A new and deadly mixture is intensifying America’s overdose epidemic: the combination of xylazine, a powerful veterinary tranquilizer, and fentanyl, a synthetic opioid already responsible for thousands of deaths nationwide. Xylazine, also known as “tranq,” is not approved for human use but is increasingly found in the illicit drug supply, especially when mixed with fentanyl. The result is a sedative-opioid cocktail that not only increases the risk of fatal overdose but also causes severe soft tissue damage and non-reversible skin ulcers.
In Ohio, xylazine was detected in over 1,100 drug overdose deaths between 2022 and 2023, according to the Ohio Department of Health (2024). This surge marks a dangerous shift in the street drug landscape and signals the urgent need for public awareness, harm reduction strategies, and targeted addiction treatment solutions. As this trend spreads, understanding the risks of this toxic combination is critical to preventing more loss of life.
What is Xylazine?
Xylazine is a non-opioid veterinary sedative used primarily to tranquilize large animals such as horses and cattle. It acts as an alpha-2 adrenergic receptor agonist, producing sedative, muscle relaxant, and analgesic effects in animals. Although not approved for human use by the FDA, it has increasingly appeared as an adulterant in illicit street drugs, particularly when combined with fentanyl.
According to the U.S. Drug Enforcement Administration (2023), xylazine was detected in approximately 23% of fentanyl powder and 7% of fentanyl pills seized by law enforcement in the United States. Its presence significantly increases the risk of fatal overdose because it does not respond to naloxone, the medication used to reverse opioid overdoses.
What Forms Does Xylazine Come In?
Xylazine comes in several forms, most commonly intended for veterinary use, but now frequently found in illicit street drugs. These forms include:
- Injectable Solution: The most common veterinary formulation, typically found in vials and administered intramuscularly or intravenously to animals. On the street, it is often mixed with opioids like fentanyl and injected by users.
- Liquid for Illicit Mixing: In illegal drug manufacturing, liquid xylazine is combined with powdered fentanyl or heroin to increase sedative effects. This combination is often referred to as “tranq dope.”
- Contaminated Powder: Xylazine-laced fentanyl may appear as a white or off-white powder, making it indistinguishable from pure fentanyl to the user.
- Pressed Pills: Xylazine is sometimes pressed into counterfeit pills that resemble prescription opioids like oxycodone or benzodiazepines, increasing the risk of accidental ingestion.
These forms are not regulated for human use, and their potency and risk of overdose varies drastically.
What Happens When Xylazine is Mixed with Fentanyl?
When xylazine is combined with fentanyl, the consequences can be catastrophic, intensifying sedation, suppressing breathing, and increasing the risk of fatal overdose. Since xylazine is not an opioid, the standard reversal medication naloxone (Narcan) does not neutralize its effects according to the DEA.
In Ohio, overdose deaths involving xylazine have risen sharply, from 15 deaths in 2019 to 248 deaths by 2021, with 99.2% of those fatalities also involving fentanyl according to the Ohio Board of Pharmacy. This deadly co-occurrence underscores the severity of the xylazine‑fentanyl mixing trend.
Key risks when these substances are mixed include:
- Intense, prolonged sedation, often beyond the duration of fentanyl alone
- Respiratory suppression that may lead to overdose and coma
- Increased incidence of severe skin lesions and necrosis, especially when injected
- Higher overdose deaths, despite naloxone administration being less effective
For these reasons, harm reduction strategies, awareness campaigns, and expanded testing protocols are urgently needed to reduce the growing threat of xylazine‑adulterated fentanyl.
What Are the Effects of Xylazine?
Xylazine, when misused, produces dangerous effects that impact both the central nervous system and cardiovascular system. These effects are especially severe when xylazine is combined with opioids like fentanyl.
Short-term effects of xylazine misuse include:
- Heavy sedation and unresponsiveness
- Slowed heart rate (bradycardia)
- Low blood pressure (hypotension)
- Slowed or stopped breathing (respiratory depression)
- Blurred vision and disorientation
- Drowsiness and dizziness
Long-term or repeated use results in:
- Skin ulcers and severe soft tissue wounds (sometimes requiring amputation)
- Physical dependence with painful withdrawal symptoms
- Memory problems and impaired motor coordination
- Increased risk of fatal overdose
Can You Get Addicted to Xylazine?
Yes. While xylazine is not classified as a controlled substance and does not produce a classic euphoric “high,” repeated misuse of the drug does lead to physical dependence and compulsive use. People who use xylazine, especially in combination with opioids like fentanyl, often continue using it despite harmful consequences such as deep skin wounds, sedation, or overdose risk.
Withdrawal symptoms such as anxiety, agitation, tremors, and high blood pressure, have been reported in individuals dependent on xylazine, suggesting that physical addiction is possible, even though it is not yet officially recognized as an addictive substance.
According to a 2022 report from the National Institute on Drug Abuse (NIDA), xylazine is increasingly being used in illicit drug markets and presents serious health risks, especially when mixed with opioids. Because xylazine does not respond to naloxone, its presence increases the chance of fatal overdose during opioid use.
What Are the Treatment Options for Xylazine Dependence?
Treatment options for xylazine dependence include a comprehensive, medically supervised approach due to its sedative effects and the risk of withdrawal symptoms like agitation, hypertension, and rebound anxiety. There are no FDA-approved medications specifically for xylazine, but addiction treatment programs and behavioral therapies are effective.
Common treatment options include:
- Medical Detoxification: Inpatient monitoring to manage withdrawal symptoms, stabilize vital signs, and ensure safety, especially important since xylazine withdrawal is unpredictable.
- Residential Treatment: 24/7 care in a structured setting, offering therapy, education, and support for individuals recovering from xylazine and co-occurring drug use.
- Outpatient Programs: Therapy-based care that allows clients to live at home while attending regular treatment sessions.
- Behavioral Therapy: Approaches such as Cognitive Behavioral Therapy (CBT) and trauma-informed care to address psychological drivers of substance use.
- Peer and Case Management Support: Help with relapse prevention, life skills, housing, employment, and reintegration.
Because xylazine is used alongside opioids like fentanyl, dual-substance treatment is typically necessary, including medication-assisted treatment (MAT) for opioid dependence alongside supportive care for xylazine.
Is Xylazine a Commonly used Drug in Ohio?
Yes, xylazine is increasingly common in Ohio’s illicit drug supply, particularly in combination with fentanyl. According to the Ohio Narcotics Intelligence Center, xylazine was detected in approximately 28% of fentanyl-related drug cases in Ohio in 2022 according to Ohio Narcotics Intelligence Center, 2023 Drug Trends Bulletin. This rise has prompted urgent warnings from public health officials due to the drug’s severe health effects and the difficulty in reversing xylazine-involved overdoses with naloxone alone.
What Other Drugs is Xylazine Mixed with?
Xylazine is most commonly mixed with fentanyl, but it is also increasingly found in combinations with other opioids, benzodiazepines, cocaine, heroin, and methamphetamine. These drug mixtures intensify sedation, respiratory depression, and the risk of fatal overdose. The presence of xylazine in drug-related deaths is rising rapidly due to its use as a cutting agent to extend the effects of opioids according to the U.S. Drug Enforcement Administration, Public Safety Alert on Xylazine, March 2023.
Why is xylazine called the “zombie drug”?
Xylazine has earned the nickname “zombie drug” because of its extreme sedative effects, including prolonged unconsciousness, slowed breathing, and the development of deep, necrotic skin ulcers. These symptoms can give individuals a lifeless, “zombie-like” appearance and severely impact mobility and awareness.
What are some street names for xylazine?
On the street, xylazine is referred to as:
- “Tranq”
- “Tranq dope”
- “Zombie drug”
- “Sleep cut”
These names typically describe its tranquilizing effect and association with dangerous drug mixtures like fentanyl.
Why is Xylazine Mixed with Fentanyl?
Xylazine is mixed with fentanyl to increase the potency and duration of the drug’s effects. Drug dealers use xylazine as a cheap additive or “cutting agent” to stretch their fentanyl supply while intensifying its sedative impact. Because xylazine is not an opioid, it extends the high without increasing the cost, making it appealing in illegal drug manufacturing.
However, this mixture significantly increases health risks. Xylazine slows breathing, heart rate, and blood pressure, compounding the already dangerous effects of fentanyl and making overdoses more likely. According to the U.S. Drug Enforcement Administration (2023), over 90% of fentanyl samples in places like Philadelphia also contained xylazine, showing how widespread and dangerous this mix has become.
