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Theorizing causality: A qualitative study of xylazine-related wound diversity and perceived etiology among people who inject drugs.

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Τίτλος: Theorizing causality: A qualitative study of xylazine-related wound diversity and perceived etiology among people who inject drugs.
Συγγραφείς: German D; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Villarroel K; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Denney M; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Guta A; School of Social Work, University of Windsor, Windsor, Canada., Evans J; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Bienert J; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Fidler A; Unaffiliated, Baltimore, MD, USA., Ashburn K; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Kosinski Z; Unaffiliated, Baltimore, MD, USA., Genberg BL; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Πηγή: Addiction (Abingdon, England) [Addiction] 2026 Jul; Vol. 121 (7), pp. 1794-1807. Date of Electronic Publication: 2026 Mar 05.
Τύπος έκδοσης: Journal Article
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 9304118 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1360-0443 (Electronic) Linking ISSN: 09652140 NLM ISO Abbreviation: Addiction Subsets: MEDLINE
Imprint Name(s): Publication: Oxford : Wiley-Blackwell
Original Publication: Abingdon, Oxfordshire, UK : Carfax Pub. Co., c1993-
Ιατρικοί όροι (MeSH): Substance Abuse, Intravenous*/complications , Xylazine*/adverse effects , Wounds and Injuries*/chemically induced, Humans ; Female ; Male ; Adult ; Qualitative Research ; Baltimore ; Middle Aged ; Young Adult ; Causality
Περίληψη: Background and Aims: Incidence and severity of opioid-associated skin and soft-tissue infections, often requiring intensive and costly medical care, have increased substantially since the emergence of xylazine in the US drug supply. Although progress has been made in clinical and harm reduction recommendations for treating xylazine-related wounds and slowing their progression, the mechanisms remain insufficiently established. This study aimed to describe wound experiences among people navigating xylazine exposure and explore their perspectives on wound etiology to inform collaborative clinical and public health approaches.
Design: Qualitative research as part of a convergent parallel mixed methods rapid assessment.
Setting: Baltimore, Maryland, USA.
Participants: Eligible participants were age 18 or over, Baltimore residents and reported injection drug use and xylazine and wound experience in the past year. Participants (n = 26) were evenly distributed by gender and race, mostly over 40, heterosexual, recently unhoused and most frequently injected "fentanyl, in combination with something" or speedball.
Measurements: Semi-structured qualitative interviews and participatory body mapping, verbatim transcription, iterative thematic analysis.
Findings: Participants classified their wounds from mild (35%) to severe (23%) and commonly reported multiple wounds with shifting severity. Some characteristics matched those typically attributed to xylazine exposure, while others had less clear origins but were still perceived as xylazine-related. A spectrum from pimples, bumps, blisters to deep and blackened ulcerations were considered likely to be xylazine-related and a range of vascular and systemic symptomatology were considered possibly related, as were nasal and throat wounds for those who sniffed or snorted drugs. Participant causal attribution theories related to injection preparation (dilution, contamination), point of contact (subcutaneous tissue, vascularized areas, pulse injection) and interactions with co-occurring health conditions affecting vascular or immune systems (e.g. hypertension, auto-immune disorders). These align with physiological pathways suggested by clinicians and other researchers and offer additional explanations generated among people who inject drugs, drawing on injection-related physiological expertise and lived experience in the absence of formal clinical information. This attribution framework suggests a complex interplay between injection practices, xylazine's physiological effects and individual health conditions on wound development.
Conclusions: Participant causal attribution theories about their possibly xylazine-related wounds align with physiological pathways suggested by clinicians and other researchers and offer additional explanations for wound etiology generated among people who inject drugs.
(© 2026 The Author(s). Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)
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Grant Information: P30AI094189 Johns Hopkins University Center for AIDS Research; R21 DA060056 United States DA NIDA NIH HHS; Maryland Department of Health and Mental Hygiene; R21DA060056 National institute of Drug Abuse; Fulbright Canada; Canada Research Chairs Program
Contributed Indexing: Keywords: Baltimore; causal attribution; harm reduction; people who inject drugs; wounds; xylazine
Substance Nomenclature: 2KFG9TP5V8 (Xylazine)
Entry Date(s): Date Created: 20260305 Date Completed: 20260624 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13291103
DOI: 10.1111/add.70362
PMID: 41786273
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:1360-0443
DOI:10.1111/add.70362