“Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier. DEA has seized xylazine and fentanyl mixtures in 48 of 50 States. The DEA Laboratory System is reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.”
Xylazine-involved overdose deaths in the United States rose from 102 to 3,468 in the space of just 3 years between 2018 and 2021, and its effects on long-term users – often leaving them immobilised in the street, and prone to non-healing skin lesions – have led to its characterisation as the ‘zombie drug’.
Xylazine is taken both knowingly and unwittingly. It can be used as a cutting agent for other drugs and is also sought after to lengthen the short duration of fentanyl effect.
One of the nastier side effects from using this drug is skin wounds. "Tranq wounds" are a distinct and new presentation of complications associated with substance use. While the wounds commonly develop at the site of infection, they can appear anywhere on the body and irrespective of the method of drug administration.
Xylazine-associated wounds may initially appear as areas of blistered skin, often over reddish-purple discolored tissue, which evolve into a thick layer of eschar overlying a partial or full thickness ulcer that progressively increases in size and depth. Indeed, xylazine-associated wounds are often typified by the presence of necrotic tissue (eschar and slough) and wound diameters greater than 10cm.
Earlier this year, the Department of Public Health, City of Philadelphia, published a guide to caring for these wounds. Philadelphia has emerged as the epicentre of the xylazine crisis.
Recommendations for Caring for Individuals with Xylazine- Associated Wounds
In the section Surgical Interventions: Skin Grafting and Amputation it states
Individuals with xylazine-associated wounds are often recommended to undergo amputation, however it is not clear if existing clinical indications for amputation can be readily applied to individuals with xylazine-associated wounds. Protocols for the treatment of burn wounds offerstrategies, such as dermal substitutes, for treating xylazine-associated wounds in the hospital setting which may improve clinical outcomes. One such guidance is avoiding amputation and providing limb-sparing care. Early Burn Surgery consultation may help initiate treatments that avoid amputation. In the experience of the contributing experts, one strategy that is applied to burn wounds that has been helpful in healing xylazine-associated wounds is the application of biodegradable temporizing matrix – a synthetic dermal substitute which promotes tissue growth and tissue coverage over tendon and bone.
Recommendations:
1) Biological dermal substitutes have a poor infection profile and should not be placed on xylazine associated wounds.
2) Synthetic dermal substitutes, such as biodegradable temporizing matrix may be helpful in maintaining healthy tissue and decrease amputation rates.
The two first links below contain photos of "Tranq wounds". I warn that the photos are graphic. The PDF link is to the Philadelphia Dept of Health guide for caring for xylazine-associated wounds.
(20min delay)