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Despite limited literature on the health effects of chronic xylazine use, regular injection of xylazine has been associated with skin ulcers, abscesses and lesions in Puerto Rico.2 3 Semistructured interviews with people who use xylazine in Puerto Rico revealed that regular use of xylazine leads to skin ulcers.4 As skin ulcers are painful, people may continually inject at the site of the ulcer to alleviate the pain as xylazine is a potent 2-adrenergic agonist that mediates via central 2-receptors, which decreases perception of painful stimuli.1 People may self-treat the wound by draining or lancing it, which can exacerbate negative outcomes.8 While Philadelphia has seen a rise in skin and soft tissue infections relating to injection drug use, it is not yet clear whether or not this is due to increased presence of xylazine in the drug supply.9" Johnson J, Pizzicato L, Johnson C, et al

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Exploratory ITD system studies have established that computationally implemented decision-making agents enhanced with LLM and other AI support tools can handle huge complexity, adapt to local contexts, and operate at scale [44]