Emerging Threats in OUD: Critical Updates for Psychiatric Nurses

The opioid overdose crisis is evolving rapidly, driven by an increasingly unpredictable and toxic illicit drug supply. Synthetic opioids such, as illicitly manufactured fentanyl, continue to dominate overdose deaths, while emerging threats, including xylazine and other non-opioid adulterants, are fundamentally changing clinical presentation, overdose response, and treatment approaches. At the same time, polysubstance use involving stimulants, sedatives, and novel synthetic compounds has become the norm, complicating assessment and care delivery.

This course equips psychiatric-mental health nurses with up-to-date knowledge and practical strategies to respond effectively to these emerging threats. Participants will explore how changes in the drug supply impact overdose risk, symptom presentation, and treatment engagement. Special emphasis is placed on the recognition of atypical overdose presentations, including cases that may not respond fully to naloxone, as well as identifying complications such as xylazine-related wounds and complex withdrawal syndromes.

The course also reviews evolving practices in the treatment of opioid use disorder (OUD), including adaptations in medications for OUD (MOUD) in the context of high-potency synthetic opioids. Participants will examine the ongoing role of safety-focused interventions, such as naloxone distribution and drug checking technologies, in reducing morbidity and mortality in a rapidly changing landscape.

Through a trauma-informed and stigma-free lens, this program highlights the critical role of psychiatric-mental health nurses in early identification, patient engagement, overdose prevention, and coordination of care across settings. Learners will leave with enhanced clinical confidence and actionable tools to improve outcomes for individuals and communities affected by OUD.

Presenter:  Jennifer L. Scott, DNP, FNP-BC, PMHNP-BC 
Facilitator:  Trisha Charbonneau-Ivey, BA, MSHAL 
Interdisciplinary Team:  Jen Kreiner, MSN, NP-C, PMHNP-BC; Matthew Mitchell, DHA, LMSW, CCS CAADC; Jill Covyeou, Pharm.D.; Ricardo Bowden, MA, CPC, CADC, CPRM, CPR  

Disclosures:  The APNA planners and faculty have no relevant financial relationships to disclose. Off-label uses will not be discussed during this presentation.  

Session Length:  2 hours

Target Audience:  RN, APRN 


Learning Outcome: 
Upon completion of this program, the participant will be able to: 

• Identify one new or reinforced knowledge concept gained from this session.

Learning Objectives: 

1. Describe the clinical impact of xylazine as an opioid adulterant, including overdose management, wound assessment, and withdrawal.
2. Identify novel synthetic opioids (nitazines and emerging analogs) and the limitations of current safety focused interventions and detection tools.
   
3. Recognize designer benzodiazepines, particularly bromazolam, and their unique risks for patients with OUD.
   
4. Apply current evidence-based approaches to buprenorphine initiation in patients using fentanyl and other highly potent synthetic opioids.
   
5. Integrate interdisciplinary perspectives in OUD management using a collaborative learning model.
   

Key Takeaways: 

1. Xylazine: naloxone alone is not enough. Airway management and wound care are nursing skills now.
   
2. Novel synthetics evade test strips: counsel patients honestly. Never Use Alone (1-800-484-3731).
   
3. Designer benzodiazepines: ask every patient where their Xanax comes from. Counterfeit is common and urine drug screening will not catch it.
   
4. Buprenorphine induction: allow more time, use adjunctive meds, individualize. The supply changed the protocol.
   
5. Psychiatric hospitalization is an MOUD opportunity. Do not discharge without a warm handoff.
   

Keywords:  Opioid Use Disorder, Stimulant Use Disorder, Adolescent, Medications


Nursing Continuing Professional Development:
2.0 contact hours (of which 1.0 are in pharmacology).  * In order to receive contact hours, participants must: Listen to the entire presentation(s), complete the course evaluation, and honor statement before the expiration date. Once all steps are successfully completed, a certificate will be generated online and available for you to print immediately. Credit cannot be earned unless all components are completed. Partial credit will not be awarded.

The American Psychiatric Nurses Association is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

Grant Statement: 
Funding for this initiative was made possible (in part) by grant no. 1H79TI088037 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Release Date:  July 10, 2026
Access to this course will end:  July 1, 2029

© APNA 2026. Reproducing and distributing this material without the written permission of the American Psychiatric Nurses Association (APNA) is prohibited. 

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