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Published In: Substance Abuse | Jan 27 2025
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The Centers for Disease Control and Prevention (CDC) recently announced that the U.S. opioid crisis has reached a new phase with the rise of xylazine infiltrating the illicit drug supply. Often mixed with fentanyl and other opioids, xylazine — commonly referred to as “tranq drug” or “tranq dope” — is exacerbating an already devastating epidemic.
Unlike opioids, xylazine is not intended for human use, yet an alarming ratio of fentanyl pills seized is testing positive for this veterinary sedative. The drug is contributing to a surge in the overdose crisis and causing unique health complications, such as horrific skin infections that can lead to amputations.
The Drug Enforcement Administration reports that xylazine is rapidly spreading across the country. Its presence in street drugs and prescription medications is becoming increasingly common, leading to severe health consequences and complicating overdose interventions.
Xylazine is a powerful sedative primarily used in veterinary medicine to sedate large animals such as horses and cattle. It acts as a central nervous system depressant, inducing muscle relaxation, pain relief, and deep sedation. However, xylazine is not approved for human use, as its effects can be dangerously unpredictable and life-threatening outside of controlled veterinary settings. many individuals consuming it are unaware they are doing so, further increasing the risk of fatal overdoses.
Xylazine is commonly added to opioid supplies, as a cutting agent to extend the drug’s effects and increase profit margins for dealers. What makes it particularly insidious is that many individuals who use prescription opioids are unaware of its presence in their drugs, unknowingly putting themselves at significant risk. Others may seek it out deliberately for its sedative effects, often referred to as the “nod,” which prolongs the euphoric experience associated with opioids.
However, the appeal of xylazine is overshadowed by its dangers. Unlike opioids, which primarily act on opioid receptors, xylazine affects alpha-2 adrenergic receptors, leading to severe central nervous system depression, respiratory failure, and long periods of unconsciousness. This increases the risk of drug overdose deaths, as users may not be conscious to recognize warning signs or seek medical intervention in time.
One of the most alarming effects of xylazine use is the devastating impact on the body, particularly the skin. Chronic use of xylazine is associated with severe skin ulcers and abscesses, which can even develop in areas where the drug was not injected. This is worsened by poor circulation and slow wound healing, due to xylazine’s effects on blood vessels.
Tissue necrosis (rotting flesh), is also associated with xylazine, leading to infections that can result in amputations. These wounds often become severely infected and are resistant to typical treatment methods, leading to long-term health complications that many healthcare providers are ill-equipped to handle. Individuals struggling with xylazine-related wounds frequently avoid seeking medical attention due to stigma, fear of withdrawal, or lack of access to proper care.
Beyond the physical consequences, xylazine use takes a heavy psychological toll on individuals. The sedative’s prolonged effects can contribute to increased isolation, depression, and anxiety, making it even harder for individuals to seek help. The development of severe wounds can lead to feelings of hopelessness and shame, further pushing individuals away from support systems and medical intervention.
Accessing treatment for xylazine dependency presents unique challenges. Many treatment centers and healthcare providers lack experience dealing with xylazine-related complications, focusing primarily on opioid addiction. Withdrawal symptoms from xylazine, which can include intense anxiety, agitation, and cardiovascular issues, are difficult to manage and often require specialized care. Additionally, the lack of awareness about xylazine within the broader healthcare system means that individuals may struggle to receive appropriate, compassionate care.
Xylazine’s growing presence in the illicit drug supply is particularly alarming due to its frequent combination with fentanyl, a powerful synthetic opioid already responsible for a staggering number of overdose deaths in the U.S. This deadly mix presents a fast-emerging opioid threat that creates a perfect storm of life-threatening effects, making it even more challenging for first responders and healthcare providers to address overdose cases effectively.
The xylazine and fentanyl mixture amplifies the respiratory-depressing effects of both substances, significantly increasing the risk of overdose and death. Fentanyl can already be up to 50 times stronger than heroin and is already a primary driver of the opioid crisis. When xylazine is added, it prolongs sedation and further slows vital functions such as heart rate and breathing.
Prolonged unconsciousness is one of the main dangers as users remain unresponsive for extended periods, increasing the risk of choking, suffocation, or severe health complications and fatal overdose. Xylazine also has a complicated response to typical treatment. Standard opioid overdose treatments are often ineffective, making it harder for emergency responders to revive individuals.
Naloxone (Narcan) is usually the first line of defense against an opioid overdose. While naloxone can reverse fentanyl’s effects, xylazine is not an opioid and does not respond to it, meaning the sedative effects can persist even after opioid reversal. This can complicate overdose response efforts, confusing bystanders and emergency responders who may assume naloxone isn’t working.
Even after the fentanyl effects are reversed, xylazine sedation can still suppress breathing and consciousness. So without a naloxone-like antidote for xylazine, users still need prolonged medical monitoring, which is unfortunately something they won’t always have access to. When medical help is delayed the risk of fatality becomes even more of a threat.
The surge in xylazine-related overdoses has put additional strain on emergency responders and public health systems. Reports from cities across the U.S., including Philadelphia and New York, indicate that xylazine has been detected in a growing percentage of overdose deaths, highlighting its rapid spread and increasing danger.
Emergency responders are faced with further challenges as it is extremely difficult to distinguish xylazine-related overdoses from standard opioid overdoses, leading to delays in appropriate treatment. Hospitals and harm reduction services are also experiencing increased strain as cases continue to rise, and they aren’t always capable of providing specialized treatment protocols to address xylazine’s prolonged sedative effects and complications.
Because xylazine is often mixed with opioids, it can mask typical overdose symptoms, making it harder to identify and respond appropriately. Understanding what to look for can help bystanders, first responders, and healthcare providers take the necessary steps to provide care. Common signs of xylazine exposure include:
⚠ Heavy sedation or unconsciousness: Individuals may experience severe drowsiness, appear to “blackout” for prolonged periods, and are difficult to wake.
⚠ Extremely slow heart rate and breathing: Unlike opioids, which may cause a rapid drop, xylazine-induced respiratory depression can be more gradual but prolonged.
⚠ Hypotension (low blood pressure): This leads to dizziness, weakness, and loss of consciousness.
⚠ Unusual skin wounds and lesions: Xylazine causes skin ulcers and necrosis, even in areas where it hasn’t been injected. These wounds often appear as scaly patches or deep abscesses that worsen rapidly without treatment.
While xylazine shares some overlapping symptoms with opioid overdoses, there are key differences that can help distinguish the two:
➔Pinpoint pupils
➔Responds to naloxone
➔Cyanosis (blue skin/lips)
➔Respiratory arrest
➔Dilated or normal pupils
➔Little to no response to naloxone
➔Cold, clammy skin with slow heart rate
➔Extended respiratory depression
As xylazine continues to infiltrate the drug supply, harm reduction strategies are crucial to minimizing its devastating effects. While complete avoidance is the safest option, it might not be an option for some.
For those who use substances, understanding how to reduce harm can mean the difference between life and death. Harm reduction efforts aim to provide people with practical tools, education, and resources to stay as safe as possible while addressing the broader public health crisis.
✅ Using fentanyl test strips: While they won’t detect xylazine, they can at least confirm the presence of fentanyl, which alone presents an extreme danger, and it often coexists with xylazine.
✅ Avoid using alone: Make use of buddy systems where one user stays sober to watch over the other or utilize overdose prevention centers and harm reduction clinics where available.
✅Rotate injection sites and needles: Proper wound care can prevent serious infections and reduce the risk of long-term tissue damage. Harm reduction clinics and clean needle exchange programs are available to help with this.
✅ Administer naloxone: Although xylazine will not respond to it, fentanyl may still be present, and reversing its effects can buy crucial time.
✅ Call 911 immediately: Inform responders that xylazine may be involved so they can prepare for additional support.
✅ Monitor breathing and heart rate: If the person remains unresponsive after naloxone, continue monitoring until help arrives.
✅ Avoid leaving the person alone: They may regain consciousness briefly but experience secondary respiratory distress.
Seeking help for xylazine addiction presents unique challenges that go beyond standard opioid use disorder treatment. The combination of xylazine with fentanyl or other opioids complicates detox and recovery, requiring a comprehensive approach that addresses both physical and psychological aspects.
Despite these challenges, support is available for those struggling with drug abuse, addiction, or any co-occurring disorders. Psyclarity Health offers a full range of services, treatments, and resources to help you overcome addiction and underlying mental health conditions and get your life back on track.
Our specialized detox programs can help individuals manage the withdrawal symptoms of both opioids and xylazine. Because xylazine is not an opioid, traditional medications like buprenorphine or methadone may not fully address withdrawal symptoms. However, we provide the critical medical monitoring and assistance required to get you through it.
Our inpatient programs provide a structured environment where individuals can focus on their recovery without the stress of external pressures. We provide mental health support and counseling with licensed therapists and psychiatrists, to address substance use and its underlying causes. We also have a full medical team on location to treat any xylazine-related wounds and infections to prevent complications such as amputations.
For individuals unable or unwilling to enter inpatient care, our outpatient programs and harm reduction services offer counseling, medication-assisted treatment, and resources like wound care and overdose prevention strategies. In an outpatient setting, patients are able to receive the necessary care and assistance while maintaining their work and personal responsibilities outside of treatment.
Many people using xylazine experience homelessness or unstable housing, making it difficult to focus on recovery. Our programs offer wraparound services, such as housing assistance and job training, that can play a crucial role in long-term recovery. We also offer dedicated aftercare systems where patients have access to ongoing support whenever they need it.
For anyone struggling with xylazine-related issues, getting professional help is a crucial first step. While the challenges of xylazine addiction are complex, support is available, and recovery is possible. Psyclarity Health can provide the care needed, whether through harm reduction services, medical support, or recovery programs. Give us a call to work out the best strategy for your needs.
