The animal tranquilizer xylazine is increasingly found in illegal opioid supplies across the country, causing serious injuries to drug users. New research led by a doctor and scientist at the University of Pittsburgh has been published in Drug and alcohol addiction attempts to understand the experiences of this population group with wound care.

A cross-sectional survey of drug users identified by three syringe services in Massachusetts found that the vast majority had sustained xylazine wounds in the past year. While the need for comprehensive, low-barrier wound care is growing, access to this care continues to lag behind demand.

As a result, these wounds often lead to serious complications, such as infections, or they develop into chronic, non-healing wounds that require amputation.

Of the 171 people surveyed, 87% reported xylazine wounds. Among drug users, those with xylazine wounds were ten times more likely to inject themselves subcutaneously. Almost three-quarters (74%) reported experiencing stigma from the health care system when seeking wound care, and more than half (58%) reported inadequate pain and withdrawal treatment.

“Patients with xylazine wounds often do not have access to low-barrier wound care services that would consider their substance use,” said lead author Raagini Jawa, MD, MPH, UPMC addiction medicine and infectious disease physician and assistant professor of medicine at Pitt.

“If health systems do not respond to rapidly changing drug supply, patients with xylazine wounds will be forced to treat themselves.”

Proper wound healing requires specialized and consistent wound care that is not readily available to drug users. Jawa’s previous research found that most addiction hospitals across the country lack adequate training to provide proper wound care and rely on referrals to outside specialists.

More than half of survey participants reported cleaning wounds with alcohol-based disinfectants, which can corrode the delicate wound bed and impair wound healing. Almost one in five did not cover their wounds because they did not have access to appropriate wound care products. More than half of respondents also resorted to heroin or fentanyl for the pain caused by their xylazine-induced wounds.

Although the survey was conducted in Massachusetts, which has both syringe services and community-based drug control programs, the problem of xylazine-related wounds is even more pronounced in Pennsylvania, which leads the nation in xylazine prevalence by one of these measures.

“While we do not yet fully understand the mechanism by which xylazine and other factors cause these wounds, we do know that there is an urgent need for high-quality, long-term wound care and linkage to addiction treatment, without bias,” Jawa said.

“People with xylazine-related wounds need resources, education about how to care for their own wounds, and compassionate care wherever they come into contact with the health care system – from the hospital to the emergency room to their primary care doctor’s office.”

Jawa, along with study co-author Dr. Margaret Shang and colleague Dr. Ilana Hull and an interdisciplinary team of providers, are leading efforts to streamline this care across UPMC. This includes distributing self-care wound care tools and xylazine test strips to drug users and developing system-wide protocols that other clinicians can follow.