Clinical considerations for the management of xylazine overdoses and xylazine-related wounds

The combination of opioids and xylazine likely potentiates sedation and respiratory depression, however, the exact mechanism of xylazine in these processes is unclear.

Once wounds are recognized as potentially xylazine-related, efforts to help patients cease injection drug use into or near the wound are critical. In many cases, this involves initiating or increasing doses of medication to treat opioid use disorder (e.g. buprenorphine or methadone), harm reduction strategies to decrease injection episodes, switch route of administration to intranasal and consistent access to wound care supplies and education. Keeping the wound moist, clean and covered at all times is imperative. In our clinical experience, chemical or enzymatic debridement of eschar is often preferred by patients over surgical debridement; we advise patients to avoid drying agents like alcohol swabs. Keeping the wound covered at all times with petrolatum gauze, antimicrobial dressings and self-adhesive wraps or large bandages is recommended.