BOSTON — At a virtual session of the Special Commission on Xylazine, public-health researchers and clinicians described evidence tying the veterinary drug xylazine to prolonged sedation, severe skin and soft-tissue wounds and — in one study cited — an increased risk of amputations where the drug became common in the local supply.

Senator John Vilas, the Senate chair of the commission, opened the meeting by noting that “xylazine continues to be found in opioid samples statewide as shown in Massachusetts' drug supply data stream and continues to be routinely found in opioid overdose related deaths throughout the state alongside other drug contaminants,” and said that identification, treatment and prevention work by the commission is “vitally important.”

The panel included epidemiologist Tracy Green, who summarized several recent studies; Tayah (Tayah/Tia) Johnson, a nurse practitioner with Boston Medical Center and the Grayken Center training program, who described clinical and outreach experience treating xylazine-associated wounds; and a range of commission members who asked questions about testing, treatment access and harm-reduction strategies.

Dr. Tracy Green summarized published and ongoing analyses she said show a rise in severe infections and limb loss in settings where xylazine became common. Citing a retrospective hospital analysis from Philadelphia, Green said the amputation rate among patients with opioid-related disorders rose from 0.8% in 2018 to 1.5% in 2020 and that “the odds of having an amputation were twice, or 2.08 times greater, ... in the later years.” She said the findings underscore the need for earlier identification of wounds and more accessible wound care.

Green and other witnesses discussed qualitative interviews with people who use drugs, which described painful, rapidly progressing wounds, sudden and severe withdrawal symptoms tied to alpha‑2 adrenergic agents (the drug class that includes xylazine) and episodes of prolonged, “unconscious” sedation that created safety risks. Green said results from point-of-care testing using Fourier-transform infrared spectroscopy (FTIR) showed xylazine is often present even when users did not suspect it: in one study she cited, 25% of samples tested positive for xylazine while only about 1% of participants suspected it.

“Whatever we can do to identify wounds sooner and get people to care earlier with as many touches as are necessary to heal is really important,” Green said.

Tayah Johnson described frontline clinical practices in Boston and urged three priorities: increase clinician and harm-reduction training on how sedation from xylazine differs from opioid overdose and adjust naloxone use accordingly; expand rapid, low‑barrier wound care from street outreach through primary care and low-threshold housing; and broaden access to drug-checking and other prevention tools so people can make informed choices about supply risks. Johnson said bluntly that “these wounds ... do in fact heal if patients have consistent access to wound care services.”

Commission members pressed witnesses on two recurring themes: (1) whether criminal-justice and community settings can be enlisted in drug-supply harm reduction (for example, providing test strips and pre-release education in correctional settings), and (2) how housing and treatment reimbursement systems affect continuity of care. Green and Johnson both encouraged piloted efforts that bring testing and education to people who use drugs — including those recently released from custody — and highlighted the potential public-health benefits of distributing buffers/cutting agents and test strips as supply-level interventions.

Policy and program details discussed by witnesses and commissioners included: expanding access to medications for opioid use disorder (MOUD), pharmacy access to medications referenced by Dr. Green (named in testimony as Senate Bill 1635 in the commission record), piloting overdose-prevention site models, and strengthening wound care capacity co-located with addiction treatment and low-threshold housing.

The commission’s leadership also reviewed organizational next steps. Members approved minutes from the commission’s June 23 meeting by voice vote (recorded as multiple ayes and nays; minutes were approved and will be posted), and staff will organize working groups focused on: (1) regulation and classification of xylazine and related veterinary alpha‑2 agents; (2) treatment and outreach for xylazine exposures; and (3) education and training for first responders, clinicians and people with lived experience. The commission set a working-group presentation date of Dec. 11 and virtual full-commission review meetings on Feb. 9 and March 9, with a final report due to the House and Senate clerks by March 30, 2026, per the commission’s schedule.

Commissioners and witnesses cautioned against simple, immediate criminalization of xylazine without paired public-health measures. Green described an “iron law of prohibition” concern: sharp restrictions could drive substitution to other, potentially more dangerous veterinary sedatives. She urged a mix of expanded testing, low-barrier treatment access, wound-care capacity and carefully targeted policy changes.

The meeting featured extended exchanges about practical steps commissioners could take: increasing funding and distribution for wound-care supplies at harm-reduction sites; clarifying MassHealth reimbursement for wound care provided in behavioral-health or low-threshold housing settings; piloting pre-release drug-supply education and test-strip distribution in corrections; and strengthening clinician education — including pharmacists and emergency departments — so that wound recognition and non-stigmatizing care happen earlier.

Before adjourning, commissioners reiterated that staff will contact working-group members to schedule preliminary meetings and to prepare materials for December presentations. A motion to adjourn was made and seconded and the meeting concluded.

The record for this meeting contains public testimony, working-group assignments and the exchange of the research and clinical perspectives summarized above. The commission did not enact statutory changes during this session; it assigned working groups and set dates for future deliberations and a final report.

Votes at a glance

- Motion: Approve minutes from June 23 meeting. Outcome: approved (voice vote recorded in the minutes as multiple ayes and nays; exact named vote tallies not specified).

- Motion: Adjourn meeting. Outcome: approved (moved and seconded; roll not recorded in transcript).