The Rising Threat of Xylazine in Michigan

Stephanie Sauve, an adult-gerontology clinical nurse specialist student, and Laura Pond, a psychiatric mental health nurse practitioner student, are both pursuing their Doctor of Nursing Practice degrees at the MSU College of Nursing. As future professionals in their respective fields, they bring unique perspectives to addressing the substance use disorder crisis. Their work focuses on raising awareness, providing education, and enhancing best practices to support individuals in improving their health.

As future Spartan Advanced Practice Registered Nurses, we’ve seen firsthand how the substance use disorder epidemic continues to evolve—and grow more complex. A veterinary drug, xylazine, is now making its way into the illegal drug supply, often mixed with fentanyl or heroin to enhance profits and psychoactive effects according to the Drug Enforcement Agency Intelligence Program. Alarmingly, many people who use drugs are unaware of this potentially fatal adulterant until it’s too late.

Xylazine use is on the rise, particularly in the Midwest, where overdose cases involving the drug have increased by 500% in recent years, according to the Office of National Drug Control Policy. Yet, xylazine is still underreported in overdose deaths because it’s not routinely included in postmortem toxicology testing. This lack of awareness extends to health care providers as well, leading to misdiagnosis and ineffective treatment.

Unlike opioids, xylazine does not respond to naloxone, the life-saving reversal drug used in opioid overdoses. While naloxone remains the best option for mixed overdoses, it doesn’t mitigate xylazine’s specific effects. Beyond the risk of overdose, xylazine causes severe skin ulcers and wounds that are often mistaken for infections related to injection sites. These wounds can develop not only at injection sites but also on other parts of the body—even when xylazine is inhaled or used intranasally. The exact cause isn’t fully understood, but research shows the damage likely results from decreased blood flow to the skin, leading to tissue death.

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Working with a mobile substance use recovery clinic in metro Detroit and Lansing, we’ve had the privilege of connecting directly with individuals at risk and those already impacted by xylazine. We are directly providing education and raising awareness regarding xylazine and its risks to patients. Listening to their stories has deepened our understanding of the physical and mental toll this drug takes.

The stigma surrounding substance use often leads patients to avoid medical care out of fear of judgment and mistreatment. One patient shared their experience of a four-month hospitalization that involved multiple surgeries and skin grafts due to xylazine-related wounds. They described being labeled as “drug-seeking” and left without effective pain management, compassionate care or treatment for withdrawal symptoms. This drives them to manage their wounds at home—a

choice that increases the risk of severe complications, including an estimated 19% higher risk for amputation.

To address these challenges, we have developed wound identification and care guidelines for providers at the mobile clinic. We’re also working to educate local emergency departments about xylazine to improve early identification and appropriate interventions. Our goal is to ensure that those affected by xylazine receive compassionate, patient-centered care that improves outcomes and restores dignity.

Substance use disorder is a disease that touches every community. According to the Substance Abuse and Mental Health Services Administration, over 17% of Americans are affected. By raising awareness among health care providers and people who use drugs, we can better respond to the evolving threats posed by substances like xylazine. Together, through harm reduction, education and advocacy, we can take meaningful steps to support those affected and prevent further harm. As Spartans, we are committed to making a difference—one patient, one community, and one solution at a time.