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.
Authors
- Gayle M. Gordillo (ORCID: https://orcid.org/0000-0001-8369-6637)
- Roberto León-Barriera (ORCID: https://orcid.org/0000-0002-6518-4758)
- Varidhi Nauriyal (ORCID: https://orcid.org/0000-0003-3356-4964)
- Matan Arnon
- Nicole J. Jarrett
- Kristian Feterik (ORCID: https://orcid.org/0000-0002-4427-0825)
- Simi Padival
- Lauren Glikes
- Michael G. Abesamis (ORCID: https://orcid.org/0000-0003-3561-1672)
- Graciela Bauzá
- Raagini Jawa (ORCID: https://orcid.org/0009-0001-6420-5385)
- Kimberly Baker
- Jane M. Liebschutz (ORCID: https://orcid.org/0000-0003-3492-1521)
- Joshua A. Shulman
- Payel Roy (ORCID: https://orcid.org/0000-0002-8177-2058)
- J. Alexander Viehman
- Danielle L. Heffner
- Cecilia Zamarripa (ORCID: https://orcid.org/0000-0002-5718-2496)
- Kenichi Tamama (ORCID: https://orcid.org/0000-0002-9627-9442)
- Ilana Hull (ORCID: https://orcid.org/0009-0002-0075-2651)
- Teun Teunis
- Joshua Lee (ORCID: https://orcid.org/0000-0002-3075-3711)
- Krupa Patel (ORCID: https://orcid.org/0009-0009-0295-7272)
- Michael J. Lynch (ORCID: https://orcid.org/0000-0002-8014-6530)
- Brent Thiel
- Janine Then
- Margaret Shang (ORCID: https://orcid.org/0000-0002-0421-1134)
- Joan Mapel
- Jennifer Rickens
- Eugenia Mangel
Institutions
- University of Pittsburgh (US)
- Presbyterian Hospital (US)
- UPMC Presbyterian (US)
- University of Pittsburgh Medical Center (US)
Publication Details
- Journal
- Substance Use & Addiction Journal
- Published
- 2025-04-15
- DOI
- https://doi.org/10.1177/29767342251329681
- Citations
- 2
- Primary Topic
- Veterinary Pharmacology and Anesthesia
- Type
- article
- Field-Weighted Citation Impact
- 4.71