Severe cutaneous ulcerations secondary to xylazine (tranq): A case series

Xylazine is an agonist at kappa opioid receptors and exhibits sex-specific responses to opioid antagonism

“…Considering that xylazine is a full κOR agonist, we note two prominent historical and international examples of non-medical use of the κOR agonist pentazocine: the “Ts and Blues” (pentazocine and tripelennamine) outbreak in the midwestern United States from 1977 to 1981 [ 77 – 79 ], and pentazocine injection in Nigeria [ 80 ] and India [ 81 – 84 ]. In both settings, characteristic skin lesions beyond the site of injection, eschar formation, and wound cratering were observed [ 85 – 90 ], with morphological similarity [ 91 ] to reports involving xylazine from Puerto Rico [ 92 ], the Philadelphia area [ 9 , 93 ], and New Haven, Connecticut [ 94 ]. κOR distribution in human skin has led to its study as a therapeutic target [ 95 – 97 ], suggesting new directions for research into wound etiology.…”

Xylazine in Illicit Drug Mixtures: A Growing Threat and Overlooked Danger

“…There are not any prospective clinical study articles that we are aware of that discuss the effects of fentanyl mixed with Xylazine on human populations. However, several case reports have detailed both clinically significant but nonlethal pathological problems with this combination of drugs 16 , 17 and clinical symptoms of fatal drug overdoses 18 , 19 . The rising incidence of this combination of drugs in clinical 20 , 21 and postmortem 22 populations has recently been reported in several retrospective and prospective forensic medicine studies.…”

Xylazine-Associated Wounds and Related Health Concerns Among People Who Use Drugs: Reports From Front-Line Health Workers in 7 US States

“…[18][19][20] Recent case reports in peer-reviewed literature describe such wounds as necrotic, chronic in nature, emerging at injection sites, and emerging at extremities where injection did not occur. [20][21][22][23] Many describe secondary bacterial infection. [22][23][24] Two case reports include the findings from punch biopsies at the wound site, one revealing epidermal necrosis with focal fibrin thrombi, the other revealing subcutaneous necrosis with no vasculopathy.…”

“…[20][21][22][23] Many describe secondary bacterial infection. [22][23][24] Two case reports include the findings from punch biopsies at the wound site, one revealing epidermal necrosis with focal fibrin thrombi, the other revealing subcutaneous necrosis with no vasculopathy. 24 Otherwise, the pharmacokinetics of xylazine in humans have not been systematically researched, and the most available insights must be extrapolated from animal studies.…”