How we measured xylazine’s toll in Philadelphia
The Inquirer’s analysis found that, between 2020 and 2023, about 450 people hospitalized in Philadelphia with an opioid use disorder also underwent an amputation procedure during their stay.
In an effort to measure the toll of xylazine among people with opioid use disorders, The Inquirer examined patient billing records for millions of people admitted to Pennsylvania hospitals between 2016 and 2023.
Xylazine, a veterinary sedative not approved for humans, was detected in at least 90% of street opioids 2021.
But even after years treating wounds associated with xylazine, there is no specific set of billing codes that allow health-care providers to count patients with the drug in their system.
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To work around the data’s shortcomings, The Inquirer’s analysis isolated 500,000 patients who either underwent a limb, finger, or toe amputation procedure during their hospital stay, or were diagnosed with specific soft tissue infections linked to xylazine necrosis. Within that group, the analysis focused on patients also diagnosed with an opioid use disorder.
Since 2020, more than 10,500 patients who were hospitalized in Philadelphia had an opioid use disorder and a soft tissue infection.
To identify amputations most likely linked to xylazine, the analysis excluded any patients who had certain medical issues that can also lead to amputation. That list included patients with necrotizing frostbite, burns or limb corrosions, cancers of the limbs, paralysis, or long COVID. Other conditions that can raise the risk of amputations, such as diabetes and vascular diseases, were too widespread among the patient mix to remove from the counts.
The Inquirer sought guidance on its methodology from addiction medicine specialists, public health researchers, and medical billing code experts. It also shared its analysis with New Jersey health officials, who separately analyzed a similar state dataset and identified a trend of rising amputations and soft tissue infections in people with opioid use disorder.
The Inquirer’s analysis found that, between 2020 and 2023, about 450 people hospitalized in Philadelphia with an opioid use disorder also underwent an amputation procedure during their stay. About two-thirds of those patients had soft tissue infections.
The data show the increase in patients with soft tissue infections and amputations trended upward as xylazine’s use increased.