# A Growing Crisis of Novel Injection-Related Wounds and Skin & Soft Tissue Infections among People Who Inject Drugs: A Community-Based, Longitudinal Investigation in North Carolina

> **NIH NIH R01** · RESEARCH TRIANGLE INSTITUTE · 2024 · $661,013

## Abstract

PROJECT SUMMARY/ABSTRACT
We propose a community-based, longitudinal, mixed-methods study to investigate the growing crisis of
injection-related wounds and skin and soft tissue infections (IWSSTIs) among people who inject drugs
(PWID) in the United States. Lost among the data on skyrocketing overdose deaths is an alarming increase
in the prevalence and severity of novel IWSSTIs. IWSSTIs are a leading cause of morbidity for PWID and
the most common cause of hospitalizations. More than 100,000 IWSSTIs have occurred annually since
2018. When left untreated, IWSSTIs can become septic, gangrene, and progress to catastrophic infections
that require complicated surgeries and long-term medical care. IWSSTIs can stress hospital systems
already overburdened with COVID-19, consume limited Medicaid funding, and increase stigma toward
PWID. While IWSSTIs have been a concern for PWID for decades, rising incidence of dermal reactions and
antinociceptive effects from synthetic drugs and novel psychoactive substances (NPS) represents a new
and emerging public health crisis. The Office of National Drug Control Policy recently listed xylazine as an
emerging threat and the Centers for Disease Control and Prevention warned of xylazine’s growing
involvement in fentanyl overdose deaths. Aim 1: To observe, examine, and typologize IWSSTIs by DSS
factors through Consensus-based Clinical Case Reporting Guideline Development (CARE)26-informed case
reports, ethnographic interviews, and community-based drug checking among a qualitative sample of 30
PWID (15/site) in western NC; Aim 2: To examine associations between DSS factors and IWSSTI risk
among a longitudinal cohort of PWID in NC (N = 450). To achieve these aims, we will recruit PWID from
SSPs, homeless encampments, motels, and other places where PWID reside and congregate at the two
study sites and surrounding counties (see Facilities). Aim 1 will be accomplished using targeted sampling
methods and Aim 2 will be accomplished using respondent-driven sampling (RDS). The study will be led by
Principal Investigator Jon Zibbell, a National Institute on Drug Abuse (NIDA)–funded behavioral scientist
with many years of experience studying injection drug use and infectious disease risk among PWID. The
team also includes William Zule, a NIDA-funded epidemiologist; Arnie Aldridge, a National Institutes of
Health–funded statistician; Asher Schranz, a physician and medical expert in injection-related infectious
diseases; and Sarah Duhart Clarke, an applied psychologist. Findings from the proposed study will help
characterize the etiology and unique features of IWSSTs by DSS factors and quantify xylazine prevalence
in the illicit drug supply in western NC. Because growing xylazine contamination and sharp growth in novel
IWSSTIs among PWID together comprise an emerging crisis, these data are time sensitive, and the
proposed study is poised to make a timely and effective contribution to inform public health response.

## Key facts

- **NIH application ID:** 10977935
- **Project number:** 1R01DA059457-01A1
- **Recipient organization:** RESEARCH TRIANGLE INSTITUTE
- **Principal Investigator:** Jon Eric Zibbell
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $661,013
- **Award type:** 1
- **Project period:** 2024-09-30 → 2028-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10977935

## Citation

> US National Institutes of Health, RePORTER application 10977935, A Growing Crisis of Novel Injection-Related Wounds and Skin & Soft Tissue Infections among People Who Inject Drugs: A Community-Based, Longitudinal Investigation in North Carolina (1R01DA059457-01A1). Retrieved via MORVS 2026-10-26 from https://api.morvs.ai/grant/nih/10977935. Licensed CC0.

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