HomeBlogAddictionXylazine, Called Tranq, Is Fueling the Opioid Epidemic

Xylazine, Called Tranq, Is Fueling the Opioid Epidemic

What Is Xylazine?

Xylazine is a powerful drug used for sedation, anesthesia, muscle relaxation and pain relief in animals, such as horses and cattle. It’s not an opioid. It’s a tranquilizer approved by the Food and Drug Administration (FDA) for veterinary use, but it is not for human use.

Why Xylazine is Dangerous

Xylazine can be life-threatening, particularly when combined with opioids like fentanyl. It is increasingly being found in the U.S. illegal drug supply and linked to a surge in overdose deaths. According to the Centers for Disease Control and Prevention (CDC), overdose rates due to xylazine were 35 times higher in 2021 than in 2018. Combining xylazine with fentanyl and/or heroin prolongs the euphoric effect of the drugs, heightening the risk of fatal overdose.

In addition to being in illegally manufactured fentanyl, xylazine has been detected in 48 states. Xylazine and fentanyl drug mixtures place users at a higher risk of suffering a fatal drug overdose. Because xylazine is not an opioid, naloxone (Narcan) does not reverse its effects.

“Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” said the Administrator of the Drug Enforcement Administration (DEA) Anne Milgram. “The DEA Laboratory System is reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.”

Xylazine Wounds: Skin, Muscle and Bone Infections – Even Amputations

Xylazine creates abscesses and painful skin ulcers all over the body, regardless of the intravenous injection site. These issues are believed to be caused by xylazine’s constricting effect on local blood vessels, reducing the skin’s ability to breathe.

Xylazine causes low blood pressure, a slow heart rate and shallow breathing, which leads to lower tissue oxygenation in the skin. This results in incredibly severe soft tissue infections, including abscesses, cellulitis and skin ulcerations.[1]

Many of these infections require hospitalization with antibiotics and a surgical cleaning of the wound. However, the withdrawal from the drugs is so severe that many patients do not seek treatment. Often these infections lead to severe wounds, including necrosis—the rotting of human tissue—that may lead to amputation.


[1] https://www.aafp.org/pubs/afp/afp-community-blog/entry/opioid-epidemic-updates-frankenstein-opioids-and-xylazine-induced-skin-ulcers.html

White House Calls Xylazine an Emerging Threat

Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy (ONDCP), has officially designated fentanyl with xylazine an emerging threat to the United States. This designation follows a review of the impact of xylazine on the opioid crisis, including its growing role in overdose deaths in every region of the United States.

Dr. Gupta said, “As we see the combination of tranq and fentanyl together, called tranq-dope, become more and more available, we’ve seen almost a 300% increase in deaths associated with this drug over the past few years.”

ONDCP is required to monitor evolving patterns of substance use, establish criteria for determining when a substance or combination of substances should be designated an emerging threat, and declare emerging threats when the director deems it appropriate, based on specific criteria


Xylazine Locations and Mortality Rates


According to the DEA:


  • Between 2020 and 2021, forensic laboratory identifications of xylazine rose in all four U.S. census regions, most notably in the South (193%) and the West (112%).

  • Xylazine-positive overdose deaths increased by 1,127% in the South, 750% in the West, more than 500% in the Midwest, and more than 100% in the Northeast.

According to the CDC, nearly 108,000 Americans died in 2022 from drug poisonings, with 66 percent of those deaths involving synthetic opioids like fentanyl. 


More Research and Testing for Xylazine is Needed


As xylazine has been detected in nearly every state in the country, routine xylazine testing in suspected overdose deaths is critical for additional research. Further investigation of xylazine’s effects on humans is needed to guide prevention efforts.


How to Respond to Xylazine Overdoses


People who overdose on xylazine need treatment beyond naloxone administration. However, healthcare professionals should continue to administer naloxone for opioid overdoses and consider xylazine exposure if patients are not responding to naloxone or when there are signs or symptoms of xylazine exposure (e.g., severe, necrotic skin ulcerations). Healthcare professionals should provide appropriate supportive measures, such as rescue breathing, to patients who do not respond to naloxone.[2]


As part of a harm reduction strategy, community agencies provide opioid users with fentanyl and xylazine testing strips, where legal. While fentanyl and xylazine testing strips are not currently considered illegal under federal law, several states have banned the strips as drug paraphernalia. As of July 2023, bills in the House and Senate seek to make testing strips legal.




[2] https://www.fda.gov/drugs/drug-safety-and-availability/fda-alerts-health-care-professionals-risks-patients-exposed-xylazine-illicit-drugs


How to Get Help for Fentanyl and Xylazine


Crossroads is at the forefront of treating people addicted to opioids like fentanyl, heroin and oxycodone. We provide outpatient medication-assisted treatment to help people get their lives back. We’ve helped 300,000+ people to date, treating 26,000 patients per month. Crossroads is physician-founded and led. Crossroads is highly regarded throughout the nine states and 100+ locations where we are located.  


Our Patient Access Center is open 24/7 to provide support, with instant intakes and bridge prescriptions. If you or someone you know needs help, please use the pop-up at crossroadstreatmentcenters.com and one of our teammates will call you, or you can call 800-805-6989. Use our location finder to make an appointment at one of our centers. Take the first step today.


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