Table 1.

Xylazine harm domains and clinical approaches

Harm domain	Mechanism	Clinical implications	Harm reduction strategies
Heavy sedation	Alpha-2 receptor agonism	Continued sedation after naloxone administration Pressure ulcers and skin breakdown likely Elevated risk for DVT Elevated risk of compartment syndrome Nerve, muscle, and soft tissue injury Rhabdomyolysis	Encourage using drugs with a friend Roll people nodding onto their side Move people nodding every two hours Pad under bony areas (sacrum, heels, shoulders, etc.) Avoid wrinkled or hard surfaces under nodding person
Skin wounds	Unknown	Bacterial superinfection possible Ensure adequate longitudinal wound care Can cause shame and reduced care-seeking Individuals may be deemed ineligible for in-patient substance use disorder care due to untreated wounds	Coach to avoid injecting into or near wounds Facilitate wound care access Teach individual and friends/family how to care for wounds Provide wound care supplies Teach on signs of worsening condition
Anemia	Unknown; perhaps sympathetic antagonism	Vague symptoms may delay care-seeking Important to rule out dietary or other causes	Coach communities on signs and symptoms; when care-seeking is necessary Encourage and facilitate community support to identify changes in health status in self and others
Dysglycemia	Unknown	Vague symptoms may delay care-seeking Important to rule out other causes of metabolic derangement Potential to worsen skin wound progress	Coach communities on signs and symptoms; when care-seeking is necessary Encourage and facilitate community support to identify changes in health status in self and others