New Clinical Protocols for Managing Xylazine-Related Wounds

A multidisciplinary team at UPMC has developed comprehensive treatment guidelines for patients hospitalized with xylazine exposure, an increasingly common component found in unregulated opioid supplies. Xylazine, originally a veterinary sedative, has been linked to severe clinical complications including challenging withdrawal symptoms and persistent skin ulcers prone to infections. These wounds often become chronic, difficult-to-heal conditions that pose significant treatment challenges.

Toxicology data from UPMC revealed a fivefold increase in positive xylazine tests among patient samples from 2019 to 2021, highlighting the rising prevalence of this substance in the community. In response, the team created detailed protocols aimed at improving clinical management and patient outcomes, which have recently been published in the Substance Use & Addiction Journal.

"With increasing cases of patients presenting with complex xylazine-related health issues, especially in Western Pennsylvania, there's an urgent need for standardized, trauma-informed care approaches," stated Dr. Raagini Jawa, senior author and infectious disease specialist. Dr. Jawa, along with colleagues Dr. Margaret Shang and Dr. Ilana Hull, brought together clinicians across various specialties including addiction medicine, toxicology, emergency medicine, psychiatry, and plastic surgery.

Recognizing that managing xylazine-related harms spans multiple fields, the team emphasized the importance of a coordinated, multidisciplinary strategy involving physicians, nurses, pharmacists, and hospital leadership. They developed practical guidelines covering all stages of patient care—from admission and treatment to discharge and outpatient follow-up—and created educational materials for patients focusing on wound management and harm reduction.

These protocols facilitate early symptom recognition, enable effective multidisciplinary treatment, and empower clinicians to better handle complex wounds and withdrawal symptoms. Early feedback indicates improved patient outcomes such as better symptom control, fewer complications, and smoother transitions to outpatient care. The guidelines also aim to streamline care processes and reduce variability across providers, which is critical in responding to this public health challenge.

This initiative offers a valuable blueprint for other health systems across the country, many of which are beginning to encounter xylazine’s impact on opioid users. By adopting a proactive approach, healthcare providers can enhance patient outcomes, minimize complications, and better prepare for the evolving landscape of substance use disorders.

Experts emphasize that addiction treatment professionals should advocate for these protocols and accompanying educational efforts, ensuring patients are informed about the risks of the drug supply and supported in seeking appropriate care. The collaboration between different medical specialties exemplifies the importance of an integrated response to complex substance-related health issues.

Source: https://medicalxpress.com/news/2025-04-protocols-patients-xylazine-wounds.html