CARE Series - Xylazine: Clinical Implications for People Who Use Drugs and Harm Mitigation Strategies

Wednesday, April 2, 2025, 12:00 PM - Sunday, April 2, 2028, 1:00 PM

AMA PRA Category 1 Credits™ (1.00 hours), ANCC Nursing Contact Hours (1.00 hours), CME-Designated Participation Credit (1.00 hours)

Review of:

• the emergence of xylazine and other common adulterant in the United States illicit opioid supply

• potential clinical harms and public health implications of combined xylazine and opioid exposures

• harm reduction strategies to minimize risk of xylazine exposure

• impact of xylazine-related wounds on substance use treatment and other medical care

• best practices for clinical management of xylazine wounds

Presenter

Ilana Hull, MD, MSc
Family Medicine & Addiction Medicine Physician 
Internal Medicine and Obstetrics, Gynecology & Reproductive Sciences 
University of Pittsburgh Medical Center

Ilana Hull, MD, MSc is a board-certified family medicine and addiction medicine physician.  Prior to medical school, she got a master's degree in health policy, planning and finance from London School of Economics and London School of Hygiene and worked in health policy at both the state and national level.  She then got her medical degree from Oregon Health and Science University and completed a family medicine residency with obstetrics at Oregon Providence Family Medicine and then an addiction medicine fellowship at the University of Pittsburgh.  She currently works in inpatient and outpatient addiction medicine for both the Internal Medicine and Obstetrics, Gynecology and Reproductive Sciences departments at the University of Pittsburgh where she strives to improve access to low-barrier substance use treatment for vulnerable populations.  Her research work focuses on improving access to treatment and harm reduction services for pregnant and parenting individuals with substance use disorders.

1. Describe the emergence of xylazine as a common adulterant in the opioid supply, including its implications for medical care and substance use treatment.
2. Identify risk mitigation strategies to reduce harms associated with xylazine exposure.
3. Explain wound care strategies for the spectrum of xylazine-associated wounds.

In support of improving patient care, Dartmouth Health is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

American Medical Association (AMA)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Nurses Credentialing Center (ANCC)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 ANCC contact hours. 

All other learners may claim CME-designated participation credit. Consult your professional licensing board regarding the applicability and acceptance of CME-designated participation credit for programs certified for credit by organizations accredited by Joint Accreditation for Interprofessional Education.

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Bibliographic Material

• Choi S, Irwin MR, Kiyatkin EA. Xylazine effects on opioid-induced brain hypoxia. Psychopharmacology (Berl). 2023 Jul;240(7):1561-1571. doi: 10.1007/s00213-023-06390-y. Epub 2023 Jun 21. PMID: 37340247; PMCID: PMC10775769.

• Jawa R, Ismail S, Shang M, Murray S, Murray-Krezan C, Zheng Y, Mackin S, Washington K, Alvarez P, Dillon J, McMurtrie G, Stein M, Walley A, Liebschutz JM. Drug use practices and wound care experiences in the age of xylazine adulteration. Drug Alcohol Depend. 2024 Oct 1;263:112390. doi: 10.1016/j.drugalcdep.2024.112390. Epub 2024 Aug 15. PMID: 39173221.

• Kacinko SK et al. Journal of Analytical Toxicology 2022

• Kariisa M, O’Donnell J, Kumar S, Mattson CL, Goldberger BA. Illicitly Manufactured Fentanyl–Involved Overdose Deaths with Detected Xylazine — United States, January 2019–June 2022. MMWR Morb Mortal Wkly Rep 2023;72:721–727. http://dx.doi.org/10.15585/mmwr.mm7226a4

• Krotulski AJ. Xylazine – Perspectives from Forensic and Clinical Toxicology; October 4, 2023. https://reaganudall.org/news-and-events/events/public-meeting-mitigating-risks-human-xylazine-exposure

• Love JS, Levine M, Aldy K, Brent J, Krotulski AJ, Logan BK, Vargas-Torres C, Walton SE, Amaducci A, Calello D, Hendrickson R, Hughes A, Kurt A, Judge B, Pizon A, Schwarz E, Shulman J, Wiegan T, Wax P, Manini AF. Opioid overdoses involving xylazine in emergency department patients: a multicenter study. Clin Toxicol (Phila). 2023 Mar;61(3):173-180. doi: 10.1080/15563650.2022.2159427. PMID: 37014353; PMCID: PMC10074294.

• McFadden, Rachel MPH, BSN, RN; Wallace-Keeshen, Sara FNP-BC; Petrillo Straub, Kristi AGNP-C; Hosey, Rebecca A. MPH, BSN, RN; Neuschatz, Rachel MSN, RN; McNulty, Keara BSN, RN; Thakrar, Ashish P. MD, MS. Xylazine-associated Wounds: Clinical Experience From a Low-barrier Wound Care Clinic in Philadelphia. Journal of Addiction Medicine 18(1):p 9-12, 1/2 2024. | DOI: 10.1097/ADM.0000000000001245’

• PA Groundhogs Alerts Alerts | PAGroundhogs

• Shang, Hull, et al. Building Multidisciplinary Consensus on Inpatient Xylazine Management Through Clinical Protocol. Substance Use and Addiction Journal (accepted for publication)

• Vermont Department of Health, Xylazine Involvement in Fatal Opioid Overdoses Among Vermont Residents, October 2021, https://www.healthvermont.gov/sites/default/files/documents/pdf/ADAP-XylazineBrief.pdf

• Xiao YF, Wang B, Wang X, Du F, Benzinou M, Wang YX. Xylazine-induced reduction of tissue sensitivity to insulin leads to acute hyperglycemia in diabetic and normoglycemic monkeys. BMC Anesthesiol. 2013 Oct 20;13(1):33. doi: 10.1186/1471-2253-13-33. PMID: 24138083; PMCID: PMC4016475

• Zagorski CM, Hosey RA, Moraff C, Ferguson A, Figgatt M, Aronowitz S, Stahl NE, Hill LG, McElligott Z, Dasgupta N. Reducing the harms of xylazine: clinical approaches, research deficits, and public health context. Harm Reduct J. 2023 Sep 30;20(1):141. doi: 10.1186/s12954-023-00879-7. Erratum in: Harm Reduct J. 2023 Nov 27;20(1):170. PMID: 37777769; PMCID: PMC10544173.

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