The animal tranquilizer xylazine is increasingly found in the illegal opioid supply nationwide, leading to serious injury to people who use the drug. New research led by a University of Pittsburgh physician-scientist and published in Drug and alcohol addiction seeks to understand the wound care experiences of this population.
A cross-sectional survey of drug users identified through three syringe service providers in Massachusetts found that the vast majority had experienced xylazine injuries in the previous year. As the need for comprehensive low-barrier wound care increases, access to such care continues to lag behind demand. As a result, these wounds often lead to serious complications, such as infections, or become chronic, non-healing wounds that require amputation.
Of the 171 people surveyed, 87% reported injuries from xylazine. Among people who inject drugs, those with xylazine injuries were 10 times more likely to inject subcutaneously. Nearly three-quarters (74%) reported experiencing health care stigma when seeking trauma care, and more than half (58%) reported inadequate management of pain and deprivation.
Patients with xylazine injuries often do not have access to low-barrier wound care services that could address their substance use. When health systems fail to respond to the rapidly changing supply of drugs, patients with xylazine injuries are forced to fend for themselves.”
Raagini Jawa, MD, MPH, Lead Study Author and UPMC Addiction and Infectious Diseases Physician and Assistant Professor, University of Pittsburgh
Proper wound healing requires specialized and consistent wound care, which is not easily accessible to people who use drugs. Jawa’s previous research found that most addiction care providers nationwide are inadequately trained to provide appropriate trauma care treatment and depend on referrals to outside specialists.
More than half of respondents reported cleaning wounds with alcohol-based disinfectants, which can be corrosive to a sensitive wound bed and affect wound healing. Almost 1 in 5 people did not cover their wounds due to lack of access to appropriate wound care supplies. More than half of the respondents used heroin or fentanyl for pain caused by their xylazine wounds.
While the research was conducted in Massachusetts, which has syringe services and community-based drug testing programs, the problem of xylazine injuries is even more pronounced in Pennsylvania. The Commonwealth leads the nation in entrenching xylazine according to one measure.
“Although we do not yet fully understand the mechanism by which xylazine and other agents cause these traumas, we know that there is an urgent need for high-quality, longitudinal trauma care and a link to addiction treatment, all provided without judgment.” Jawa said. “People with xylazine injuries need resources, education on how to care for their injuries, and compassionate care at every point they touch the health care system – from the hospital to the emergency room to their PCP’s office.”
Jawa, with study co-author Margaret Shang, MD and colleague Ilana Hull, MD are leading efforts along with a multidisciplinary team of providers to streamline this care across UPMC, including distributing wound self-care resources and xylazine test strips in drug users and development of system-wide protocols for other clinicians to follow.
