Xylazine (a sedative and analgesic approved only for veterinary use) has been designated by the US federal government as an emerging threat due to its increasing presence in fatal overdoses.¹ Xylazine-involved overdose deaths in the US rose from 102 in 2018 to 3468 in 2021,² and 99.1% of these deaths also involved fentanyl.² Xylazine-involved overdose deaths are primarily concentrated in the eastern US,² especially in the Northeast.³ Nonetheless, it is less clear to what extent xylazine is involved in overdose deaths within individual states across the US, as xylazine is not uniformly included in every jurisdiction’s postmortem toxicology testing, and counts of xylazine-involved overdose deaths are not accessible via the Centers for Disease Control and Prevention (CDC)’s national mortality database. State-level data on xylazine-involved overdose deaths are currently limited in peer-reviewed publications, including analyses from individual states (Connecticut⁴; West Virginia⁵; Tennessee⁶) and a CDC report⁷ providing ranges (eg, 100 to 499 deaths) of fentanyl-xylazine–positive deaths for 31 states. In a 2022 publication,⁸ data on xylazine-related overdose deaths were available for only 14 jurisdictions in the US (including cities, counties, and states).

Recent evidence points to racial and ethnic disparities in drug-related deaths and health conditions. Informed by stigma, intersectionality, intersectional stigma, and fundamental cause theories, we aimed to explore whether intersectional stigma was a fundamental cause of health. We document key events and policies over time and find that when progress is made new mechanisms emerge that negatively affect health outcomes for Black and Hispanic persons. We then focus on intersectional stigma targeting Black and Hispanic persons who use drugs. We document that when a person, or group of people, occupy multiple stigmatized identities the processes of stigmatization and scapegoating are particularly persistent and pernicious since people and groups can be stigmatized and scapegoated on varying intersections. We propose that an intersectional stigma framework allows for a better understanding of observed patterns over time, thereby providing a better guide for policies and interventions designed to reduce disparities. As a framework, intersectional stigma aims to recognize that when different sources of stigma collide, a new set of circumstances is created for those who reside in the intersection. We conclude that intersectional stigma is a fundamental cause of health inequities and provide policy recommendations aimed at dismantling intersectional stigma processes and mitigating the effects of intersectional stigmas to ultimately promote better health outcomes for Black and Hispanic persons who use drugs.

Background: Suicide and suicidal behaviors were already a global public health problem, producing preventable injuries and deaths. This issue may worsen due to the COVID-19 pandemic and may differentially affect vulnerable groups in the population, including children, adolescents, and young adults. The current study evaluated the association of affective variables (depression, hopelessness, and anxiety), drug use (alcohol, tobacco, and others), emotional intelligence, and attachment with suicidal behaviors. Methods: A state-wide survey included 8033 students (51% female, 49% male; mean age of 16 years) from science and technology high-schools using a standardized questionnaire that was distributed online. Multinomial logistic regression models tested associations between suicidal behaviors and several covariates. The analyses accommodated the complex structure of the sample. Results: Approximately 21% of all students reported a suicidal behavior (11% with a low-lethality suicide attempt, 6% with self-injuries, and 4% with a high-lethality suicide attempt). Variables associated with higher odds of suicidal behavior included: female sex, depression, hopelessness, anxiety, alcohol and tobacco use, childhood trauma, and having to self-rely as issues affecting attachment, and low self-esteem. Security of attachment was associated with lower odds of suicidal behavior. Conclusions: The complexity of suicidal behavior makes it clear that comprehensive programs need to be implemented.