UPMC creates treatment blueprint for patients with wounds and withdrawal symptoms from Xylazine-laced drugs
UPMC is one of the first health systems to write a blueprint for treating patients experiencing gruesome side effects from drugs laced with xylazine.
Xylazine is not an opioid. It's an animal tranquilizer often referred to as the "zombie drug." The alarming substance is turning up more and more in illegal opioid drugs.
"Here in Pennsylvania and in Western Pennsylvania, we've been seeing xylazine mixed in with fentanyl and heroin since 2019. So, Pennsylvania has been the epicenter of xylazine adulteration for our patients," said Dr. Raagini Jawa, an infectious disease and addiction medicine physician researcher with UPMC.
Dr. Jawa said many of UPMC's patients didn't know xylazine was in their drugs. It's called "tranq" when mixed with opioids like fentanyl, which puts people at risk of more than an overdose.
UPMC doctors keep seeing patients dealing with scary side effects, including intense sleepiness, hard-to-manage withdrawal symptoms and skin-rotting wounds.
"Can cause them to be very sleepy for long periods of time, on the order of hours. And some people are at risk of developing dependence and withdrawal from this drug that they were never intending to use. And finally, some of them are at risk of developing these necrotic painful ulcers or wounds," Jawa said.
She said it's important that doctors can identify a patient's wounds that were caused by xylazine and start treatment as soon as possible.
"If they do not start getting wound care early enough, then they can develop infections, and sometimes they can progress into needing amputations," said Jawa.
Dr. Jawa said doctors need to be ready to take care of patients dealing with the side effects and complications. At UPMC, the health care giant saw the urgent need for a hospital-wide playbook and created a team of specialists.
"From addiction medicine, hospital medicine, toxicology, infectious disease, nursing, wound care, plastic surgery, all came together," she said in part.
They developed and implemented detailed protocols to better care for people who come into the hospital with symptoms and wounds linked to xylazine.
"Hospital-wide multidisciplinary guidelines on how we can better provide inpatient care for three things: withdrawal management for xylazine, testing on who needs to get xylazine testing and who doesn't, and then finally to try to streamline how we provide medical wound care for these patients," Jawa said.
The UPMC team published the guidelines in the Substance Use and Addiction Journal to share the easy-to-follow roadmap for other hospitals to use.
Dr. Jawa is the senior author and co-leader of the workgroup. She said many hospitals in Pennsylvania are now employing similar protocols.
"If our health centers are not up to date with the changing drug supply, it can be really frustrating for people in the community who are trying to get the help, but they don't necessarily have their withdrawal managed or their pain managed or their wounds managed," she said.
Toxicology testing at UPMC revealed a five-fold increase in patient samples testing positive for xylazine between 2019 and 2021.
Naloxone will not reverse the effects of xylazine, but since it's often mixed with opioids like fentanyl, naloxone should still be given in response to any suspected overdose.
Dr. Jawa said there are lots of resources in the state for anyone needing help to take that first step toward recovery. UPMC has outpatient addiction centers, including the Internal Medicine Recovery Engagement Program at UPMC Mercy.
She added that people who need help can also turn to Prevention Point Pittsburgh, a local harm reduction organization that does wound care and drug checking.
