Opioids Mixed With Xylazine: Effects & Risks

In the U.S., xylazine is increasingly being used as an additive in illegal drugs like fentanyl and heroin and contributing to the number of accidental overdoses reported nationwide each year.¹

This article provides an overview of what xylazine is, what it’s used for, the dangers of mixing xylazine with opioids, and more.

What Is Xylazine?

Xylazine is a non-opioid tranquilizer with no approved human use in the United States.  It is used in veterinary medicine for its sedative, pain relieving (analgesic), and muscle relaxant properties. On the illicit market, xylazine is sometimes known as tranq or tranq dope.^1,2

First developed by Bayer in 1962, xylazine was investigated for use as an anesthetic, sleep aid, and pain reliever in humans, but trials were discontinued because of adverse side effects like dangerously low blood pressure and slowed breathing.²

Today, xylazine is approved for use in animals for veterinary purposes only.² However, the drug’s illicit use is gaining traction across the country and being used—both intentionally and unintentionally—in combination with opioids, especially illicitly manufactured fentanyl.^1,3

In 2015, xylazine was involved in less than 1% of fatal overdoses in the U.S.¹ Since then, that number has surged, with one report citing a 276% increase in the monthly percentage of deaths involving illicit fentanyl with xylazine between the years 2019 and 2022.⁴

Fentanyl laced with xylazine has been encountered in at least 48 states.5 Use is particularly widespread in the South, where deaths have risen by 1,127% in recent years.⁶ 

Although xylazine is not yet a controlled substance, the White House’s Office of National Drug Control Policy has issued a National Response Plan to address this emerging public health threat.¹

What Is Xylazine Used For?

Xylazine is FDA-approved for use as an animal tranquilizer and pain reliever.²

However, the drug has been appearing more and more in the illegal drug supply as an adulterant in cocaine and opioids like fentanyl and heroin.¹ Xylazine can be purchased cheaply, making it an ideal substance for drug traffickers to mix with other more expensive drugs and increase their profits.⁶

People who use xylazine may knowingly combine it with opioids to prolong the desired euphoric effects.³

Although less common in the mainland U.S., xylazine is sometimes used as a drug of abuse on its own. There have also been reports of the drug being used in crimes to induce sleep.^2,6

When used illicitly, xylazine is most commonly injected but may also be snorted or swallowed.¹

Effects of Xylazine

Because the drug’s early clinical trials were halted, the effects of xylazine in humans remain largely unstudied.^4,6

People who have used xylazine report serious health effects, including:^1–3

• Drowsiness.
• Memory loss.
• Slowed breathing.
• Decreased heart rate.
• Low blood pressure.

Dangers of Opioids Mixed with Xylazine

There is still a lot that we do not know about the dangers of mixing xylazine with opioids.^4,6 But we do know that the combination can be deadly, and it is having a growing impact on the nation’s opioid and overdose crisis.³

In addition, repeatedly injecting xylazine or xylazine mixed with other drugs like opioids may also cause severe and infected skin lesions. This is associated with an increased risk of amputation due to necrosis (dead skin tissue), as compared to people who inject drugs without xylazine.⁶

Recent statistics highlight the rising use and fatality of opioids mixed with xylazine. In Maryland, authorities detected xylazine in nearly 80% of opioid drug samples tested between 2021 and 2022. In Philadelphia, toxicology reports from 31% of heroin- or fentanyl-involved deaths in 2019 showed traces of xylazine.¹

Can You Overdose on Xylazine?

Yes, it is possible to overdose on xylazine, and the risk may increase when combined with opioids like heroin and fentanyl, which is where the substance is often found.^1,3 Overdose is the most serious risk associated with mixing xylazine and opioids.

An overdose is a life-threatening medical emergency. If you think you or someone else is overdosing, call 911 immediately.

Signs of a possible xylazine-opioid overdose may include:^3,7

• Diminished reflexes.
• Muscle weakness.
• Lack of coordination and slurred speech.
• Extreme drowsiness or sedation.
• Stupor or confusion.
• Vomiting.
• Pinpoint pupils.
• Decreased heart rate and weak pulse.
• Low blood pressure.
• Slow or labored breathing.

As mentioned above, xylazine overdoses are on the rise. In some clinical settings, however, xylazine’s role in an overdose may go undetected, because symptoms can overlap with those of an opioid overdose and many places do not routinely screen for xylazine in drug tests. This leads some experts to believe the true number of xylazine overdoses may be underreported.^3,6

There is no antidote approved to reverse the effects of xylazine, and the FDA has voiced serious concerns that naloxone, the opioid overdose reversal drug, may not always be effective for overdoses involving xylazine, since the adverse effects of xylazine may persist after opioid effects are blocked.^6,8

Still, the FDA and CDC urge people to use naloxone in the event of a suspected overdose because xylazine is frequently used in combination with opioids.^1,8

Is Xylazine Addictive?

The addiction potential of xylazine has not been well studied. However, xylazine is usually mixed with opioids like heroin and fentanyl, as well as other illicit substances like cocaine, which we do know are extremely addictive.^1,3

Becoming addicted to opioids or other drugs can therefore increase a person’s likelihood of consuming xylazine—either knowingly or unknowingly—and increase their overall risk.³ 

However, while there is some evidence for patterns of xylazine misuse on its own in Puerto Rico, the most alarming issues here in the U.S. are the drug’s increasing link to polysubstance use, addiction, and overdose.^3,6–8

Opioid Addiction Treatment in Mississippi

If you or a loved one is concerned about xylazine or opioid misuse and addiction, professional treatment can help. At Oxford, we offer several different types of rehab and personalized care to meet the individual needs of each patient.

Inpatient rehab, also known as residential treatment, includes safe housing, medical attention, and 24-hour structured care, as well as a range of therapies. Outpatient programming involves many of the same therapies used in inpatient treatment, but patients are not required to live on-site.

To learn more about your treatment options and start the rehab admissions process, call our free, confidential helpline at . Our admissions navigators are available around the clock to answer questions about how to pay for addiction treatment and using insurance to pay for rehab.

Or you can fill out this simple and secure to instantly verify your insurance coverage with us.

Don’t let the devastating side effects of addiction go on. Our inpatient rehab facility in Mississippi is ready to help you begin the path to recovery today.