{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:31:47Z","timestamp":1791570707337,"version":"4.3.4"},"reference-count":47,"publisher":"SAGE Publications","issue":"2","license":[{"start":{"date-parts":[[2024,10,27]],"date-time":"2024-10-27T00:00:00Z","timestamp":1729987200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Use &amp; Addiction Journal"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The United States opioid crisis has been worsened by the emergence of fentanyl adulterated or associated with the veterinary sedative xylazine. Designated by the White House as an \u201cemerging threat to the US\u201d in 2023, xylazine use is associated with severe skin wounds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      This research explored beliefs, concerns, and treatment behaviors for skin wounds among 93 participants recruited outside of a Philadelphia, Pennsylvania harm reduction agency who reported past-6-month history of a skin wound via a cross-sectional survey administered August-September 2022 (group 1;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200933). Following a December 2022 Philadelphia Department of Public Health Report that indicated xylazine was becoming more prevalent in the Philadelphian drug supply, additional data was collected with new participants from February-March 2023 (group 2;\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200960) using the same survey. Participants were \u226518 years old, reported past-year fentanyl use, and spoke English. Our 17-item tool measured skin wound-related beliefs, concerns, treatment behaviors, and treatment sources. An open-response item explored why participants self-treat skin wounds.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Participants averaged 41\u2009years old (SD\u2009=\u20099), slightly more than half were men (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200954, 58%), 31% (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200929) were non-White, and most (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200966, 71%) were unhoused. Overall, 79% of participants self-treated skin wounds. Participants endorsed worry about limb loss (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200977; 83%), wound shame (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200976; 82%), and appearance changes (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200980; 86%). Sixty participants (65%) reported waiting to see wound severity before seeking care. Forty-one participants (44%) delayed wound care because of withdrawal fears.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>People with probable xylazine-associated skin wounds have psychosocial concerns about and self-treat these wounds. Findings may be a harbinger of skin wound harm in other regions of the United States and internationally where xylazine is increasing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/29767342241289797","type":"journal-article","created":{"date-parts":[[2025,3,15]],"date-time":"2025-03-15T02:58:56Z","timestamp":1742007536000},"page":"347-356","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Psychosocial Impact of Suspected Xylazine-Associated Skin Wounds Among People Using Fentanyl, Philadelphia, 2022 to 2023"],"prefix":"10.1177","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1462-1150","authenticated-orcid":false,"given":"Patrick J. A.","family":"Kelly","sequence":"first","affiliation":[{"name":"Department of Behavioral Social Sciences, Brown University School of Public Health, Providence, RI, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy B.","family":"Jessop","sequence":"additional","affiliation":[{"name":"Prevention Point Philadelphia, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison","family":"Scialanca","sequence":"additional","affiliation":[{"name":"Prevention Point Philadelphia, Philadelphia, PA, USA"},{"name":"Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie","family":"Singley","sequence":"additional","affiliation":[{"name":"Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caseem C.","family":"Luck","sequence":"additional","affiliation":[{"name":"Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Hoadley","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, USA"},{"name":"Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Meisner","sequence":"additional","affiliation":[{"name":"Prevention Point Philadelphia, Philadelphia, PA, USA"},{"name":"Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah B.","family":"Bass","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, PA, USA"},{"name":"Risk Communication Laboratory, Temple University College of Public Health, Philadelphia, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,10,27]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12954-023-00879-7"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp2303120"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2023.110985"},{"key":"e_1_3_2_5_2","unstructured":"DEA Reports Widespread Threat of Fentanyl Mixed with Xylazine | DEA.gov. Accessed April 4 2023. https:\/\/www.dea.gov\/alert\/dea-reports-widespread-threat-fentanyl-mixed-xylazine"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.50630"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7226a4"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2023.104118"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.15620\/cdc:129519"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/injuryprev-2020-043968"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1556-4029.2007.00648.x"},{"key":"e_1_3_2_12_2","unstructured":"Philadelphia Department of Public Health. Health Update: Xylazine (Tranq) Exposure among People Who Use Substances in Philadelphia. 2022. 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