Xylazine
What is Xylazine and Why Should I Care?
Xylazine is a strong tranquilizer used in veterinary medicine that has been showing up in heroin, fentanyl, and speedballs in many parts of the U.S. In 2019, about a third of overdose deaths in Philadelphia involved xylazine (and all that involved xylazine also involved fentanyl). Over the past decade, it’s also been confirmed or suspected to be in drug supplies in lots of other places, including Puerto Rico, Maryland, North Carolina, South Carolina, Illinois, Ohio, and Kentucky, with reports increasing throughout 2020.
The effects of xylazine look a lot like the effects of heroin, fentanyl, and other opioids – muscle relaxation, pain relief, slowed breathing, contracting pupils, and drowsiness– but it’s not an opioid, so naloxone doesn’t work on it like it would on heroin, fentanyl, pain pills, and methadone.
What does xylazine look like?
Xylazine itself is a white powder, but in a 2012 study done with people using xylazine in Puerto Rico, study participants reported that powder heroin and speedballs containing xylazine had a distinct, dark brown color. They also said that it had a strong, medicine-like smell and taste. Xylazine overdose looks really
similar to opioid overdose: slowed or shallow breathing, unresponsiveness, and lowered heart rate are all symptoms.
What else should I know about xylazine?
People who use xylazine have reported developing painful skin ulcers – both at the injection site and elsewhere. If you develop an ulcer, do your best to keep it clean and covered, and seek medical attention if it swells, gets bigger, or starts to ooze.
Can I detect xylazine with fentanyl test strips?
Unfortunately not. Since xylazine isn’t an opioid, it isn’t fentanyl or a fentanyl analogue–so a fentanyl test strip won’t be able to tell you if there is xylazine in your drug.
What do I do if I think someone I’m with is overdosing on xylazine?
If you have naloxone on hand, use it! While naloxone doesn’t work on xylazine, it’s important to remember that all the overdose deaths involving xylazine in Philadelphia in 2019 also involved fentanyl, so trying to reverse the impacts of any potential opioids is a good first step here.
If naloxone isn’t working, call 911 or go to the ER for medical attention if you haven’t already. If you can rescue breathe for the
person who’s overdosing in the meantime, this is also a good step.
10.1016/j.forsciint.2014.03.015. Epub 2014 Mar 26. PMID: 24769343.
Is there a naloxone equivalent for xylazine?
Sort of / not really. There is an antidote medication for xylazine that’s used on animals like cows, but it hasn’t been tested on humans – but that doesn’t mean doctors can’t treat xylazine overdose in humans.
How will a xylazine OD be treated at the hospital?
Intubation and IV fluids are used to treat xylazine overdoses. In some cases, xylazine overdoses may cause hypertension or hypotension, and doctors might prescribe medications to treat these symptoms.
Resources
• Torruella RA. Xylazine (veterinary sedative) use in Puerto Rico. Subst Abuse Treat Prev Policy. 2011;6:7. Published 2011 Apr 11. doi:10.1186/1747-597X-6-7
• Reyes JC, Negrón JL, Colón HM, et al. The emerging of xylazine as a new drug of abuse and its health consequences among drug users in Puerto Rico. J Urban Health. 2012;89(3):519-526. doi:10.1007/ s11524-011-9662-6
• Ruiz-Colón K, Chavez-Arias C, Díaz-Alcalá JE, Martínez MA. Xylazine intoxication in humans and its importance as an emerging adulterant in abused drugs: A comprehensive review of the literature. Forensic Sci Int. 2014 Jul;240:1-8. doi:
• https://www.healio.com/news/primarycare/20210203/xylazine-found-in-onethirdof-fatal-opioid-overdoses-in-philadelphia
• https://www.michigan.gov/documents/ mdhhs/Xylazine03042019_648483_7.pdf
• https://www.nvopioidresponse.org/wpcontent/uploads/2020/10/u-public-alertxylazine-003.pdf
• Rodríguez N, Vargas Vidot J, Panelli J, Colón H, Ritchie B, Yamamura Y. GCMS confirmation of xylazine (Rompun), a veterinary sedative, in exchanged needles. Drug Alcohol Depend. 2008;96(3):290-293. doi:10.1016/j.
drugalcdep.2008.03.005
• https://www.mdpoison.com/media/SOP/ mdpoisoncom/ToxTidbits/2019/Jan%20 2019%20ToxTidbits.pdf
• NCSU Xylazine flyer