Table 1 Xylazine harm domains and clinical approaches
From: Reducing the harms of xylazine: clinical approaches, research deficits, and public health context
Harm domain | Mechanism | Clinical implications | Harm reduction strategies |
|---|---|---|---|
Heavy sedation | Alpha-2 receptor agonism | Continued sedation after naloxone administration Pressure ulcers and skin breakdown likely Elevated risk for DVT Elevated risk of compartment syndrome Nerve, muscle, and soft tissue injury Rhabdomyolysis | Encourage using drugs with a friend Roll people nodding onto their side Move people nodding every two hours Pad under bony areas (sacrum, heels, shoulders, etc.) Avoid wrinkled or hard surfaces under nodding person |
Skin wounds | Unknown | Bacterial superinfection possible Ensure adequate longitudinal wound care Can cause shame and reduced care-seeking Individuals may be deemed ineligible for in-patient substance use disorder care due to untreated wounds | Coach to avoid injecting into or near wounds Facilitate wound care access Teach individual and friends/family how to care for wounds Provide wound care supplies Teach on signs of worsening condition |
Anemia | Unknown; perhaps sympathetic antagonism | Vague symptoms may delay care-seeking Important to rule out dietary or other causes | Coach communities on signs and symptoms; when care-seeking is necessary Encourage and facilitate community support to identify changes in health status in self and others |
Dysglycemia | Unknown | Vague symptoms may delay care-seeking Important to rule out other causes of metabolic derangement Potential to worsen skin wound progress | Coach communities on signs and symptoms; when care-seeking is necessary Encourage and facilitate community support to identify changes in health status in self and others |