Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Robert Heimer

Second Advisor

Laura Bothwell


Xylazine, a clonidine analog, is a potent alpha-2 adrenergic agonist used as an analgesic sedative in veterinary medicine. Known to people who inject drugs (PWID) as “tranq”, xylazine has recently infiltrated the U.S. illicit opiate drug supply and has been associated with severe, necrotic lesions, sedation, and respiratory depression. Unlike opiates, xylazine has no human reversal agent or standardized withdrawal treatment protocol and its effects are unclear.

The objective of this study was to conduct a scoping review synthesizing the available clinical research and reporting on xylazine associated subcutaneous lesions and systemic infections. The study also sought to identify gaps in knowledge of the effects of illicit xylazine use and propose opportunities for further research.

While there is limited knowledge and research on xylazine, the selected articles produced insight into some of its effects. The findings from this study reveal that it is probable that the characteristic lesions that are developing in the injection drug use community are attributable to xylazine used in conjunction with an opiate. The development of lesions is not restricted to the site of injection and are more severe at the site of a missed vein. The lesions are also likely a result of chronic xylazine use. Furthermore, an association between illicit xylazine use and the rise in systemic infections is still unclear.

Further research on the topic should focus on the medical cause of the lesions, why they are more severe than typical injection related skin and soft tissues infections, why they appear away from the site of injection, and xylazine’s contribution to an increase in systemic infections.


This is an Open Access Thesis.

Open Access

This Article is Open Access