ArticleThe International journal on drug policy2025
Tranq burn: Exploring the etiology of xylazine-related soft tissue injuries.
Article in The International journal on drug policy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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Who cites it
13 citing papers in PubMed.
- Musculoskeletal imaging findings of xylazine-associated wounds.Emergency radiology · 2026Article
- Pharmacokinetics of xylazine and fentanyl in patients presenting to the emergency department after non-fatal opioid overdose.Drug and alcohol dependence · 2026Article
- Theorizing causality: A qualitative study of xylazine-related wound diversity and perceived etiology among people who inject drugs.Addiction (Abingdon, England) · 2026Article
- Navigating an unpredictable supply: lived experiences of xylazine exposure among people who use drugs.Harm reduction journal · 2026Article
- Amputation Rates Among Opioid-Related Hospitalizations in the United States, 2016 to 2022.Annals of internal medicine · 2026Article
- Xylazine's κ opioid agonist activity is not shared with other FDA-approved αbioRxiv : the preprint server for biology · 2026Article
- Evidence that xylazine disrupts skin homeostasis by acting on epithelial cells through the kappa opioid receptor.Disease models & mechanisms · 2026Article
- Unmasking a neurotoxic duo: a comprehensive overview of fentanyl-xylazine crosstalk in kinase pathways.Frontiers in cellular neuroscience · 2026Article
- The Donovan Memorial Lecture: 'Fentanyl-Plus': A New Era of Fentanyl Polydrug Combinations in the North American Overdose Crisis.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2026Article
- Early evidence of the effects of xylazine-adulterated fentanyl in Ohio.The International journal on drug policy · 2025Article
- Xylazine and fentanyl co-administration delays wound healing in mice.bioRxiv : the preprint server for biology · 2025Article
- Prevalence of Wounds and Association With Xylazine Using Respondent-driven Sampling Among People Who Inject Drugs in Baltimore, Maryland.Journal of addiction medicineArticle
- Development and Validation of an Image-Based Deep Learning Tool for Identification of Xylazine-Associated Wounds.Journal of addiction medicineArticle
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9 authors.
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Abstract
introduction'Tranq dope' is a combination of xylazine and fentanyl that is increasingly common in the US. Frequently injected, its use appears related to severe skin and soft tissue wounds (SSTW) through an unknown mechanism. Previous research suggests that the high acidity of certain heroin source-forms contributes to vein damage and SSTW, however, the possibility of a role between the acidity of tranq dope and SSTW is understudied.
methodsA convenience sample of persons who use drugs participated in semi-structured interviews (Philadelphia, Oct. 2023, n = 30). Observations of wounds/injection locations were made. We analyzed narrative data for perceptions of wound causation. Our partner lab analyzed the pH of 10 independently obtained samples, including tranq dope (n = 4), street opioids without xylazine (n = 2), xylazine alone (n = 2), and street stimulants (n = 2).
resultsObserved SSTW were extraordinarily severe. Several themes emerged related to wound etiology: 1) tranq dope injection caused burning sensations; 2) vein loss occurred rapidly following uptake of tranq dope; 3) vein loss resulted in increased injection attempts, the use of large central veins (e.g., jugular and femoral), as well as more frequent 'skin-popping'; and 4) wounds (called 'tranq burn') rapidly followed vein loss. The average pH of the samples was 4, with samples containing fentanyl ranging from pH 2.1-5.9; samples containing xylazine ranging from pH 3.6-5.9; and the cocaine sample with a pH of 3. DISCUSSION: While this study cannot confirm a causal role, our findings of reported burning sensations and moderate to high acidity of lab-tested drugs are coherent with reported rapid vein loss following initiation of tranq injection. This, in turn, lends early support to a synergistic hypothesis of tranq-related SSTW etiology: vein loss and subcutaneous injections stem from the injection of acidic drugs followed by poor tissue perfusion from vasoconstriction due to xylazine. Possible harm reduction interventions include dilution and buffering. Stigma reduction and enhanced wound care are required in harm reduction and clinical settings.
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