Wounds Attributed to Xylazine Exposure Are Associated With Subcutaneous Injection Drug Use and Healthcare Stigma

People who use drugs (PWUD) are at risk of soft tissue infections and chronic wounds. As the illicit drug supply has become increasingly adulterated with xylazine in some areas, there has also been a rising incidence of skin wounds among PWUD. Researchers surveyed PWUD at three Massachusetts community-based syringe service programs to better understand their experiences with xylazine wounds. Participants were adults who reported having any wounds related to substance use in the past year; those who reported having wounds consistent with illustrations of typical xylazine wounds were considered to have “xylazine wounds.”

• The cohort included 171 PWUD; 63 percent were male, and 91 percent had injection drug use (IDU). Overall, 80 percent of the cohort reported xylazine exposure; 148 (87 percent) reported xylazine wounds.
• PWUD with xylazine wounds reported high rates of healthcare stigma (74 percent), inadequate pain treatment (58 percent), and inadequate withdrawal treatment (58 percent).
• Participants with IDU who reported xylazine wounds were more likely to report subcutaneous injection than those with non-xylazine wounds (30 percent versus 5 percent, respectively).

Comments: This study provides some insight into the experiences of PWUD with xylazine-associated wounds. It is still not clear to what extent xylazine or specific drug use practices (like subcutaneous injection) are responsible for the development of these wounds. Increased access to patient-centered treatment and wound management education among PWUD who are at risk for developing wounds is needed.

Darius A. Rastegar, MD

Reference: Jawa R, Ismail S, Shang M, et al. Drug use practices and wound care experiences in the age of xylazine adulteration. Drug Alcohol Depend. 2024;263:112390.