The animal tranquilizer xylazine is increasingly prevalent in the illegal opioid market across the country, resulting in significant injuries among individuals who use drugs. Research has revealed that a substantial majority had suffered from xylazine-related wounds. Despite the growing need for comprehensive and accessible wound care, the availability of such services remains insufficient to meet the demand. Consequently, these injuries frequently lead to severe complications, including infections, or develop into chronic, non-healing wounds that may require amputation.
Studies indicated that individuals who inject drugs and have xylazine wounds are 10 times more likely to engage in subcutaneous injection. Approximately 74% reported experiencing stigma in healthcare settings when seeking wound care, while over half (58%) indicated that they received inadequate management of pain and withdrawal symptoms.
Patients with xylazine wounds often lack access to low-barrier wound care services that could address their substance use issues. When healthcare systems fail to adapt to the rapidly evolving drug landscape, individuals with xylazine wounds are left to manage their treatment.
Effective wound healing necessitates specialized and consistent care, which is not readily available to those who use drugs. Previous research has shown that the majority of addiction care providers across the nation are not sufficiently trained to deliver appropriate wound care treatment and often rely on referrals to external specialists.
Therefore, it’s necessary to explore the alarming rise of xylazine misuse, its connection to severe open wounds, and the critical need for professional addiction treatment. At Discovery Institute in Marlboro, New Jersey, our comprehensive substance abuse programs such as medical detox, residential treatment, and holistic therapy, can help individuals recover from opioid abuse, and other substances while addressing the physical and emotional toll it has on people’s lives.
What is Xylazine?
Xylazine is a tranquilizer, analgesic, and central nervous system depressant that has received approval from the U.S. Food and Drug Administration (FDA) for veterinary applications. However, it is not authorized for human consumption. Illegally obtained xylazine is commonly found mixed with illicit opioids, particularly fentanyl, although it is not classified as an opioid itself.
This substance is often referred to as “tranq,” and when combined with fentanyl or other opioids, it is known as “tranq dope.” Xylazine can be administered through various methods, including injection, snorting, ingestion, or inhalation.
Xylazine has the potential to induce drowsiness and can lead to dangerously low levels of breathing, heart rate, and blood pressure. The interaction between xylazine and fentanyl raises uncertainties regarding whether xylazine heightens the risk of a fatal overdose. Nonetheless, the profound sedation caused by xylazine may result in respiratory failure. Most overdose fatalities associated with both xylazine and fentanyl also involved additional substances, such as cocaine, heroin, benzodiazepines, alcohol, gabapentin, and prescription opioids.
Although opioid overdose reversal agents, including naloxone and nalmefene, do not counteract the effects of xylazine, public health authorities advise administering these reversal medications in cases of suspected overdose involving xylazine, as the majority of individuals exposed to xylazine do so through fentanyl use.
What Substances Has Xylazine Been Found In?
Xylazine is often encountered in conjunction with other substances, particularly opioids like illicitly produced fentanyl. Studies indicate that certain individuals may intentionally use xylazine to prolong the euphoric effects of fentanyl. However, there are also reports from drug users who have ingested it unintentionally, describing it as an unwelcome additive in their substances.
Given the rapid evolution of the drug supply, the National Institute on Drug Abuse (NIDA) endorses the National Drug Early Warning System (NDEWS), which monitors the emergence of various substances, including xylazine, throughout the nation.
How Does Xylazine Affect the Brain and Body?
Xylazine functions as a central nervous system depressant, resulting in drowsiness, reduced brain activity, muscle relaxation, and a decrease in heart rate and respiratory function. Individuals who have consumed these drugs report experiencing additional adverse xylazine side effects. Prolonged use of xylazine can lead to the development of painful and challenging-to-treat sores on the skin and muscles, referred to as “soft tissue” injuries. If these sores are not addressed, they may expand and become infected, potentially resulting in necrotic tissue. In severe instances, amputation of the affected limb may be necessary. Patients with these injuries often require continuous wound care and pain management. The sores may manifest at the injection site, but they can also appear in other areas of the body. Some healthcare professionals have noted that these wounds can occur even when xylazine is smoked or snorted rather than injected.
The practice of sharing syringes for drug use can lead to various adverse health consequences. This behavior increases the risk of bacterial infections, such as infective endocarditis, as well as viral infections, including HIV and hepatitis C. Xylazine misuse is associated with the following:
- Linked to overdose deaths.
- This can lead to long periods of blackout.
- Increases the risk of assault and injury.
- Can increase the time needed to fully revive someone who has overdosed.
- Can cause serious skin wounds that can lead to amputation if not treated promptly.
At certain dosages, the effects of xylazine can pose significant health risks, particularly when combined with other depressants like opioids (including fentanyl), alcohol, and benzodiazepines.
Xylazine Wounds and the Need for Treatment
Exposure to xylazine has been linked to wounds that differ from conventional injection-related skin and soft tissue infections. Our objective was to investigate the wound care practices and treatment experiences of individuals who use drugs (PWUD) in an area with a high prevalence of xylazine contamination.
Xylazine is a sedative designed for veterinary use and poses significant risks to humans, potentially leading to severe skin infections and other critical reactions, such as respiratory depression.
Skin injuries associated with xylazine may manifest as infections, subcutaneous abscesses, and open, oozing ulcers. While these wounds can heal with continued substance use and appropriate medical intervention, preliminary findings suggest that healing may be delayed for individuals using xylazine-containing substances. These injuries can be quite painful, and in severe cases, may necessitate pain management and hospitalization. If not adequately treated, such infections could result in the amputation of the affected limb.
Currently, there are no established medical guidelines for the management of xylazine-related wounds. Nonetheless, it is essential to maintain cleanliness of the wounds. Initial evidence indicates that keeping the wounds clean and open, without sutures or skin grafts, may be beneficial. The National Institute on Drug Abuse (NIDA) is advocating for research to enhance understanding of effective treatments for xylazine-related injuries. These wounds can occur regardless of injection practices and may appear anywhere on the body, not limited to injection sites, presenting as:
- Blisters
- Small purple bruises or scabs
- “Pinpoint” perforations in the skin
- Large open sores
- Dark or necrotic patches of skin
Xyalazine wounds frequently occur in individuals who engage in the use of illicit opioids; however, access to appropriate wound care is often limited.
Is Xylazine Addictive?
To receive a diagnosis of a substance use disorder, an individual must fulfill certain diagnostic criteria indicating persistent and compulsive substance use despite experiencing adverse consequences. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published by the American Psychiatric Association, serves as a key reference for health professionals in diagnosing substance use disorders and other mental health conditions; however, it does not provide a specific diagnosis for xylazine.
Xylazine Withdrawal Symptoms
The National Institute on Drug Abuse (NIDA) is actively engaged in research to enhance understanding of the prevalence and severity of withdrawal and substance use disorder symptoms among individuals who use xylazine.
Preliminary studies indicate that the symptoms of substance use disorder and withdrawal may be more severe in individuals using xylazine in conjunction with fentanyl compared to those using fentanyl alone. Further investigation is necessary to comprehend this observation and to assess the addictive properties of xylazine. Xylazine withdrawal symptoms include:
- Fever or chills
- Severe pain at wound site
- Skin that is red, hard, and hot to touch
- Thick, smelly yellow or green discharge coming out of a wound
- Pieces of skin falling off
- Bone is showing
- Numbness (lack of feeling) or tingling on the skin
- Inability to move the body part where the wound is located
The NIDA is committed to supporting research aimed at elucidating these findings, including the effects of xylazine on fentanyl in the body and the potential for confirming these initial observations.
What is Xylazine’s Role in the Overdose Crisis?
There has been an alarming rise in xylazine misuse. Xylazine has recently emerged as a contributing factor in the overdose crisis, yet the national extent of overdose fatalities involving this substance remains unclear. It was first identified in the drug supply in Puerto Rico during the early 2000s. Between 2019 and 2022, the detection of xylazine in drug seizures more than doubled across 30 states.
According to the U.S. Centers for Disease Control and Prevention’s (CDC) State Unintentional Drug Overdose Reporting System (SUDORS), the monthly percentage of fentanyl-related overdose deaths that included xylazine rose by 276% from January 2019 (2.9%) to June 2022 (10.9%), although these rates may differ by state. A study focusing on fatal overdoses in Michigan indicated that xylazine was present in 4.7% of such cases in 2023.
Preliminary research does not suggest that the combination of xylazine and opioids increases the likelihood of a fatal overdose. Research funded by the National Institute on Drug Abuse (NIDA) revealed that individuals who had both xylazine and fentanyl in their systems during an overdose exhibited lower rates of heart attack and coma compared to those who tested positive for opioids alone.
Furthermore, the same study indicated that individuals with xylazine present during an opioid overdose were not at a higher risk of death than those who experienced an opioid overdose without xylazine. Additionally, individuals with opioid overdoses accompanied by xylazine exposure were not more likely to require hospitalization, nor did they have longer hospital stays compared to those who used opioids without xylazine.
Another investigation found that individuals with both fentanyl and xylazine in their systems during an opioid overdose were not more likely to receive naloxone, the overdose reversal medication, and were more likely to have a pulse upon the arrival of emergency responders compared to those with fentanyl alone.
Treatment for Xylazine Wounds and Opioid Addiction
The NIDA is committed to advancing both pre-clinical and clinical research regarding the human application of xylazine. The NIDA is dedicated to research that enhances the understanding of xylazine’s effects on both individual and public health. Additionally, they’re supporting initiatives that monitor and analyze emerging patterns of drug use and shifts in the drug supply throughout the United States, including the role of xylazine.
Discovery Institute in Marlboro, NJ, aims to join the NIDA’s mission to address the physical and emotional toll of addiction, as well as, the importance of family support and relapse prevention in long-term recovery. We’re focusing on examining the alarming rise of xylazine misuse, by doing the following:
- Recognizing the prevalence of xylazine within the drug supply and its associated health implications. This includes examining the frequency of intentional versus accidental use of xylazine in conjunction with other substances, as well as the incidence of xylazine-related skin and muscle injuries.
- Providing strategies for comprehending and managing xylazine-related overdoses, and the potential for withdrawal symptoms associated with xylazine on fentanyl dependency,
- Community-driven approaches to address the presence of xylazine in local drug markets.
At Discovery Institute, our addiction treatment professionals are providing our patients with access to the substance abuse treatment they need.
Harm Reduction Techniques and Xylazine Wound Care
Early intervention in wound care is essential for effective healing. The body can recover when provided with appropriate support. Harm reduction techniques and tips for wound care include:
- Begin by thoroughly washing your hands with soap and water before handling any wounds, or use sterile gloves.
- Gently cleanse the wound using soap and water or saline solution (a mixture of water and salt). Apply ointment to a bandage and then affix it to the wound.
- Secure the bandage with additional dry bandages, ensuring that they are wrapped lightly to avoid excessive pressure on the skin.
- If self-adhesive wrap (which is sticky on one side) is unavailable, you may use long sleeves or pants to cover the bandage.
- It is important to clean the wound and replace the bandage every 2-3 days. Maintain the wound in a clean, moist (but not overly wet) environment, ensuring it remains covered.
- Avoid using products such as alcohol or hydrogen peroxide, as these can lead to dryness of the wound.
- Daily cleaning with mild soap and warm water is recommended; gently pat the area dry with a clean cloth and apply a thin layer of petroleum jelly before covering it with a bandage.
- Whenever feasible, change the bandages daily. Ensure that bandages are not wrapped too tightly or too thickly; they should be secure enough to stay in place while adequately protecting the wound.
- Wounds associated with xylazine may exhibit slower healing rates; consider marking a circle around each wound with a permanent marker to monitor changes in size.
Medical Opiate Detox at Discovery Institute
At Discovery Institute, we understand xylazine’s effects on the body, its impact on communities, and its role in the overdose crisis. Access to comprehensive care is of utmost importance, and therefore, our opiate detox center in New Jersey is at the forefront making sure our patients receive the care and guidance they need throughout their addiction detox and recovery journeys. Your treatment options will vary based on your circumstances. We strive to ensure that your recovery journey is as comfortable as possible. Our goal is to guide you through a successful treatment process that leads to total liberation from substance abuse and dependence.
For further details regarding our services, please reach out to us today. Allow us to assist you in embarking on the path toward a renewed and healthier version of yourself. You can contact us to discover more about what we offer.
Dr. Joseph Ranieri D.O. earned his BS in Pharmacy at Temple University School of Pharmacy in 1981 and His Doctorate Degree in Osteopathic Medicine at the Philadelphia College of Osteopathic Medicine in 1991. He is Board Certified by the American Board of Family Medicine and a Diplomate of the American Board of Preventive Medicine Addiction Certification. Dr. Ranieri has lectured extensively to physicians, nurses, counselors and laypeople about the Disease of Addiction throughout New Jersey and Pennsylvania since 2012.
