PHILADELPHIA, PA — Surgeons and public health experts in Philadelphia are sounding the alarm over the severe medical challenges posed by xylazine-associated wounds, a crisis fueled by the increasing use of the veterinary sedative in the city’s illicit drug supply. A recent study led by Cooper University Hospital highlights the devastating impact, both medical and socioeconomic, of xylazine-related injuries as healthcare providers grapple with a surge in complex cases.
Xylazine, a non-opioid tranquilizer known as “tranq,” is commonly mixed with fentanyl and heroin, leading to necrotic wounds that frequently damage bones, tendons, and soft tissue. The study reviewed 55 patients with upper-extremity wounds linked to xylazine use, offering a sobering snapshot of the difficulties faced by both patients and healthcare teams.
The findings were stark. On average, patients experienced 5.9 hospitalizations, with one individual requiring 44 separate admissions. Nearly half left the hospital against medical advice, and 68% continued drug use during their hospital stay, compounding complications. Of the group, 60% received non-surgical care, while others required operations that carried a 59% complication rate, including infections and skin graft failures.
“These wounds are very challenging to treat,” said Dr. Asif Ilyas, an author of the study and President of the Rothman Institute Foundation for Opioid Research & Education. “They are often very deep and involve tendons, bones, and other structures. And many of these patients are struggling with addiction, which can make it difficult for them to follow through with treatment.”
Socioeconomic factors further complicate care. Researchers noted that 40% of patients were homeless, while 67% had Hepatitis C and 26% had existing psychiatric diagnoses. These vulnerabilities hinder the effectiveness of traditional treatment approaches.
Dr. Ilyas emphasized the need for a multidisciplinary model of care. “This is more than just a surgical issue,” he said. “Philadelphia’s healthcare system is facing an enormous burden. We need to work as a team—surgeons, addiction specialists, social workers—to treat not only the wounds but the underlying factors leading to them. This is a growing public health concern.”
Drawing on insights from a diverse collaboration, including Drexel University College of Medicine, the Philadelphia College of Osteopathic Medicine, and the Rothman Opioid Foundation, the study underscores the necessity for integrated solutions. Recommendations from the authors include preventive measures, addiction treatment access, and public education about the dangers of xylazine.
Dr. Ilyas emphasized the need for a coordinated response to the crisis, stressing the importance of providing care and resources to those at risk before their condition worsens and leads to severe injuries.
The study will be published in The Journal of Hand Surgery and is available online at https://www.sciencedirect.com/science/article/abs/pii/S0363502324005987. The Journal of Hand Surgery, the official journal of the American Society for Surgery of the Hand (ASSH), features articles on diagnosing and treating conditions of the hand, wrist, and upper extremity.
The escalating prevalence of xylazine presents not only an urgent medical challenge but also a broader societal issue. With the healthcare system under strain, experts warn that without comprehensive efforts to address addiction and its underlying drivers, the cycle of harm will persist, deepening the human and financial toll on Philadelphia.
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