Using Demographic and Substance Use Features to Predict Suspected Xylazine-associated Wound Development Among People Who Use Drugs in North Carolina

<ns3:p>Background Xylazine, a veterinary sedative increasingly detected in the illicit drug supply, has been associated with severe skin and soft tissue wounds among people who use drugs (PWUD). Despite growing clinical concern, empirical evidence describing predictors of xylazine-associated wound development remains limited. Methods A sample of 919 individuals who used illicit drug within the past two years in Cumberland County, North Carolina reported demographic characteristics, drug use behaviors, and experiences with xylazine-associated wounds in an online survey. Ordinal regressions were used to examine predictors of wound presence and severity. Results Among participants reporting possible xylazine exposure, over 40% reported developing suspected wounds. Among those reporting wounds, approximately 70% reported moderate or severe wounds requiring medical treatment. Injecting drugs was associated with higher likelihood of wound occurrence compared to snorting, smoking, or ingesting substances. Highest frequency of drug use was associated with less severe wounds compared to lower frequencies. Demographic variables (age, sex, and race) were not significant predictors of either wound outcome. Conclusions Xylazine-associated wounds represent a substantial emerging health burden among PWUD. Current findings highlight the importance of harm reduction strategies, clinical wound management, and surveillance systems to address the evolving health consequences of the synthetic drug supply.</ns3:p>