Xylazine and Opioids: Effects and Overdose Risk

Xylazine, sometimes also known as “tranq,” is a potent veterinary sedative drug that is now frequently being used as an adulterant in illicit opioids and other drugs.1,2 In particular, xylazine is mixed with illegally manufactured fentanyl, an already deadly opioid drug on its own. A report from 2022 stated that about 23% of fentanyl powder and 7% of fentanyl pills that were seized by the DEA were found to contain traces of xylazine.1

In this article, we will talk about xylazine, describe its sedating effects, as well as combination effects when it is used with opioids such as fentanyl, and the risks this may pose to your health.

What Is Xylazine?

Xylazine is a non-opioid sedative analgesic drug with pain-relieving and muscle relaxant properties approved for use in veterinary treatment. It is not approved for human use.2 In the 1960s, clinical trials were initiated to investigate xylazine for human medicinal use, but the drug’s severe side effects resulted in these trials being halted.3

 Only licensed veterinarians are approved to authorize use of xylazine in their animal patients.4 However, xylazine is not regulated under the Controlled Substances Act,5 making it relatively easy for illicit drug manufacturers to obtain inexpensive liquid and powder forms of the drug, potentially through foreign internet suppliers.6, 7 From there, it is mixed with other drugs, like fentanyl, to enhance the street value of the adulterated drug by increasing psychoactive effects as well as to increase the profit made by illicit drug trafficking.6

Xylazine Side Effects

Because there have not been extensive human trials, the full extent of adverse effects from xylazine is not fully known. However, reports from people who have used xylazine – most often inadvertently – indicate that it can cause a variety of adverse side effects, including:6

  • Dry mouth.
  • Drowsiness.
  • Initial rise in blood pressure, followed by hypotension.
  • Initial elevation of heart rate, followed by marked slowing.
  • Abnormal heart rhythm.
  • Hypothermia.
  • Respiratory depression.
  • Coma.

Furthermore, individuals who inject xylazine or drug combinations containing xylazine may develop skin infections that can turn necrotic.6

Xylazine and Fentanyl

Mixing xylazine and fentanyl has become increasingly prevalent, with the DEA reporting seizures of xylazine-laced fentanyl in 48 out of 50 states.1

It is worth noting that while xylazine is most commonly associated with fentanyl,5 it is also being reported as a contributor to other types of mixed overdose deaths, including those involving benzodiazepines, cocaine, and prescription opioids.2

The Dangers of Xylazine with Opioids or Other Drugs

Xylazine-adulterated drugs are an emerging threat in the U.S.1, and as such there is still a great deal to learn about the full scope of the risks associated with this dangerous combination. However, experts are aware of a number of dangers, including:

  • Profound sedation that can outlast the effects of substances it is mixed with.7
  • Muscle and nerve injuries resulting from staying in the same position for several hours, due to xylazine’s sedative effects (e.g., compartment syndrome).
  • Soft tissue damage from infections, rotting tissue, and tissue death. This can result in an increased risk of limb loss.7

Xylazine and Opioid Overdose

Overdose is the most serious risk associated with xylazine and opioid combinations, as it can be fatal. Xylazine is commonly mixed with opioids, like fentanyl or heroin,2 which can have additive effects such as decreased respiratory rates and profound sedation.2, 7  This can lead to a much higher risk of overdose and death.2

Xylazine overdose symptoms may appear to be like opioid overdose symptoms. The combination of xylazine and opioid overdose symptoms include:8

  • Profound sedation/drowsiness.
  • Dizziness.
  • Weakness.
  • Lack of coordination.
  • Reduced or absent muscle reflexes.
  • Stumbling, slurred speech, disorientation (i.e., ataxia).
  • Blurred vision.
  • Vacillations in heart rate and blood pressure.
  • Markedly constricted or “pinned” pupils.
  • Respiratory depression.
  • Coma.

Not all jurisdictions in the U.S. test for xylazine in overdose deaths, so the exact number of overdose deaths is unknown.6 However, reports from jurisdictions where xylazine was found in postmortem toxicology testing found a significant increase in the number of xylazine-related overdose deaths. In 2021, the total number of deaths rose to 3,089, up from 808 in 2020.6

Is Xylazine Addictive?

Since xylazine is most often used in combination with other substances, its own addiction potential is not completely understood. At this point in time, much attention has rightfully been placed on xylazine for its contribution to an ongoing opioid overdose epidemic. However there has been some evidence that the drug is being misused on its own Puerto Rico, that repeated xylazine use can lead to physiological dependence, and that the drug may be associated with other symptoms consistent with a xylazine-related substance use disorder.5-7

Xylazine Withdrawal

Individuals who have used xylazine have reported that they experience withdrawal symptoms.5-7 Some of the symptoms of xylazine withdrawal include:7

  • Acute anxiety.
  • Panic.
  • Dysphoria.
  • Increased heart rate.
  • Increase blood pressure.

Addiction Treatment Near Tampa

If you are experiencing addiction to opioids or are concerned about misuse of xylazine and opioids, help is available today at River Oaks. Our Tampa metro area inpatient rehab facility offers multiple rehab levels of care designed to meet your unique needs.

Contact our rehab admissions team at today for more information. Our staff can help you explore rehab payment options, including payment plans and using insurance to pay for rehab. Don’t wait another day to start your journey on the road to recovery. We are here for you.

Was this page helpful?
Thank you for your feedback.

American Addiction Centers (AAC) is committed to delivering original, truthful, accurate, unbiased, and medically current information. We strive to create content that is clear, concise, and easy to understand.

Read our full editorial policy

While we are unable to respond to your feedback directly, we'll use this information to improve our online help.

The Price of Not Getting Help
When contemplating the costs of addiction treatment for yourself, child, or loved one, consider the costs, or consequences, of “things as they are now.” What would happen if the substance abuse or addiction continued? Rehab doesn't have to be expensive. We accept a variety of insurances. Learn more below.