Xylazine

What is xylazine?

Xylazine is a central nervous system depressant that has long been approved by the Food and Drug Administration for use in animals. Veterinarians performing surgery on horses, deer, or other large animals administer the drug to induce sleep or control pain.

Xylazine is not safe for human use in any circumstances. However, people have begun to use the drug either alone or in combination with other drugs, especially with the dangerous synthetic opioid fentanyl. They may use xylazine to get high or make the high from fentanyl or another drug last longer.

Illicit xylazine is often a white or brown powder, which can be mixed into other powders or pressed into pills. People take xylazine by injecting, snorting, smoking, or swallowing it. 

In some cases, people take xylazine without knowing it. That’s because dealers are lacing other illicit drugs with xylazine, as it is cheap, addictive, and hard to identify.

Xylazine use is contributing to a spike in overdose deaths. In July 2023, the White House issued an “emerging threat” response plan to deal with the harms of xylazine, and especially xylazine combined with fentanyl.

Xylazine effects and risks

Effects

After people take xylazine, they quickly enter a trancelike state or a deep sleep that can last between 30 minutes and several hours. Xylazine is sometimes called the “zombie drug” because of these effects.

Side effects may include:

• Blurry vision.
• Coma.
• Difficulty breathing or slowed breathing.
• Disorientation and stumbling movement.
• Drowsiness.
• Elevated blood sugar.
• Low blood pressure.
• Memory loss.
• Severe skin wounds.
• Slowed heart rate.
• Small pupils.

Risks

Suffocation. Heavy sedation from xylazine may cause suffocation or restricted breathing.

Experiencing violence. People are at risk of being robbed or assaulted while sedated.

Body sores and xylazine wounds. Lying in one place for a long time while sedated may cause body sores. Additionally, people who use xylazine can develop severe skin wounds that are easily infected — regardless of whether the drug is injected, snorted, smoked, or swallowed. This could be due to xylazine’s restriction of blood flow to the skin. Limbs with untreated wounds (or “xylazine necrosis”) may need to be amputated.

Overdose. People who use xylazine alone, and especially those who use it with other drugs, are at risk of injury or death by overdose. Taking fentanyl mixed with xylazine can cause profound sedation and suppressed breathing, which can be fatal. Still, experts believe these fentanyl-xylazine deaths are primarily caused by fentanyl, which is why they recommend administering naloxone to anyone experiencing an overdose. Fentanyl and xylazine are even more likely to cause a fatal overdose when taken with other drugs such as alcohol, cocaine, heroin, and benzodiazepines.

Dependence. A “dual” dependence on xylazine and fentanyl appears to cause people to experience severe withdrawal symptoms when they try to stop use. Experts are exploring the best remedies to treat xylazine-related withdrawal symptoms. However, the pain of withdrawal from opioids like fentanyl can be treated with medication for opioid use disorder.

How to reduce risk

Public health experts are still studying the use of xylazine in humans, including how to treat its effects. Ways to reduce your risk include the following:

• Carry naloxone (i.e., Narcan or RiVive) to stop overdoses potentially involving opioids.
• If you can, use test strips to check every batch of illegal drugs for fentanyl and xylazine. Order test strips for fentanyl and xylazine online or get them at stores or community-based nonprofits.
• Do not use xylazine or opioids, including fentanyl, by yourself. 
• Do not use opioids with alcohol or other types of drugs.
• If you are going to use drugs, do so in a safe location and from a seated position that doesn’t cut off circulation.

Find more harm reduction methods.

Find xylazine treatment and start your recovery

Recovery from substance misuse and dependence is a personal journey, and there’s no single solution that works for everyone. 

Start by finding a trained health care professional to conduct a medical needs assessment. They can work with you to create a recovery plan, care for wounds, and recommend treatment, therapies, and support groups to promote your recovery.

Recovery from substance misuse is possible.

Sources

Fentanyl Adulterated or Associated With Xylazine Response Plan, White House Office of National Drug Control Policy, July 2023

Fentanyl Test Strips: A Harm Reduction Strategy, Centers for Disease Control and Prevention, Sept. 30, 2022

FDA Alerts Health Care Professionals of Risks to Patients Exposed to Xylazine in Illicit Drugs, Food and Drug Administration, Nov. 8, 2022

FDA Takes Action To Restrict Unlawful Import of Xylazine, Food and Drug Administration, Feb. 28, 2023

Harm Reduction Issues: Fentanyl, National Harm Reduction Coalition

ICYMI: In Continued Response to Overdose Epidemic, the White House Releases National Response Plan To Address the Emerging Threat of Fentanyl Combined With Xylazine, White House Office of National Drug Control Policy, July 11, 2023  

Opioid Overdose, Substance Abuse and Mental Health Services Administration, March 21, 2023  

The Growing Threat of Xylazine and Its Mixture With Illicit Drugs, DEA Joint Intelligence Report, Drug Enforcement Administration, U.S. Department of Justice, October 2022

What Is Rescue Breathing and How Does It Differ From CPR? Healthline, Nov. 9, 2020

What You Should Know About Xylazine, Centers for Disease Control and Prevention, July 17, 2023

Xylazine, Drug Enforcement Administration, May 2023

Xylazine, National Institute on Drug Abuse  

Xylazine, New York Office of Addiction Services and Supports

Xylazine Fact Sheet, New York Office of Addiction Services and Supports, May 2023

Xylazine Hydrochloride, PubChem, National Library of Medicine

Xylazine: What Clinicians Need To Know, New York State Department of Health