What you need to know about xylazine. a veterinary sedative being added to "tranq" dope throughout the United States.
Beginning in the early 2000s, the veterinary anesthetic xylazine was detected in illegal drug supplies in Puerto Rico. From there, it spread to the East Coast of the United States, beginning in Philadelphia, where this so-called "tranq" dope attracted an ardent fan base.
At present, xylazine has been found in fentanyl and heroin samples from throughout the continental United States. It is most prevalent in the South and Northeast.
Drug Enforcement Agency statistics indicate that in 2022, 23% of seized fentanyl powder contained xylazine.
As these DEA figures released in October 2022 indicate, xylazine was most often found in fentanyl samples seized in the Northeast and Southern United States. Its prevalence continues to increase nationwide.
These data, released in October 2022, indicate that overdoses involving xylazine, the vast majority of which also involve fentanyl, are increasing throughout the continental United States, most dramatically in the Southern United States. From 2020 to 2021 in the South, the number of xylazine-positive fatal overdoses increased from 116 to 1,423 (a rise of over 1,100%).
Fast Fact #1 - Xylazine is a Veterinary Tranquilizer
Xylazine belongs to a group of chemicals known as phenothiazines.
Significantly, this group of structurally related compounds also includes tricyclic antidepressants and the alpha-adrenergic agonist clonidine, a blood pressure regulator that is used to mitigate the Restless Legs Syndrome (RLS) and anxiety caused by opioid withdrawal.
In veterinary medicine, xylazine is used as a surgical anesthetic for horses, rabbits, and other animals because it produces sedation, muscle relaxation, and analgesia (decreased pain).
Possible medical uses of xylazine for humans were investigated, but its side effects, particularly bradycardia (slow heart rate) and hypotension (low blood pressure), were judged to be too severe.
Fast Fact #2 - Xylazine Boosts the Effects of Fentanyl
The vast majority of the xylazine available in the United States is combined with fentanyl in so-called "tranq" dope.
When taken on its own, xylazine is unlikely to be particularly recreational.* However, when mixed with fentanyl, it increases the sedation, respiratory depression, and other effects of fentanyl.
*During college, I injected veterinary xylazine; trip report available here. Previously, I wrote about xylazine hitting the dope supply in my home city in Upstate New York here.
Mixing xylazine with fentanyl causes a "nod" that is much closer to anesthetized unconsciousness than to your average, in-and-out heroin or fentanyl high.
Fast Fact #3 - Xylazine Increases the Chance and Severity of Overdose
Because it increases the respiratory depression and low blood pressure caused by fentanyl, xylazine greatly increases the risk of OD.
Because xylazine is not an opioid, Narcan [naloxone] is not effective in reversing xylazine overdose. However, Narcan should still be administered in cases of suspected OD because the majority of xylazine in the U.S. is sold in combination with illicit fentanyl powder and pills.
There is no approved antidote or reversal agent for xylazine overdose; treatment consists of supportive care involving mechanical ventilation in an Intensive Care Unit (ICU).
Fast Fact #4 - Xylazine Causes Skin Sores That Can Lead to Sepsis and Amputation
For reasons that are not yet understood, in some users, xylazine causes widespread skin lesions that appear 24 to 48 hours after first use.
These ulcers begin as pea- to penny-sized, semicircular lesions found on the arms, legs, face, and other areas (see pic below). They grow rapidly for as long as xylazine is ingested, and they have a tendency to become infected.
Infection of the ulcers can lead to sepsis, in which bacteria spread to the blood, causing multi-organ-system damage and death.
The rate of amputations is very high in xylazine users relative to users of fentanyl, heroin, and other illicit opioids not mixed with xylazine.
Once the user stops ingesting xylazine, the ulcers gradually disappear over a period of days to weeks (so long as infection is resolved and they are kept clean to promote healing).
However, the sores can cause significant, long-term scarring.
Important note: These xylazine sores are not related to route of administration. They appear whether the xylazine is snorted, injected, or smoked.
![A photo of a dozen penny-sized lesions (red, circular spots) spread throughout the skin on the legs of a male in his mid-thirties who is a xylazine user (the ulcers appeared 24 to 36 hours after ingesting the xylazine ["tranq" dope] and disappeared after one to two weeks of abstinence from the drug).](https://static.wixstatic.com/media/6cc57b_529f8aae1f014ce9b4c36f26f04e60bb~mv2.jpeg/v1/fill/w_147,h_196,al_c,q_80,usm_0.66_1.00_0.01,blur_2,enc_auto/6cc57b_529f8aae1f014ce9b4c36f26f04e60bb~mv2.jpeg)
Sores from xylazine, which appeared 24-36 hours after my friend Mike ingested the drug (it was combined with fentanyl and procured in the Indianapolis, IN area). These are early-stage lesions; if you Google "xylazine sores," you will see arm and leg bones exposed because great tracts of tissue have been eaten away by the ulcers.
Unless the user stops ingesting xylazine, the sores rapidly spread over the face, legs, arms, and other areas of the body. They enlarge until they extend over entire hands / feet / arms / legs.
The sores frequently become infected, which can lead to sepsis, a disseminated infection in which bacteria enter the bloodstream and cause multi-organ-system damage and even death.
There seems to be some genetic / immunological predisposition to developing the sores, perhaps akin to an allergy. Interestingly, people can begin reacting to xylazine in this manner even if they haven't developed sores after taking the drug in the past (this happened to Mike's girlfriend, who'd thought she was "immune" to developing them).
Harm Reduction / Risk Mitigation Strategies
If you are using fentanyl in the United States in 2024, it is very likely that at least some of the dope that you are snorting or injecting contains xylazine.
It is imperative that you obtain test strips for xylazine, which are available for free from a variety of government divisions / agencies as well as nonprofit groups.
In New York State, for example, the Office of Addiction Services and Supports (OASAS) will send you xylazine test strips for free (order form here; Narcan [naloxone] and other harm reduction supplies are available as well).
If you have recently ingested what you believe to be tranq dope and have even a single sore anywhere on your body, you need to go to a doctor and obtain a broad-spectrum antibiotic immediately. It is quite possible that life and limb depend upon it.
Carpe Diem Before There Isn't Any Diem Left To Carpe
The wave of fatal xylazine-fentanyl overdoses that the U.S. is currently experiencing is reminiscent of the period in 2015-2016 when fentanyl began replacing heroin in the U.S. illicit opioid supply, as a result of which addicts were dropping like flies.
There has never been a better time to get clean and sober - while you still have all four limbs and haven't sustained severe brain damage from an OD!
Use the resources below to find a 12-Step meeting and / or an opioid maintenance treatment provider.
As always, feel free to use the "Contact" form or Instagram (concreteconfessional) to reach me with questions.
Buprenorphine and Methadone Provider Directories
*Brixadi is another injectable formulation that you might want to look into
*In certain states, you might be able to obtain buprenorphine by e-consultation. I recommend avoiding this whenever possible because A) these doctors tend to be more expensive, and B) I have heard about too much sketchiness tied to these providers. Very few ethical clinicians are willing to dole out buprenorphine without seeing you face-to-face and drug testing you randomly.
*Includes methadone clinic listings
12-Step Meetings (Alcoholics Anonymous [AA] and Narcotics Anonymous [NA])
Intherooms.com has daily, digital meetings at many different times and with different foci / themes throughout the week.
The official meeting listings for your area are best found by Googling the nearest town or city or the name of the region that you live in plus "AA meetings" or "NA meetings" (so, I use the Syracuse AA Intergroup website and the Heart of New York page on the Northern NY NA site).
Intherooms.com has a meeting directory, as well.
Alternatively, you can call your state's addiction treatment division for help finding 12-Step and SMART Recovery meetings.
In New York State, the Office of Addiction Services and Supports (OASAS) has a helpline that will help you to connect with treatment resources (1-877-8-HOPENY).
Stay safe and keep your heads up!