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Xylazine

Xylazine, commonly referred to as tranq or tranq dope, is an animal tranquilizer that is increasingly found in the illicit drug supply. Xylazine can result in life-threatening outcomes, especially when combined with opioid use. This use of Xylazine in conjunction with opioids has been declared an emerging threat by the White House’s Office of National Drug Control Policy and has been appearing more frequently throughout the United States.

Common symptoms of Xylazine use include (FDA):

Sedation.
Difficulty breathing.
Dangerously low blood pressure.
Slowed heart rate.
Wounds that can become infected.
Severe withdrawal symptoms.
Death.

Response to a possible overdose involving Xylazine:

Call 911
Initiate rescue breathing or chest compressions. This ensures that the individual is receiving oxygen. Rescue breathing has been found especially beneficial for those in an overdose state as the respiratory system is compromised by the substance.
Administer naloxone. Naloxone can reverse the effect of opioids that may be in the system and contributing to the overdose state. It will not reverse the effect of Xylazine. Rescue breathing or chest compressions may need to be continued.

Websites

Good Samaritan Law

The Good Samaritan Drug Overdose Act of 2015 prevents punitive actions against health professionals and any person who administers naloxone or calls 911 to assist someone who may be overdosing on opiates. It also provides immunity to persons seeking medical treatment for an opioid overdose for themselves or someone else.

What is Xylazine?

Information about Xylazine, commonly referred to as tranq or tranq dope, an animal tranquilizer that is increasingly found in the illicit drug supply.

Tools & Resources

Wound Care & Medical Triage for People Who Use Drugs and the Programs That Serve Them

This comprehensive guide provides information and recommendations regarding general health, safer use practices, common viral, fungal, parasitic, and other injection-related infections, overdose and overamp, tapering, withdrawal, medications for opioid use disorder, and seeking medical care.

Never Use Alone

Toll-free national overdose prevention, detection, life-saving crisis response and medical intervention services for people who use drugs while alone. Never Use Alone’s peer operators are available 24-hours a day, 7 days a week, 365 days a year.

Publications

Xylazine Basics: Overdose Prevention, Harm Reduction, and Wound Care

This document provides information on xylazine, a non-opioid veterinary tranquilizer used as an additive in illicit drug supplies, notably in combination with heroin and fentanyl. It discusses the effects of xylazine use, including sedation and potential risks such as hypotension and bradycardia. The document also emphasizes harm reduction interventions for individuals who may encounter xylazine in the drug supply, including the use of naloxone for responding to overdoses and the importance of wound identification and treatment.

Dear Colleague Letter – Xylazine

This “Dear Colleague” letter from the Substance Abuse and Mental Health Services Administration (SAMHSA) provides a report on the risks of Xylazine.

Posters & Infographics

FOR MORE RESOURCES, VISIT HARMREDUCTION.ORG XYLAZINE IN THE DRUG SUPPLY XYLAZINE (ZIE-LUH-ZEEN) THE BAD STUFF Tranq Anestesia de caballo Rompún AnaSed Horse tranquilizer NAMES Xylazine causes really bad skin ulcers when injected, even beyond the site of injection, like anywhere with a bite or cut. Missed shots can make skin ulcers worse Xylazine may cause a life-threatening drop in your blood’s ability to carry oxygen to tissues (low blood iron, but we don’t know a lot about this yet) Other symptoms may include: High blood sugar; less bladder control; tired all the time; slower reflexes; trouble swallowing; really dry mouth OVERDOSE It’s found in powder heroin/fentanyl mostly, and sometimes coke and meth • It’s not an opioid. It’s a deep sedative, like clonidine or ketamine. It starts quickly and makes you fall out hard for about the first hour if you’re not used to it • Xylazine can give fentanyl legs so you’re not sick again in two hours, but can be very dangerous when it shows up in dope unexpectedly • If you have skin wounds that are not healing, it may be because of xylazine • HARM REDUCTION TIPS It is best t • o avoid dope with xylazine in it if you can Some harm reductionists think it may be safer to sniff/smoke/booty-bump dope with xylazine, but we don’t know what other harms this can cause • Try to be in a comfortable seated position, it’s important to be in a position that doesn’t cut off circulation to arms or legs • Eat foods high in iron if xylazine is in your drug supply. Harm reduction programs can consider testing participants for hemoglobin using handheld devices • Don’t use alone. Because of the heavy sedation, be aware of your surroundings and your possessions, especially if you’re somewhere that’s not secure • Get your drugs tested at a harm reduction program if you can • If someone is unresponsive, it’s very very important to see if they are breathing! If they are taking 10 breaths each minute, keep an eye on them for the next hour. You don’t need to use naloxone unless their breathing gets slower Naloxone doesn’t work on xylazine BUT it will help if the opioid/fentanyl is making it hard for them to breathe Only if their breathing is slow or shallow, use naloxone the way you normally would (or titrate a lower dose of injectable naloxone), because they probably have opioids in their system too. They may not become responsive right away, but as long as they are taking 10 breaths per minute, just stay with them and keep checking. Put them in the recovery position if you have to leave them October, 2022 XYLAZINE IN THE DRUG SUPPLY FOR MORE RESOURCES, VISIT HARMREDUCTION.ORG DISCLAIMER: Advice in this guide comes from people who use xylazine or have used the tips they contributed. However, there’s very little about xylazine that we know for sure, and wound progression in particular can vary widely Dope that’s been cut with xylazine is sometimes darker, browner, chunkier, flakier, and weird-smelling. But dope that appears normal (white powder) can still have xylazine Cooking it twice can help dissolve chunks. After drawing up, wipe off needle with an alcohol prep, let dry, THEN inject Go as slow and precise as you can; for arms, use a tie and get the vein anchored. Count to 5 before taking the needle out. You want to avoid ANY leaking outside the vein and into the muscle or tissue Short-tips (31g) may be higher-risk than regular 1/2" needles. Muscling and skin popping are EXTREMELY HIGH RISK for skin problems Try booty-bumping or smoking from a hammer pipe; less injecting = less risk INJECTING Xylazine wounds can take months or years to heal, and may not heal without medical care. Wounds can get very goopy/yellow/red/swollen/tend to be most painful at this stage Can appear anywhere there’s an opening in your skin—NOT just where you inject. Try to keep all cuts/wounds/injection sites clean and covered If the wound goes necrotic (dead black tissue; you’ll know when it happens) go to an emergency room ASAP. The first step is cleaning the wound and removing some of the dead tissue and you may need skin surgery WOUNDS AND WOUND CARE TIPS The only way to know for sure whether xylazine is in your dope is through drug checking machines, which very few harm reduction programs have • If you are part of a drug user union, harm reduction program, or health department, you can get free drug checking kits for participants through this anonymous mail-in service https://streetsafe.supply • If you are an individual and want to test your own supply by mail, Erowid’s https://DrugsData.org offers an anonymous service (for a fee) • • 24/7 Never Use Alone Hotline: 800-484-3731

Xylazine in the Drug Supply Infographic

This infographic from the National Harm Reduction Coalition contains information on Xylazine in the drug supply.

Download the infographic

Xylazine: Clinical Management and Harm Reduction Strategies for Patients

This fact sheet is intended to guide healthcare professionals on the clinical management of Xylazine use and harm reduction strategies for their patients.

Download the fact sheet

A Guide to Wound Care Self-management for People Who Use Drugs Caring for a wound 1 5 2 6 3 4 Wash your hands with soap and water, or wear gloves. For larger wounds, wrap the area with medical bandage. Clean the wound with soap and water and dry well. Do not use alcohol or hand sanitizer to clean a wound. Change the gauze or medical bandage twice per day. Apply antibiotic cream to the wound surface. Cover the wound with sterile gauze and secure with a bandage. 4.23When to seek medical care If you experience any of these issues, the wound may be serious and need medical attention. To find a health care provider, call 311 or 844-692-4692. For support for people who use drugs, including harm reduction and medication services, visit nyc.gov/alcoholanddrugs. The wound gets larger, deeper, more painful or tender. There is a foreign object, such as a needle tip, in the wound. There is spreading redness, red streaks around the edges of the wound or a darkened border. There is increased discharge or the presence of pus, or the wound smells. The wound is over an artery or on the face, neck, hands, feet or chest. You experience fever or chills, shortness of breath, weakness, muscle pain, and fatigue.

Wound Care Pocket Card

This pocket card from NYC.gov is a guide to wound care self-management for people who use drugs.

Download the Wound Care Pocket Card

Webinars & Online Learning

This recorded webinar from the PS ROTA-R provides an overview of the fentanyl crisis impacting non-metropolitan rural communities, and the emerging issue of xylazine.

This recorded webinar from the National Council for Mental Wellbeing discusses emerging practices in Xylazine wound care.

In this recorded webinar, panelists provide a brief overview of Xylazine, a substance newly found in illicit drug supplies, and its impacts on the unsheltered community. Panelists will share their lived expertise with xylazine, its effects, organizational best practices for wound care, overdose response, and harm reduction.

Current News & Research

DEA Reports Widespread Threat of Fentanyl Mixed with Xylazine

WASHINGTON – The U.S. Drug Enforcement Administration is warning the American public of a sharp increase in the trafficking of fentanyl mixed with xylazine. Xylazine, also known as “Tranq,” is a powerful sedative that the U.S. Food and Drug Administration has approved for veterinary use.

Southern Nevada Health District calls attention to xylazine risk

The Southern Nevada Health District (SNHD) is urging heightened public awareness of the health dangers associated with xylazine, an animal tranquilizer that is increasingly being found in the country’s illicit drug supply and linked to overdose deaths throughout the United States. Xylazine, also known as “tranq,” is not approved for human consumption. It can be life-threatening and is especially dangerous when combined with opioids such as fentanyl.