Overdose Deaths

The opioid crisis continues to escalate, with opioid-related overdose deaths reaching unprecedented levels. A significant study conducted in Maryland from 2020 to 2023 reported that among 8,721 fentanyl overdose deaths, 1,798 (20.6%) were associated with xylazine, a potent contaminant. The annual rates of xylazine-related overdose deaths peaked in 2021, highlighting the urgent need for targeted interventions to address this growing epidemic. Notably, the demographic analysis revealed that certain groups, particularly individuals aged 31-40 and those using concurrent substances like morphine and methadone, were at heightened risk for xylazine-related mortality (Characterization of xylazine-related overdose deaths in Maryland, 2020–2023).

Additionally, the findings indicate a concerning trend in rural areas where methadone-related deaths increased significantly over a seven-year period, predominantly due to polydrug toxicity. This underscores the necessity for comprehensive public health strategies to combat opioid misuse and enhance overdose prevention efforts.

The Impact of Xylazine on Opioid Mortality Rates

Xylazine, originally an animal tranquilizer, has emerged as a critical factor in the rising mortality rates associated with opioid use. Its presence in the illicit drug supply has complicated the overdose crisis, as it often co-occurs with fentanyl, leading to more severe clinical manifestations. Studies indicate that xylazine can exacerbate respiratory depression and prolong sedation, complicating treatment protocols in emergency settings (Zhu, 2025).

The interaction between opioids and xylazine poses unique challenges for healthcare providers. As xylazine is not an opioid, traditional opioid reversal agents like naloxone do not effectively mitigate its effects. This necessitates the adaptation of emergency department protocols to manage severe sedation and cardiovascular instability associated with xylazine overdoses (Zhu, 2025).

Role of Pharmacy Staff in Harm Reduction Services

Pharmacy staff are positioned uniquely within the healthcare system to play a pivotal role in harm reduction strategies for people who use drugs (PWUD). Their accessibility and expertise in medication management equip them to implement harm reduction services effectively, such as providing naloxone and managing opioid prescriptions (Navarrete et al., 2024).

A recent scoping review has highlighted the importance of pharmacy staff in implementing harm reduction services tailored to the needs of PWUD. These services include overdose prevention education, distribution of naloxone, and referrals for further treatment. However, challenges remain, including the need for training pharmacy staff to recognize and respond to the complexities of substance use in their communities (Navarrete et al., 2024).

Efficacy of Mindfulness-Based Cognitive Therapy for Opioid Use

Mindfulness-Based Cognitive Therapy (MBCT) has shown promise in addressing opioid misuse, particularly among populations at high risk for suicide. A preliminary study indicated that participants engaged in MBCT reported a significant reduction in opioid misuse and suicidal ideation over a 12-month follow-up period. Specifically, those receiving MBCT alongside enhanced treatment as usual (eTAU) exhibited a relative risk reduction of 42% for acute psychiatric hospitalization (Using Mindfulness-Based Cognitive Therapy to Prevent Suicide among High Suicide Risk Patients who also Misuse Opioids, 2023).

The integration of MBCT into treatment protocols offers a multifaceted approach, addressing both substance use and mental health concerns, thereby improving overall outcomes for individuals battling opioid addiction.

Addressing the Opioid Crisis: Clinical and Public Health Strategies

To effectively combat the opioid crisis, a multifaceted approach incorporating clinical practices and public health strategies is essential. This includes enhancing access to harm reduction services, improving education for healthcare providers on recognizing and managing substance use disorders, and fostering community partnerships to support at-risk populations (Grunau et al., 2025).

Implementation of harm reduction practices, particularly in pharmacy settings, can optimize opioid management and reduce overdose risks. A systematic review emphasizes the need for further research to refine and expand these services, ensuring they meet the diverse needs of PWUD (Navarrete et al., 2024).

Table 1: Trends in Opioid-Related Overdose Deaths in Maryland (2020-2023)

FAQ

What is xylazine and how does it impact opioid overdoses?

Xylazine is a veterinary sedative that has increasingly appeared in the illicit drug supply, often mixed with fentanyl. Its presence complicates overdose treatment because it does not respond to naloxone, leading to prolonged sedation and higher risk of death.

How can pharmacy staff contribute to harm reduction?

Pharmacy staff can provide naloxone, educate patients on overdose prevention, and manage prescriptions for opioids, thereby playing a crucial role in reducing the risks associated with opioid misuse.

What is Mindfulness-Based Cognitive Therapy (MBCT)?

MBCT is a therapeutic approach that combines mindfulness practices with cognitive behavioral therapy. It aims to help individuals manage thoughts and emotions related to addiction and mental health issues, showing effectiveness in reducing opioid misuse and suicidal ideation.

What are the key strategies to address the opioid crisis?

Effective strategies include enhancing access to harm reduction services, improving education for healthcare providers, fostering community partnerships, and implementing evidence-based clinical practices to manage opioid prescriptions.

References

1. Characterization of xylazine-related overdose deaths in Maryland (2020–2023). https://doi.org/10.1016/j.drugalcdep.2025.112553
2. Using Mindfulness-Based Cognitive Therapy to Prevent Suicide among High Suicide Risk Patients who also Misuse Opioids: A Preliminary Probe of Feasibility and Effectiveness. https://pubmed.ncbi.nlm.nih.gov/11931725/
3. Implementation of harm reduction services for people who use drugs provided by pharmacy staff: a scoping review protocol. https://doi.org/10.1136/bmjopen-2024-093272
4. Grunau, B., O’Neil, B. J., Giustini, D., Drennan, I. R., & Lavonas, E. J. (2025). Opioid-associated cardiac arrest: A systematic review of intra-arrest naloxone and other opioid-specific advanced life-support therapies. https://doi.org/10.1016/j.resplu.2025.100906
5. Zhu, D. T. (2025). Responding to medetomidine: clinical and public health needs. https://doi.org/10.1016/j.lana.2025.101053
6. Navarrete, J., Hughes, C., Kung, J. Y., Salokangas, E., Taylor, M., & Hyshka, E. (2024). Implementation of harm reduction services for people who use drugs provided by pharmacy staff: a scoping review protocol. https://doi.org/10.1136/bmjopen-2024-093272