Xylazine and fentanyl co-administration delays wound healing in mice

Abstract

Xylazine, a veterinary sedative increasingly found in the unregulated drug supply, is associated with severe skin wounds in humans, particularly when co-used with fentanyl. Despite growing concern, the mechanisms underlying these wounds remain unclear. To investigate how xylazine and fentanyl affect wound healing, we administered subcutaneous injections of saline, xylazine (3.2 mg/kg), fentanyl (1.0 mg/kg), or their combination to female C57BL/6J mice for 28 days. After a standardized punch biopsy, wound closure was tracked for 14 days, with continued drug exposure. Mice receiving the xylazine-fentanyl combination exhibited significantly delayed wound healing compared to all other groups, as shown by slower closure rates and increased area under the healing curve. A follow-up study without chronic pretreatment showed that acute xylazine-fentanyl exposure still altered healing dynamics, although it did not significantly delay time to closure. Neither drug alone impaired healing at the tested doses. These findings suggest that prior exposure to xylazine and fentanyl contributes to impaired wound healing and support the hypothesis that xylazine-associated wounds may arise from delayed healing of pre-existing skin injuries rather than spontaneous formation. This is the first preclinical model of xylazine-related wound impairment and provides a foundation for future research into biological mechanisms and potential interventions for these emerging soft tissue injuries.