What You Should Know About Xylazine

What is Xylazine?

Xylazine (also called “tranq” or “tranq dope”) is a non-opioid sedative or tranquilizer. Although not a controlled substance in the United States, xylazine is not approved for use in people (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

How are people exposed to xylazine?

Illegal drugs such as cocaine, heroin, and fentanyl can be mixed with xylazine, either to enhance drug effects or increase street value by increasing their weight. People who use illegal drugs may not be aware of the presence of xylazine. DEA has seized xylazine and fentanyl mixtures in 48 of 50 states, and the DEA laboratory system reported that approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA in 2022 contained xylazine. Xylazine is usually injected, although it can be swallowed or sniffed (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Should naloxone be given in the case of an overdose involving xylazine?

YES

Naloxone will not reverse the effects of xylazine

However, because xylazine is often used with opioids like fentanyl, naloxone should still be given. It’s important to call 911 for additional medical treatment, especially since the effects of xylazine may continue after naloxone is given (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

What should be done for someone with signs and symptoms of a possible opioid overdose or an overdose involving opioids and xylazine?

Call 911. Stay with the person until first responders arrive. Overdose is a medical emergency. First responders can assess the situation and provide treatment (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).
Give naloxone. Naloxone can reverse the effect of any opioids and will not cause harm if opioids are not involved in an overdose. However, because naloxone will not address the impact of xylazine on breathing, the effects of xylazine may continue after naloxone is given (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).
Give rescue breaths. First responders have reported that rescue breaths are especially helpful for people who have used xylazine because it causes breathing to slow down. To give rescue breaths to adults, make sure the person’s airway is clear; place one hand on the person’s chin, tilt the head back, and pinch the nose closed. Place your mouth over the person’s mouth to make a seal and give two slow breaths. Watch for the person’s chest (but not the stomach) to rise and follow up with one breath every 5 seconds (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

For people who use illegal drugs, the following strategies can help reduce the risk of overdose.

Never use it alone. A trusted contact can help reduce overdose risk by giving naloxone or calling 911 in case of an emergency. People who don’t have a trusted contact nearby can take advantage of services that allow people to seek non-judgmental support over a phone or video call when they are using drugs. Never Use Alone is a nationwide service that connects callers to trained volunteers who will gather basic information about the caller’s location, stay on the line to support the caller if they plan to use substances alone, and alert 911 if the caller becomes unresponsive (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Carry naloxone and learn how to use it. Because xylazine is often mixed with opioids like fentanyl, naloxone should be given in response to a suspected overdose to reverse any possible opioid effects. Importantly, naloxone will not reverse the effects of xylazine. In the event of an overdose, call 911 for additional medical treatment (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Provide rescue breaths. Rescue breaths are especially helpful for people who have used xylazine since xylazine causes breathing to slow down. Harm reduction experts also suggest rolling individuals on their side, into the recovery position (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Know the risks of using illegal drugs with unknown ingredients. Illegal drugs are unregulated—they don’t come with an ingredient list. As a result, dosage and purity are difficult to determine. Heroin, fentanyl, and cocaine may be mixed with xylazine or other substances. Counterfeit pills that closely resemble prescription medications and contain illegal substances are increasingly common in the illegal drug market (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Seek medical care for skin wounds. Skin wounds may become infected and worsen quickly. When treated early, wounds can be managed with basic wound care techniques. If left untreated, wounds can lead to amputation or become life-threatening (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Reduce injection-related risks. According to the National Harm Reduction Coalition, the risk of infection can be reduced by using sterile injection equipment, rotating injection sites, allowing skin veins time to heal before another use, and taking drugs in other ways besides injection (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Test drugs before using. There are commercially available test strips to test for the presence of xylazine in a sample of drugs (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Fentanyl test strips can be used to test opioids, stimulants, or prescription medications for fentanyl. When people have knowledge that their drugs contain fentanyl, they can take steps to reduce their risk of opioid overdose (What You Should Know about Xylazine | Drug Overdose | CDC Injury Center, 2023).

Resources

What You Should Know About Xylazine | Drug Overdose | CDC Injury Center. (2023, May 5). Www.cdc.gov. https://www.cdc.gov/drugoverdose/deaths/other-drugs/xylazine/faq.html

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