Building Multidisciplinary Consensus on Inpatient Xylazine Management through Clinical Protocols

• Published in: Substance use & addiction journal p. 29767342251329681
• Main Authors: Shang, Margaret, Hull, Ilana, Liebschutz, Jane M, Abesamis, Michael, Lynch, Michael, Tamama, Kenichi, Glikes, Lauren, Roy, Payel Jhoom, León-Barriera, Roberto, Shulman, Joshua A, Thiel, Brent, Patel, Krupa, Heffner, Danielle, Then, Janine, Mapel, Joan, Baker, Kimberly, Bauzá, Graciela, Rickens, Jennifer, Padival, Simi, Viehman, John Alexander, Nauriyal, Varidhi, Gordillo, Gayle, Teunis, Teun, Jarrett, Nicole J, Zamarripa, Cecilia, Lee, Joshua, Mangel, Eugenia, Arnon, Matan, Feterik, Kristian, Jawa, Raagini
• Format: Journal Article
• Language: English
• Published: United States 15.04.2025
• Subjects: opioid use disorder; clinical protocols; xylazine; harm reduction
• ISSN: 2976-7350
• DOI: 10.1177/29767342251329681

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.