Theme: Epidemiology & Public Health Research Year: 2024
Background: There is substantial concern about the spread of xylazine in drug markets throughout the United States. Despite frequent reports of wounds associated with xylazine use and increasing reports of nasal damage due to xylazine inhalation, there is limited epidemiologic data. This study aimed to estimate prevalence of xylazine-associated wounds and characterize their occurrence among people who inject drugs (PWID) in Baltimore, Maryland.
Methods: 229 PWID were recruited using respondent driven sampling in May-June 2024. Surveys assessed xylazine and other drug use, socio-demographic, behavioral, health and service utilization characteristics. Participants reported wounds based on similarity to clinical photos, and described timing, severity, and likelihood of association with xylazine. We estimated wound and nasal damage prevalence and examined associated factors.
Results: The sample was majority male (68%), Black or African-American (58%), over 45 years (52%), and recently unhoused (59%). Seventy-six percent reported suspected xylazine use in the past year; 33% reported known use. The estimated prevalence of wounds in the sample was 40%, 52% of which occurred within the last month. Among those reporting wounds, 40% reported small blisters or bumps, 36% reported an ulcer or lesion of a small size, 55% reported severe wounds, including deep ulcers, necrotic slough, or eschar. Many reported multiple wound types and half reported wounds in non-injection sites. Eighty-five percent believed their wounds were likely related to xylazine. Forty-five percent reported nasal damage, and 35% of these respondents believed this was likely due to xylazine.
Conclusions: Wound prevalence and nasal damage among PWID is substantial. There is a need for xylazine harm reduction and wound care to encompass a range of wound severity, including care for nasal damage. Further analyses to examine factors associated with wounds and nasal damage will help inform prevention and healthcare needs.