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Key points
- The drug xylazine was developed in the 1960s and is now an addictive and deadly street drug.
- Xylazine can lead to skin wounds and ulcers. In serious cases, this can lead to the amputation.
- Healthcare providers can educate the public and advocate for better treatment.
A recent tranq episode at our center left a strong impression on many of us.
When a patient arrived for his treatment, we gave him the same physical exam that all of our new residents receive. When he removed his shirt, our nursing team was stunned to see deep, open wounds on his arms. We admitted him, and immediately began wound care for him, along with his substance use treatment.
Seen in patients who are abusing opioids such as fentanyl, these kinds of wounds often result from heavy xylazine use. When this veterinary sedative is mixed with the potent opioid fentanyl, it creates a highly addictive and deadly cocktail nicknamed “tranq,” “tranq dope,” or the “zombie drug.”
The xylazine/tranq story
Developed in the 1960s as a veterinary tranquilizer mainly used on large animals going into surgery, xylazine began appearing as a street drug in the early 2000s. For years, Philadelphia was the drug’s epicenter; it is now found in the drug supply in 48 of the 50 states.
When combined with fentanyl or heroin, xylazine is purported to lengthen the high of those relatively short-acting opioids, thus its powerful allure.
Because xylazine is a central nervous system sedative, it acts as a depressant and can cause drowsiness, slow breathing, and dangerously low blood pressure and heart rate. These effects can occur within minutes of ingestion or injection, and may last several hours.
For opioid overdoses, such as from heroin and fentanyl, naloxone (sold as Narcan) spray has proven to be a highly effective reversal agent. However, naloxone has no effect on xylazine. At this point, there is no life-saving reversal agent for xylazine.
The dangers I’m seeing with tranq
I mentioned the skin wounds and ulcers we saw on our resident, which is common among heavy users, and in serious cases can lead to the amputation of affected legs and arms. It’s also clear that xylazine enhances fentanyl’s already formidable addictive properties. The combination high of the two has become the go-to of many users thanks to xylazine’s ability to lengthen and strengthen fentanyl’s effects.
When people are admitted to us who have been using the two together, their recovery may take longer. If wounds are present, that also makes full recovery more complicated.
Withdrawal from xylazine can be very difficult as well, and I fear the word on that is out among users. I have no doubt some people are bypassing treatment altogether knowing the brutal withdrawal they may face.
Another concern: People who use tranq often don’t know they’re using it. They think they’re taking straight heroin or fentanyl. Both are deadly, but not as deadly as their combination with xylazine. A test strip has recently been made available that detects xylazine, but it is not yet in wide distribution.
A robust, if belated, government response
In April 2023, the White House Office of National Drug Control Policy (ONDCP) listed xylazine combined with fentanyl as an emerging threat. In July, the ONDCP followed up with an all-hands-on-deck nationwide plan involving several federal agencies to decrease xylazine-related deaths.
The effort aims to beef up testing, tracking, and treatment for people taking drugs laced with xylazine. Clearly, the situation is urgent. CDC data shows, for example, that samples from eight syringe service programs tested in Maryland between 2021 and 2022 contained xylazine in 80% of samples that contained opioids.
What can we do
As healthcare providers in the mental field, we can:
- Educate the public, our colleagues, and our patients about the increasing threat of xylazine in the drug supply.
- Support mass distribution of xylazine/fentanyl test strips, which will help people know what they’re taking.
- Advocate for better medical treatment of xylazine withdrawal, which will lower the barrier to seeking help.
As citizens, we can better prepare ourselves to act when we witness an opioid overdose. In these cases:
- Call 911. Then stay with the person until first responders arrive.
- Give naloxone (Narcan). This nasal spray can reverse the effects of opioids, and won’t cause harm if opioids aren’t present. Just remember, naloxone is not a reversal agent for xylazine.
- Consider giving rescue breaths. Rescue breaths can be effective for an overdose involving xylazine because xylazine often lowers breathing rates to dangerous levels. With the person on their back, tilt their head back slightly to open the breathing passage, pinch the nose, and give one sharp breath every five seconds.
Final thoughts
The White House called xylazine’s infiltration into the drug supply an “emerging threat” back in April. Less than six months later, it’s clear the threat is upon us. Tranq truly is a killer on the loose.
This means we need to fight the xylazine/fentanyl scourge with everything we’ve got—from education outreach to improved medical treatments to harm reduction strategies that save lives.
