Xylazine-Induced Skin Ulcers in a Person Who Injects Drugs in Philadelphia, Pennsylvania, USA

Malayala, Srikrishna V; Papudesi, Bhavani Nagendra; Bobb, Raymond; Wimbush, Aliya

doi:10.7759/cureus.28160

Cited by 45 publications

(60 citation statements)

References 14 publications

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“…The biologic plausibility of xylazine use contributing to increased skin wounds has not been elucidated, however, this study adds to other studies that have reported this finding. 1,13,14,28 Second, this study corroborates the findings from other studies that xylazine use is concentrated in the northeastern United States. 14,27,28 A majority of our participants reported that they were from the Northeastern United States; Pennsylvania was the most common state reported in that region.…”

Section: Discussionsupporting

confidence: 89%

“…While this study's findings that people who used xylazine tended to also use fentanyl, experience prolonged sedation, and had increased skin wounds is similar to other studies of people who use xylazine, more research is needed to understand the range of adverse effects of xylazine use. 1,13,25,27 As the prevalence of xylazine in the drug supply moves across different geographic regions in the country, the demographics of its use concurrently with other drugs may change. Thus ongoing research into how xylazine is being used across time and geographics is needed to address the emerging needs of PWUDs who are exposed to xylazine.…”

Section: Limitationsmentioning

confidence: 99%

“…11,12 Emerging evidence from forensic, confiscated, and donated drug samples demonstrate that xylazine is increasingly found in the opioid drug supply in the Northeast and rapidly spreading to the rest of the country. 2,[13][14][15] In 2019, the CDC reported that of 45,676 overdose deaths in the State Unintentional Drug Overdose Reporting System (SUDORS) there were 826 (1.8%) that were xylazine-positive, and that 99.1% of all xylazine-involved deaths also involved fentanyl or fentanyl analogues. 16 More recently in Philadelphia, xylazine is being found in up to 75-90% of drug samples.…”

Section: Introductionmentioning

confidence: 99%

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Self-reported Xylazine Experiences: A Mixed Methods Study of Reddit Subscribers

Spadaro¹,

O’Connor

Lakamana

et al. 2023

Preprint

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Objectives: Xylazine is an alpha-2 agonist increasingly prevalent in the illicit drug supply. Our objectives were to curate information about xylazine through social media from People Who Use Drugs (PWUDs). Specifically, we sought to answer the following: 1) what are the demographics of Reddit subscribers reporting exposure to xylazine? 2) is xylazine a desired additive? and 3) what adverse effects of xylazine are PWUDs experiencing? Methods: Natural Language Processing (NLP) was used to identify mentions of "xylazine" from posts by Reddit subscribers who also posted on drug-related subreddits. Posts were qualitatively evaluated for xylazine-related themes. A survey was developed to gather additional information about the Reddit subscribers. This survey was posted on subreddits that were identified by NLP to contain xylazine-related discussions from March 2022 to October 2022. Results: 76 posts mentioning xylazine were extracted via NLP from 765,616 posts by 16,131 Reddit subscribers (January 2018 to August 2021). People on Reddit described xylazine as an unwanted adulterant in their opioid supply. 61 participants completed the survey. Of those that disclosed their location, 25/50 (50%) participants reported locations in the Northeastern United States. The most common eoute of xylazine use was intranasal use (57%). 31/59 (53%) reported experiencing xylazine withdrawal. Frequent adverse events reported were prolonged sedation (81%) and increased skin wounds (43%). Conclusions: Among respondents on these Reddit forums, xylazine appears to be an unwanted adulterant. PWUDs may be experiencing adverse effects such as prolonged sedation and xylazine withdrawal. This appeared to be more common in the Northeast.

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Section: Discussionsupporting

confidence: 89%

Section: Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Self-reported Xylazine Experiences: A Mixed Methods Study of Reddit Subscribers

Spadaro¹,

O’Connor

Lakamana

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…Management of skin ulcers caused by Xylazine requires wound care, including debridement techniques, and the use of silver sulfadiazine cream or antibacterial ointments. In severe cases, skin grafting and/or amputation may be considered [ 72 , 77 ].…”

Section: Reviewmentioning

confidence: 99%

Xylazine in the Opioid Epidemic: A Systematic Review of Case Reports and Clinical Implications

Ayub¹,

Parnia²,

Poddar³

et al. 2023

Cureus

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Introduction and objectives: The opioid overdose epidemic is exacerbated by the emergence of Xylazine as an illicit drug adulterant. Xylazine, a veterinary sedative, can potentiate opioid effects while also causing toxic and potentially fatal side effects. This systematic review aims to assess the impact of Xylazine use and overdoses within the opioid epidemic context. Method: A systematic search was conducted following PRISMA guidelines to identify relevant case reports, and case series related to Xylazine use. A comprehensive literature search included databases like Web of Science, PubMed, Embase, and Google Scholar, utilizing keywords and Medical Subject Headings (MeSH) terms related to Xylazine. Thirty-four articles met the inclusion criteria for this review. Results: Intravenous (IV) administration was a common route for Xylazine use among various methods, including subcutaneous (SC), intramuscular (IM), and inhalation, with overall doses ranging from 40 mg to 4300 mg. The average dose in fatal cases was 1,200 mg, compared to 525 mg in non-fatal cases. Concurrent administration of other drugs, primarily opioids, occurred in 28 cases (47.5%). Intoxication was identified as a notable concern in 32 out of 34 studies, and treatments varied, with the majority experiencing positive outcomes. Withdrawal symptoms were documented in one case study, but the low number of cases with withdrawal symptoms may be attributed to factors such as a limited number of cases or individual variation. Naloxone was administered in eight cases (13.6%), and all patients recovered, although it should not be misconstrued as an antidote for Xylazine intoxication. Of the 59 cases, 21 (35.6%) resulted in fatal outcomes, with 17 involving Xylazine use in conjunction with other drugs. The IV route was a common factor in six out of the 21 fatal cases (28.6%). Conclusion: This review highlights the clinical challenges associated with Xylazine use and its co-administration with other substances, particularly opioids. Intoxication was identified as a major concern, and treatments varied across the studies, including supportive care, naloxone, and other medications. Further research is needed to explore the epidemiology and clinical implications of Xylazine use. Understanding the motivations and circumstances leading to Xylazine use, as well as its effects on users, is essential for developing effective psychosocial support and treatment interventions to address this public health crisis.

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“…During the study period, the program had a census of 610 patients and offered treatment with methadone, buprenorphine, and long-acting injectable Buprenorphine and Naltrexone. 12 …”

Section: Methodsmentioning

confidence: 99%

Hepatitis C Treatment in Persons Who Inject Drugs in a Medication Assisted Treatment Program: A Retrospective Review of an Integrated Model

Bobb¹,

Malayala²,

Ajayi³

et al. 2023

J Prim Care Community Health

Self Cite

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Background: Hepatitis C virus (HCV) infection is common among persons who inject drugs (PWID), mostly due to needle sharing. The number of new cases in PWID are steadily increasing despite the availability of effective treatments. The objective of this model is to increase uptake and compliance with HCV treatment. We developed a model to treat HCV and opioid use disorder simultaneously in a methadone maintenance program. Methods: Patients were screened on site for HCV at admission and then annually. Once HCV was positive, the genotypes and fibrosis scores were identified. Patients were enrolled into the treatment program after obtaining written consent. Patients either self-administered the medications at home or utilized a directly observed treatment (DOT). The sustained virologic response (SVR) was tested at 12 weeks posttreatment. We conducted a retrospective review of patients who received treatment and reviewed the demographic data, co-infections, medication administration, and SVR results at the end of study period. Results: One hundred ninety patients were identified as Hepatitis C positive. 88.9% (169 patients) received HCV treatment during the study period. 62.7% (106 patients) were male and 37.3% were female (63 patients). 62.7% of them (106 patients) completed HCV treatment by the end of study period. Out of them, 96.2% (102 patients) achieved SVR. 68.9% (73 patients) utilized DOT for medication administration. Conclusions: Our model successfully treated HCV in our patient population, who are otherwise deprived of resources and access to health care. Replicating this model is a potential strategy to reduce the disease burden and break the transmission cycle of HCV.

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Xylazine-Induced Skin Ulcers in a Person Who Injects Drugs in Philadelphia, Pennsylvania, USA

Cited by 45 publications

References 14 publications

Self-reported Xylazine Experiences: A Mixed Methods Study of Reddit Subscribers

Self-reported Xylazine Experiences: A Mixed Methods Study of Reddit Subscribers

Xylazine in the Opioid Epidemic: A Systematic Review of Case Reports and Clinical Implications

Hepatitis C Treatment in Persons Who Inject Drugs in a Medication Assisted Treatment Program: A Retrospective Review of an Integrated Model

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