ArticleDrug and alcohol dependence2025
Amputation trends among people who use drugs in the context of Philadelphia's increasingly xylazine adulterated drug supply.
Article in Drug and alcohol dependence, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Trends in diagnosis of amyloid kidney disease in people who inject drugs (PWID).Preventive medicine reports · 2026Article
- New trends in the overdose epidemic: postural impact on abusers of fentanyl and xylazine and clinical and forensic implications.Forensic science, medicine, and pathology · 2026Review
- Theorizing causality: A qualitative study of xylazine-related wound diversity and perceived etiology among people who inject drugs.Addiction (Abingdon, England) · 2026Article
- Amputation Rates Among Opioid-Related Hospitalizations in the United States, 2016 to 2022.Annals of internal medicine · 2026Article
- Development and Validation of an Image-Based Deep Learning Tool for Identification of Xylazine-Associated Wounds.Journal of addiction medicineArticle
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7 authors.
Funding
Abstract
backgroundXylazine-adulterated fentanyl has rapidly spread across the United States and has been increasingly detected in overdose deaths in Philadelphia, PA through medical examiner reports, clinical testing, and widescale drug checking. Xylazine use has been associated with wounds which may lead to amputation, but the extent of this outcome has not been explored.
methodsUtilizing the 10th revision of the International Classification of Diseases (ICD-10) codes, we conducted a de-identified retrospective analysis of data for patients identified with opioid related disorders (ICD-10 code F11) admitted to four different hospitals in Philadelphia, PA between 2018 and 2023. Exposure to xylazine use and active substance use among the sample was not confirmed. Year as proxy for xylazine adulteration was examined for association with amputation using multivariable logistic regression. Demographics, diabetes, number of visits and leaving before treatment completion were examined as factors associated with amputation.
resultsThere were 20,595 acute care visits among 12,047 unique patients with an F11 diagnosis. Among patients, 211 received ≤ 1 amputations across 277 visits. The incidence of amputations increased from 0.81 % in 2018 to 1.55 % in 2023. The adjusted odds of receiving an amputation were 2.08 greater in 2022-2023 than 2018-2019 (OR 2.18, 95 % CI [1.51, 314], p < 0.001; AOR 2:08, 95 % CI [1.43, 3.01], p < 0.001).
conclusionThe odds of receiving an amputation among individuals with an ICD-10 F11 code rose alongside increased presence of xylazine in the drug supply. As xylazine continues to spread throughout the United States, health providers need more information to better address risk factors for amputation and develop protocols to decrease incidence of PWUO leaving before treatment completion.
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