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Building Multidisciplinary Consensus on Inpatient Xylazine Management through Clinical Protocols.

Margaret Shang¹, Ilana Hull¹, Jane M Liebschutz¹

¹Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Substance Use & Addiction Journal

|April 15, 2025

Summary

This summary is machine-generated.

Pennsylvania faces a rise in harms from xylazine-adulterated synthetic opioids. This study details hospital protocols for managing patients with xylazine exposure, focusing on toxicology, withdrawal, and wound care.

Keywords:

clinical protocols harm reduction opioid use disorder xylazine

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Area of Science:

Public Health
Toxicology
Emergency Medicine

Background:

The US drug supply increasingly includes xylazine, a non-opioid tranquilizer, mixed with synthetic opioids.
This adulteration causes severe health problems, with Pennsylvania experiencing a high burden of xylazine-related morbidity and mortality.
Patients with xylazine exposure require specialized care, including complex management and seamless transitions to outpatient services.

Purpose of the Study:

To describe the development and implementation of hospital-wide clinical protocols for managing patients with xylazine exposure.
To address the unique challenges posed by xylazine-adulterated synthetic opioid use in an acute care setting.
To improve patient outcomes through multidisciplinary collaboration and standardized care pathways.

Main Methods:

A hospital-wide multidisciplinary xylazine workgroup was formed, operating from February to June 2024.
The workgroup comprised three subgroups focused on toxicology screening/harm reduction, withdrawal management, and inpatient/outpatient wound care.
The process involved collaborative development of time-sensitive clinical protocols for inpatient management.

Main Results:

Established protocols for toxicology screening, harm reduction strategies, and xylazine withdrawal management.
Developed guidelines for inpatient wound care and facilitated linkage to outpatient wound care services.
Identified critical cross-cutting issues including drug supply changes, education, and care coordination.

Conclusions:

Multidisciplinary collaboration is essential for developing effective inpatient management protocols for xylazine exposure.
Standardized clinical protocols can improve care coordination and patient outcomes for individuals with complex drug-related harms.
Addressing the evolving drug supply requires ongoing adaptation of clinical practices and educational resources.