Building Multidisciplinary Consensus on Inpatient Xylazine Management through Clinical Protocols

The evolving unregulated drug supply in the United States has led to an unprecedented rise in xylazine-adulterated synthetic opioid use-related morbidity and mortality, of which Pennsylvania shoulders a disproportionate burden. People experiencing these xylazine harms who seek acute medical care require complex clinical management, multidisciplinary coordination, and appropriate linkage to outpatient care. We describe our experience leading a hospital-wide multidisciplinary xylazine workgroup from February to June 2024 to collaboratively develop time-sensitive clinical protocols on inpatient management of patients exposed to xylazine. Workgroup participants were organized into three subgroups: (1) toxicology screening and harm reduction; (2) withdrawal management; and (3) inpatient wound care management and linkage to outpatient wound care. We summarize our implementation process and clinical protocol recommendations of each subgroup and highlight important cross-cutting issues related to the changing drug supply, standardized patient and provider educational tools, care coordination, and next steps.