Xylazine, a powerful sedative not approved for human use, is increasingly infiltrating the illicit street drug supply in the United States, raising alarm bells among health officials. This non-opioid tranquilizer, often referred to as “tranq” or “tranq dope” on the streets, poses significant dangers, especially when combined with opioids like fentanyl. Its presence is linked to a surge in overdose deaths and severe health complications, prompting urgent public health responses.
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The White House Office of National Drug Control Policy has officially designated fentanyl adulterated with xylazine as an “emerging threat,” highlighting the severity of the situation. In response, a National Response Plan was launched in July 2023 to combat this growing crisis.
This guide aims to provide crucial information about xylazine in the context of Street Drugs. It addresses common questions regarding its nature, risks, and what steps can be taken to mitigate harm. Please note that this information is for educational purposes and does not constitute medical advice or treatment guidelines.
What is Xylazine and Why is it in Street Drugs?
Xylazine is classified as a non-opioid sedative or tranquilizer. While it is not a controlled substance at the federal level, it is explicitly not approved for human use in the United States. In veterinary medicine, xylazine is used to sedate large animals. On the street, it’s a different story.
Why is xylazine showing up in street drugs? Drug dealers are increasingly mixing xylazine with substances like cocaine, heroin, and particularly fentanyl for a few dangerous reasons:
- Enhanced Effects: Xylazine intensifies the sedative effects of opioids, creating a stronger and potentially longer-lasting high that users may seek.
- Weight and Volume: Xylazine is relatively inexpensive and adds bulk to drug mixtures, allowing dealers to increase the weight of their product and potentially their profits without increasing the amount of the more expensive primary drug.
- Deception: Unsuspecting drug users may not be aware that the substances they are purchasing are laced with xylazine, leading to unexpected and dangerous reactions.
The Drug Enforcement Administration (DEA) has reported seizing xylazine-fentanyl mixtures in a staggering 48 out of 50 states. In 2022, DEA lab analysis revealed that approximately 23% of fentanyl powder and 7% of fentanyl pills seized contained xylazine. This widespread contamination underscores the urgent need to understand and address this emerging threat in the landscape of street drugs. Xylazine is typically injected but can also be swallowed or snorted, depending on the form of the street drug.
The Alarming Health Risks and Symptoms of Xylazine Use
Using street drugs contaminated with xylazine carries a range of severe health risks and can manifest in alarming symptoms. Because xylazine is not meant for human consumption, its effects on the human body are unpredictable and dangerous.
Key health risks and symptoms associated with xylazine use include:
- Intense Sedation: Xylazine is a powerful sedative, causing users to become excessively drowsy and unresponsive for extended periods.
- Respiratory Depression: It significantly slows down breathing, which can lead to hypoxia (oxygen deprivation) and potentially fatal respiratory failure.
- Dangerously Low Blood Pressure (Hypotension): Xylazine can drastically lower blood pressure, leading to dizziness, fainting, and organ damage.
- Slowed Heart Rate (Bradycardia): It can cause the heart to beat too slowly, reducing blood flow to vital organs.
- Skin Ulcers and Necrosis: A particularly concerning and distinctive effect of xylazine use is the development of severe skin wounds. These wounds can become infected, necrotic (tissue death), and may require amputation. The exact reason for these wounds is still under investigation, but they are a hallmark of xylazine exposure.
- Severe Withdrawal Symptoms: Discontinuing xylazine after regular use can lead to intense withdrawal symptoms, further complicating recovery efforts.
- Overdose and Death: The combination of xylazine with opioids like fentanyl significantly increases the risk of fatal overdose due to compounded respiratory depression.
Image alt text: A close-up shot shows a syringe filled with a clear liquid, symbolizing the injection of xylazine-adulterated street drugs and the associated risks of overdose and health complications.
Xylazine Overdose: What to Do in an Emergency
Recognizing and responding to a suspected overdose involving xylazine, particularly when combined with opioids, is critical. While naloxone is a vital tool, it’s important to understand its limitations in this context.
Should naloxone be administered in a xylazine overdose?
Yes. Naloxone (Narcan) should be administered in any suspected drug overdose situation. Naloxone is an opioid antagonist, meaning it can reverse the effects of opioids like fentanyl. While naloxone will not reverse the effects of xylazine itself, it is crucial to administer it because:
- Xylazine is often mixed with opioids: In many cases, xylazine is combined with fentanyl or other opioids. Naloxone can counteract the opioid component of the overdose, potentially restoring breathing and consciousness.
- It’s impossible to know for sure: Without drug testing, it’s impossible to immediately determine if opioids are involved in an overdose. Administering naloxone is a safe and potentially life-saving first step.
Key steps to take in a suspected xylazine-involved overdose:
- Administer Naloxone: Give naloxone immediately. Multiple doses may be needed, especially in cases involving potent opioids like fentanyl.
- Call 911 Immediately: Even after naloxone is administered, call emergency services (911 in the US) right away. Xylazine’s effects will not be reversed by naloxone, and its prolonged sedative effects and other health risks require immediate medical attention. Paramedics and hospital staff can provide critical supportive care, such as assisted ventilation and blood pressure management.
- Provide Rescue Breathing: Because xylazine causes respiratory depression, rescue breathing (or CPR if breathing and pulse stop) is crucial and should be administered while waiting for emergency services to arrive.
- Be Aware of Prolonged Effects: Understand that the effects of xylazine can last for several hours, even after naloxone has been given. Continued monitoring and medical care are essential.
Harm Reduction Strategies for Street Drug Users and Communities
Addressing the xylazine crisis requires a multi-faceted approach, focusing on harm reduction strategies for individuals who use street drugs and broader community-level interventions.
For individuals who use street drugs:
- Never Use Alone: Using drugs with someone else present allows for immediate assistance in case of an overdose.
- Carry Naloxone: Always have naloxone readily available and ensure that those around you know how to administer it.
- Test Your Drugs: Utilize drug checking services and fentanyl test strips when available to check for the presence of fentanyl and xylazine. While not always readily accessible, these resources can provide critical information.
- Start Low and Go Slow: Use a small test dose first to gauge the strength and effects of the drug, especially when using a new batch or source.
- Be Aware of Wounds: Regularly inspect your skin for any signs of wounds or infections, and seek medical attention promptly if you notice anything concerning.
- Seek Support and Treatment: If you are struggling with drug use, reach out for help. Substance use treatment programs can provide support, resources, and pathways to recovery.
For communities and public health organizations:
- Public Education: Launch public awareness campaigns to educate the community about the dangers of xylazine-adulterated street drugs, overdose prevention, and harm reduction strategies.
- Harm Reduction Services: Expand access to harm reduction services, including:
- Naloxone distribution programs: Make naloxone widely available to drug users, their families, and community members.
- Syringe service programs: Provide clean syringes and other harm reduction supplies, as well as drug checking services and referrals to treatment.
- Drug checking initiatives: Increase the availability of drug checking services to allow users to test their drugs for xylazine and fentanyl.
- Training for First Responders: Provide specialized training to first responders (police, firefighters, paramedics) on recognizing and responding to xylazine-involved overdoses, including the need for rescue breathing and prolonged monitoring.
- Collaboration and Data Sharing: Enhance collaboration between public health agencies, law enforcement, healthcare providers, and community organizations to monitor the evolving street drug supply, track xylazine-related overdoses and health outcomes, and share data to inform effective interventions.
Image alt text: A naloxone kit is displayed, highlighting its crucial role as a harm reduction tool in reversing opioid overdoses, even in the context of xylazine-contaminated street drugs where it can counteract the opioid component.
The Growing Data on Xylazine in the Street Drug Supply
Data reveals a concerning upward trend in the presence of xylazine in the US street drug supply.
- Geographic Spread: The presence of xylazine in drug samples has increased across all regions of the United States between 2020 and 2021, with the most significant increase observed in the Southern region.
- Rising Overdose Deaths: Studies in major US cities show a dramatic increase in xylazine involvement in overdose deaths. In a study spanning 10 cities, xylazine was implicated in less than 1% of overdose deaths in 2015, but this figure surged to nearly 7% by 2020.
- High Prevalence in Opioid Samples: Testing of drug samples from syringe service programs in Maryland between 2021 and 2022 revealed xylazine in almost 80% of samples that also contained opioids.
- Significant Impact in Specific Areas: In Philadelphia, Pennsylvania, xylazine was detected in 31% of overdose deaths involving heroin and/or fentanyl in 2019.
- National Trend: CDC’s State Unintentional Drug Overdose Reporting System (SUDORS) data from 20 states and Washington D.C. indicates that the monthly percentage of deaths involving illicitly manufactured fentanyl with xylazine detected rose from 3% in January 2019 to 11% in June 2022. The Northeastern U.S. showed a particularly high percentage of illicit fentanyl-involved deaths with xylazine detection during January 2021–June 2022.
This data paints a clear picture: xylazine is not a localized problem; it is a growing national crisis within the street drug landscape, demanding urgent and comprehensive action.
