CTN Community Representation Council Meeting Summary (February 2026)

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The CTN Community Representative Council (CIRCL) is a collaborative of the national CTN that comes together bimonthly to courageously share what’s happening in their communities.

This brief is an overview of topics discussed at this meeting and is not an exhaustive review. Download a copy of the brief.

The following themes and discussions were highlighted during this meeting:


The thoughts and experiences herein are those of CIRCL members and do not represent the National Institute on Drug Abuse or the Clinical Trials Network. The voices empowered by CIRCL are intended to drive research and clinical efforts in the CTN and across the US.

Trends in substance use

  • Increasing rates of smoking versus IV use nationally.
  • Kratom and 7O-H use are increasing across the country (Reports of euphoria despite MOUD).
  • “Kryptonite” green-colored fentanyl (Midwest).
  • Condoms being used to get high in Midwest, but unsure how (potentially this trend seen in India).
  • Medetomidine and xylazine in the supply (Northeast).
  • Disruption in supply altering fentanyl precursors (BTMPS to tetramethylfentanyl; Northeast).

Public health impacts across the US

  • Rural areas turning down vital resources needed for treatment and harm reduction (Appalachia).
  • Not being able to use “Never use alone” language has been detrimental.
  • While data show OD reductions, front-line workers are not reporting the same in some communities.
  • Higher rates of serious mental health and limited resources for mental health in some regions.
  • Involuntary commitment being discussed or introduced in legislation across the US

Trust has been lost – how do we regain it?

  • When people have negative interactions (health care, police, etc.), they stop trusting everyone.
  • Data systems sometimes used to track rather than treat (e.g., unhoused tracking systems sometimes used to identify areas for law enforcement sweeps. Providers report using this service sparingly, if not avoiding it completely).
  • Relationships are key. Once trust is broken, hard to
    build trust back. Must consider repercussions of
    public health actions on trust.
  • Use unique ways to get information out to communities (e.g., local zine [privately printed small magazine]).

Hep C infection rates may be increasing

  • Many patients misinformed about infection, treatment, and access to medication.
  • Referral and treatment programs are growing, especially in the Northwest and Northeast.
  • Technology can facilitate access and treatment, and in some cases get people treated without having to see a provider in person.

Housing crisis is getting worse for people with substance use

  • Particularly affecting pregnant and parenting people.
  • Harsh winter climates seeing hurting people who are displaced.

Despite challenges, solutions rise to the top

  • Mobile units are engaging community members afraid to come into the clinic.
  • New initiatives across the US are lowering barriers to access:
    • Mobile HCV/HIV screening and referral program (Northwest).
    • Program with police and peers to reduce citations for people using substances who seek help (Northwest).
    • Syringe services integrating MOUD and basic health care.
    • Warming shelters in cold regions become de facto Housing First facilities with colder weather.
    • Education about the drug supply is helping people recognize effects/stay safe.
    • Drug testing sites helping communities be more aware of the drug supply composition.

Posted on April 13, 2026.