Clinical and Demographic Characteristics of Hospitalized Patients With Xylazine-related WoundsClinical and Demographic Characteristics of Hospitalized Patients With Xylazine-related Wounds
Addiction Medicine: Beyond the Abstract
An infectious diseases physician discusses xylazine-related wounds in people using fentanyl, the risks of patient-directed discharge, and practical harm reduction and treatment strategies in hospital settings. The conversation also touches on future research needs and the importance of mentorship for clinicians entering this challenging field.
23:26•4 Sept 2026
Xylazine Wounds, Fentanyl, and Harm Reduction at the Hospital Bedside
Episode Overview
- Xylazine, not fentanyl itself, was strongly linked to severe necrotic skin wounds in a Philadelphia hospital population.
- Patients with xylazine-related wounds were more likely to leave hospital via patient-directed discharge, often due to unaddressed pain, withdrawal and stigma.
- Effective strategies to reduce early discharge include early addiction medicine consultation, rapid initiation of medications for opioid use disorder, and aggressive symptom management.
- Many wounds looked severe but lacked systemic infection, shifting clinical focus towards consistent wound care and reducing xylazine exposure rather than broad-spectrum antibiotics.
- Harm reduction education on rotating injection sites and avoiding injection into active wounds or high-risk areas is crucial for safer care.
“The problem was just how scary it is to take care of patients in the era of an ever-changing drug supply, where the adulterants are changing all the time.”
This episode sheds light on the personal battles against addiction through the eyes of an infectious diseases specialist working on the front line of the opioid crisis. You’ll hear about how xylazine, a veterinary sedative slipped into illicit fentanyl supplies, led to a sudden surge in large, necrotic skin wounds that were terrifying for patients and clinicians alike. The conversation follows Dr.
Liz Novick’s journey from residency in Washington, DC to fellowship in North Philadelphia, where she trained in caring for infections linked to substance use and later conducted a retrospective study on xylazine-related wounds at Thomas Jefferson Hospital. She explains how these wounds started appearing "almost overnight" and why the team realised the real culprit wasn’t fentanyl itself, but the widespread presence of xylazine in the local "dope" supply.
You’ll get a clear explanation of why many patients with these severe wounds chose patient-directed discharge, leaving hospital before their treatment was complete. Dr. Novick talks frankly about how unmanaged pain and withdrawal, loss of autonomy and stigma all push people out the door, and why early addiction medicine input, rapid access to medications for opioid use disorder, and genuine harm reduction approaches make such a difference. A major theme is practical wound care and harm reduction. Dr.
Novick describes seeing people inject directly into open wounds to avoid new ones, and how clinicians worked to re-teach safer injecting practices like rotating sites and avoiding high-risk areas such as the neck and groin. She also explains that, in many cases, the wounds looked dreadful but didn’t show systemic infection, making xylazine exposure and consistent wound care — rather than broad-spectrum antibiotics — the real focus.
The episode closes on mentorship and career advice for future clinicians and researchers, stressing the value of finding mentors and peers who bring you "to the table" and following your interests without so much anxiety. If you’re curious about how changing drug supplies affect real people and real care, this one’s worth your time.
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