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Newswise — A new study examining the treatment of xylazine-associated wounds in Philadelphia sheds light on the severe medical complications and healthcare challenges caused by the widespread presence of the drug in the city’s illicit supply.
Conducted by surgeons at Cooper University Hospital and researchers from Drexel University College of Medicine and the Philadelphia College of Osteopathic Medicine, and overseen by the Rothman Institute Foundation for Opioid Research & Education, the study provides some of the first detailed insights into how hospitals are grappling with the influx of patients suffering from severe necrotic wounds linked to the veterinary sedative known as “tranq.”
Xylazine is a non-opioid veterinary tranquilizer that is increasingly being used as an adulterant in heroin and fentanyl. The drug can cause severe necrotic wounds that are difficult to treat, can compromise limb viability, and often require surgery.
The study reviewed the cases of 55 patients with self-reported xylazine use and upper-extremity wounds treated at a single Philadelphia-area hospital. Researchers found that 40% of these patients were homeless, 26% had psychiatric diagnoses, and 84% had a history of tobacco use. Hepatitis C was present in 67% of cases, and 5% were HIV-positive. Patients were frequently hospitalized for their wounds, with an average of nearly six admissions per person and some requiring dozens of hospital visits. One patient was readmitted 44 times.
“These wounds are very challenging to treat,” said Dr. Asif Ilyas, one of the study’s authors. “They are often very deep and involve tendons, bones, and other structures.”
Dr. Ilyas also noted that patients with xylazine-associated wounds often have underlying health conditions that make it difficult for them to heal properly. “Many of these patients are also struggling with addiction, which can make it difficult for them to follow through with treatment,” he said. Of the 55 patients, 60% received nonoperative wound care, while 22 underwent surgery. However, surgical intervention was complicated by continued drug use, with a 59% complication rate due to infections, graft failures, and other wound issues. Despite the severity of their injuries, nearly half of the patients left the hospital against medical advice, and 68% continued drug use during their hospital stay.
The study’s authors, led by Katharine Criner Woozley, MD, Chief of Hand and Nerve Surgery at Cooper University Hospital, recommend that surgeons take a multidisciplinary approach to treating patients with xylazine-associated wounds. This approach should involve working with addiction medicine specialists, social workers, and other healthcare professionals to address the underlying factors that contribute to the development of these wounds before intervening surgically.
“We need to do a better job of identifying and treating patients at risk for developing these wounds,” said Dr. Ilyas, President of the Rothman Institute Foundation for Opioid Research & Education and Professor of Orthopaedic Surgery at Drexel University College of Medicine. He also noted that the increasing prevalence of xylazine is a public health concern. “This is a growing problem that we need to address,” he said. “We need to educate the public about the dangers of xylazine, and we need to make sure that people who are struggling with addiction have access to the treatment they need.”
The study highlights the strain on Philadelphia’s healthcare system, with patients averaging 5.9 hospital admissions for xylazine-associated wounds, and the most extended hospital stay was 75 days, illustrating the demanding nature of this issue in the city.
“Philadelphia’s healthcare system is facing an enormous burden in treating these wounds, and the reality is that this is more than a surgical issue, says Dr. Ilyas. “We are seeing patients with severe infections and devastating wounds, but what makes treatment so difficult is the the interplay between the addiction, socioeconomic challenges, and the underlying mental health conditions.”
The study, The Management of Upper-Extremity Xylazine-Associated Wounds, was conducted by Parker Johnsen, MD; Aaron Jackson, MD; Sara Hope Buchner, MD, Pietro Gentile, MD, and Katharine Criner Woozley, MD, of Cooper University Hospital; Genoveffa R. Morway, DO, of Philadelphia College of Osteopathic Medicine; and Asif M. Ilyas, MD, of Drexel University College of Medicine and the Rothman Opioid Foundation.
The study will appear in The Journal of Hand Surgery and is found online at https://www.sciencedirect.com/science/article/abs/pii/S0363502324005987 The Journal of Hand Surgery is the Official Journal of the American Society for Surgery of the Hand (ASSH), publishes articles related to the diagnosis, treatment, and pathophysiology of diseases and conditions of the hand, wrist, and upper extremity.
About the Rothman Institute Foundation for Opioid Research and Education.
The Rothman Opioid Foundation, for short, is a non-profit 501c3 organization dedicated to raising awareness of the ongoing opioid crisis, educating physicians and patients on safe opioid prescribing and use – respectively, and advising policymakers on sound opioid and pain management policy. Most importantly, the Rothman Opioid Foundation performs and supports the highest quality research on opioids and alternative pain modalities to yield findings that can better inform patients, physicians, and the greater healthcare community in the most evidenced-based pain management strategies while working to mitigate opioid abuse and addiction. https://www.rothmanopioid.org/