Lethal street drug resistant to Naloxone gains popularity

By Lisa Marie Basile | Fact-checked by Barbara Bekiesz
Published February 22, 2023

Key Takeaways

  • Xylazine (or “Tranq”) is a dangerous new recreational drug often combined with other substances. It is responsible for a growing number of overdoses. 

  • It can lead to skin ulcers, central nervous system and respiratory depression, hypotension, and other health complications, including death.

  • There are no FDA-approved medications available to treat xylazine dependence. Naloxone does not work to reverse potential overdoses.

​​A dangerous new recreational drug, xylazine—also referred to as “tranq”—has made its way through cities across America. Its effects can cause serious health consequences and, in many cases, overdose and death, according to the journal Drug and Alcohol Dependence.[] 

Xylazine’s impact in recent years is undeniable. For example, deaths related to xylazine in Pennsylvania jumped from 2 percent to 26 percent from 2015 to 2020, while xylazine was involved in 19 percent of all overdose deaths in Maryland in 2021.[]  Deaths related to xylazine may also be underreported, as many forensic labs and toxicology tests do not test for xylazine. Its popularity comes down to how cheap it is to access and how strong its effects are. According to Abid Nazeer, MD, a psychiatrist and senior medical advisor for Symetria Recovery, “Xylazine’s popularity is connected to its ability to potentially extend the effect of other drugs, such as heroin and fentanyl.” Xylazine can also be bought very cheaply by dealers, who can order it online, Nazeer tells MDlinx.

What is xylazine?

Xyalzine was approved by the US Food and Drug Administration (FDA) for veterinarian use only (although it’s not a federally controlled substance)—specifically as a sedative, muscle relaxant, and analgesic for cattle, horses, sheep, and other animals.[] Originally formulated in 1962 by the Bayer Company, it had been studied in humans, but it was not approved for human use due to its negative effects on health, according to the United States Department of Justice’s Drug Enforcement Administration (DEA).[]

In illegal use, xylazine is most often incorporated as an adulterant in combination with fentanyl, a synthetic opioid. Illicitly manufactured fentanyl has been responsible for a surge in overdose deaths due to its very lethal effects, according to the National Institute on Drug Abuse.[] 

Physicians—especially those treating persons with substance use disorders—should know that xylazine is also commonly mixed with cocaine and heroin, among other substances.[] Xylazine users can administer it in various ways, including oral ingestion, inhalation, or, most commonly, through injection.[] While some drug users seek it out, many do not know they’re consuming it. 

What are the effects of xylazine?

Xylazine, a central alpha-2-adrenergic receptor agonist in the brainstem, explains the FDA.[] It causes a rapid decrease in the release of norepinephrine and dopamine in the central nervous system (CNS). Persons using this drug may experience CNS and respiratory depression, hypotension, bradycardia, hypothermia, miosis, or high blood glucose levels.

Megan Tangradi, MS, LPC, LCADC, CCS, CCTP, who is Clinical Director at Achieve Wellness & Recovery in Northfield, NJ, describes the effects of xylazine.

“Physicians should know that effects of the drug can vary from person to person, but typically include feeling relaxed and euphoric, and having an altered perception of reality,” she says.

"It produces a relaxing and euphoric effect, making it attractive for people looking for a new way to get high.  "

Megan Tangradi, MS, LPC, LCADC, CCS, CCTP

Nazeer offers some other observations. "[Because] xylazine has a tranquilizing effect on the body,...a person using the substance may appear drowsy, forgetful, and disoriented,” he explains. 

Xylazine also affects the skin. According to an article in Cureus,[] skin ulcers are reported in individuals who inject the drug—both in the injection site area and other areas, particularly where cuts are present.[]

Discussing a case report, the authors of the article noted that, in their patient, the skin lesions were associated with drainage and a foul smell. In addition, there was also extensive necrosis of the subcutaneous tissues, abscesses, and tibial osteomyelitis, which led to multiple hospitalizations and treatment with intravenous antibiotics, along with topical treatment and debridement of the wounds.

Treating patients who use xylazine

People who use xylazine may experience serious health consequences and withdrawal symptoms. Currently, there are no FDA-approved treatments to help patients who want to quit using xylazine. The FDA recommends that patients receive treatment for withdrawal in an outpatient rehabilitation facility or an acute clinical setting.

If you have patients who use drugs recreationally, they should know that naloxone cannot be relied on to reverse the effects of a suspected xylazine overdose, nor can it treat the health problems associated with xylazine. However, medical practitioners should still administer naloxone to a person suspected of xylazine overdose, since the drug is frequently mixed with other drugs that do respond to naloxone.

It’s important to rule out xylazine use in patients with severe skin ulcers, as this could indicate repeated exposure. Also, it could be present in those who do not respond to naloxone after an overdose.[]

Tangradi emphasizes that compassionately supporting patients who use drugs is key to their getting care. “Physicians should understand that it can be difficult for patients to take the first step in seeking help and support,” she says. Physicians need to create an “open and non-judgmental environment where patients feel comfortable discussing their mental health needs.”

When it comes to patients who may be using xylazine—or any other illicit drug—Tangradi says it’s essential to provide patients with the resources and referrals necessary to find the right support. “This could include recommending a mental health professional, a helpline, community resources, and information about any treatments or therapies available in the area,” she says.

From there, you must follow up, especially with people who need continued support. As Tangradi recommends, physicians should ensure that patients are getting the help they need and should monitor them for any changes in their condition.

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