Xylazine (Tranq): What You Need to Know About the Drug Changing the Overdose Crisis
A veterinary tranquilizer is contaminating the fentanyl supply—and it’s making overdoses harder to reverse, causing devastating wounds, and complicating treatment.
If You Suspect an Overdose Involving Xylazine
Still give naloxone (Narcan)—it will reverse the opioid component, even though it won’t reverse xylazine. Call 911 immediately. The person may need rescue breathing and emergency medical care.
Xylazine causes dangerous sedation that naloxone cannot reverse. Even after naloxone is given, the person may still have slowed breathing, low blood pressure, and extreme drowsiness. Do not leave them alone.
What Is Xylazine?
Xylazine is a veterinary tranquilizer used to sedate horses, cattle, and other large animals. It has never been approved for human use. But over the past several years, xylazine—also known as “tranq” or “tranq dope”—has been increasingly found mixed into the illicit fentanyl supply.
The result is a drug supply that’s more dangerous than ever. Xylazine extends fentanyl’s sedative effects, but it also introduces new risks that people who use drugs, their loved ones, and first responders need to understand.
In April 2023, the White House declared fentanyl mixed with xylazine an “emerging threat to the United States.” Since then, xylazine has been found in the drug supply in 48 of 50 states.
Xylazine by the Numbers
Why Xylazine Is So Dangerous
Xylazine wasn’t designed for humans—and it shows. Here’s what happens when people are exposed to it:
Naloxone Doesn’t Reverse It
Xylazine is not an opioid, so naloxone (Narcan) cannot reverse its effects. Even after naloxone is given for fentanyl, xylazine’s sedation continues—and the person may still stop breathing.
Dangerous Sedation
Xylazine causes extreme drowsiness that can last for hours. Users describe “blacking out” suddenly. This sedation leaves people vulnerable to assault, accidents, hypothermia, and positional asphyxiation.
Slowed Breathing & Heart Rate
Xylazine depresses the central nervous system, slowing breathing to dangerous levels. Combined with fentanyl, the risk of respiratory failure and death increases dramatically.
Devastating Skin Wounds
“Tranq wounds” are severe, necrotic ulcers that can appear at injection sites or elsewhere on the body. These wounds are slow to heal, prone to infection, and can lead to amputation.
Difficult Withdrawal
Xylazine withdrawal is different from opioid withdrawal and can be more severe. Standard treatments like buprenorphine don’t fully address it, requiring additional medical management.
Often Unknowingly Used
Many people don’t know their fentanyl contains xylazine. It’s often added by dealers to extend the supply or create a product that seems stronger. You can’t tell by looking at drugs whether they contain xylazine.
What to Do If You Suspect a Xylazine Overdose
Naloxone won’t reverse xylazine—but it can still save a life because fentanyl is almost always present too.
DO This
- Give naloxone immediately—it will reverse the fentanyl
- Call 911 right away
- Provide rescue breaths if the person isn’t breathing
- Stay with the person until help arrives
- Place them in the recovery position if unconscious but breathing
- Tell EMS you suspect xylazine involvement
DON’T Do This
- Don’t assume naloxone “didn’t work”—xylazine effects persist
- Don’t leave the person alone after giving naloxone
- Don’t assume they’re okay if they wake up briefly
- Don’t wait to see if they get better before calling 911
- Don’t put them in cold water or try to “wake them up” forcefully
Understanding Tranq Wounds
One of the most alarming effects of xylazine is the severe skin wounds it causes. These wounds are different from typical injection-related injuries and require specialized care.
What Causes Them
Xylazine constricts blood vessels, reducing blood flow to skin and tissue. This leads to tissue death (necrosis). The wounds can appear at injection sites or elsewhere on the body—even in people who don’t inject.
What They Look Like
Tranq wounds often start as areas of darkened skin or small ulcers, then progress to deep, open sores with dead tissue. They may have a foul smell and yellow or green drainage indicating infection.
Why They’re Dangerous
These wounds heal very slowly and are prone to severe infection. Without treatment, infections can spread to bone (osteomyelitis), cause sepsis, or require amputation to save the person’s life.
Getting Help
Seek medical care for any wound that isn’t healing, looks infected, or is spreading. Many harm reduction programs now offer wound care kits. Don’t delay treatment out of fear or shame—early care prevents serious complications.
Signs Someone May Have Used Xylazine
Extreme Sedation
Unusually long periods of unconsciousness or “nodding out” that last longer than typical opioid use
Unusual Wounds
Open sores, ulcers, or areas of dead skin, especially on arms, legs, or hands—even away from injection sites
Naloxone “Not Working”
Person remains sedated or has slowed breathing even after naloxone is given
Low Blood Pressure
Dangerously low blood pressure, slow heart rate, or feeling faint when standing
Memory Gaps
Blacking out suddenly or having no memory of extended periods of time
Severe Withdrawal
Withdrawal symptoms that don’t respond to buprenorphine or seem more intense than typical opioid withdrawal
Xylazine Withdrawal Is Different
One of the biggest challenges with xylazine is that withdrawal is different from opioid withdrawal—and standard treatments may not fully address it.
Opioid Withdrawal
- Nausea, vomiting, diarrhea
- Muscle aches and pain
- Anxiety and restlessness
- Insomnia
- Sweating and chills
- Runny nose and watery eyes
- Responds to buprenorphine/methadone
Xylazine Withdrawal (Additional)
- Severe anxiety and agitation
- Rapid heart rate
- High blood pressure
- Intense physical discomfort
- Does NOT respond to buprenorphine alone
- May require clonidine or dexmedetomidine
- Often more intense than opioid withdrawal alone
Medical Supervision Is Important
If you’ve been using drugs that may contain xylazine, detoxing without medical supervision can be dangerous. Xylazine withdrawal requires different treatment than opioid withdrawal alone. A medical team can provide medications like clonidine to manage symptoms safely and ensure you get proper wound care if needed.
Treatment for Xylazine-Involved Addiction
Recovery is possible—even when xylazine is involved. Treatment addresses both the opioid addiction and xylazine-specific complications.
Medical Detox
Supervised detox is especially important when xylazine is involved. Medical staff can provide appropriate medications for both opioid and xylazine withdrawal, monitoring vital signs and managing symptoms safely.
Medication-Assisted Treatment
Suboxone or methadone address the opioid component of addiction. Additional medications like clonidine may be used to manage xylazine withdrawal symptoms. Your treatment team will develop a personalized plan.
Wound Care
If you have tranq wounds, treatment includes proper wound care to prevent infection and promote healing. Some treatment programs coordinate with medical providers for ongoing wound management.
Therapy & Support
Addiction treatment isn’t just about managing withdrawal. Therapy, counseling, and peer support address the underlying factors that drive addiction and help you build a sustainable recovery.
Harm Reduction: Staying Safer
If you’re not ready to stop using, there are steps you can take to reduce your risk:
- Test your drugs. Xylazine test strips are available through some harm reduction programs and can detect xylazine in drug samples before use.
- Don’t use alone. Have someone with you who can call 911 and give naloxone if you overdose. If that’s not possible, call a crisis line or use an app that can alert someone if you don’t respond.
- Start with a small amount. The potency of street drugs varies wildly. Start with a small test dose to gauge the strength.
- Carry naloxone. Even though naloxone doesn’t reverse xylazine, it can still save your life by reversing the fentanyl component. It’s available without a prescription in most states.
- Seek wound care early. If you notice wounds that aren’t healing or look infected, get medical care before they become life-threatening. Many harm reduction programs offer basic wound care.
- Know the signs of overdose. Blue lips, unresponsive, slow or stopped breathing—if you see these signs, give naloxone, call 911, and provide rescue breaths.
Help Is Available
If you or someone you love is struggling with opioid addiction—whether or not xylazine is involved—treatment can help. You don’t have to figure this out alone.
Frequently Asked Questions
