A team of UPMC clinicians has developed comprehensive clinical protocols for managing hospitalized patients exposed to a veterinary sedative found in the unregulated opioid supply.

Guidelines were shared in Substance Use and Addiction Journal on Tuesday, April 15, establishing best practices for treating patients exposed to xylazine.

The guidelines aim to help clinicians recognize symptoms earlier, coordinate multidisciplinary treatment more effectively, and manage complex wounds and withdrawal with greater confidence.

Xylazine has been linked to severe, unique complications, including difficult-to-manage withdrawal symptoms and necrotic skin ulcerations prone to infection which can develop into chronic, non-healing wounds. UPMC Toxicology testing revealed a fivefold increase in patient samples testing positive for xylazine from 2019–21.

UPMC said data collection is ongoing, but early anecdotal feedback suggests better symptom control, reduced complications and smoother transitions to outpatient care.

Raagini Jawa, Margaret Shang and Ilana Hull were on the team that established the guidelines.