This Week’s Focus: Xylazine
This week’s briefing focuses on xylazine, a veterinary tranquilizer that has been found in the illicit opioid supply. Xylazine is a central nervous system depressant that can cause painful and difficult-to-treat skin and muscle sores, which can lead to infection, necrosis, and even amputation of affected areas.
In this briefing, we highlight our NDEWS Special Report on xylazine-related overdoses, our latest NDEWS Web Monitoring Report, and several articles that indicate the severity of the effects that xylazine use can present.
NDEWS ORIGINAL CONTENT
NDEWS Special Report: EMS encounters for nonfatal xylazine-related overdoses in the US January 1, 2024 – September 30, 2025
There were 1,039 EMS encounters for nonfatal xylazine-related overdoses from January 1, 2024 to September 30, 2025. The ten counties with the highest rates are shown; most counties were located in the Northeastern region, particularly in Pennsylvania, as highlighted in one of our articles in this Briefing. The data shows a statistically significant increase in EMS encounters for nonfatal xylazine-related overdoses across the US during this time period.
NDEWS Web Monitoring Report: Xylazine
Why are we reporting on this?
Xylazine has become increasingly prevalent as an adulterant in the illicit opioid supply across the United States. Xylazine-adulterated drugs have now spread nationwide, with reports appearing regularly across substance use forums.
What is Xylazine?
Xylazine (street name: “tranq”) is a veterinary sedative and α2-adrenergic receptor agonist used for animal anesthesia. It is not approved for human use. Reddit commentors report that xylazine is being used as a cutting agent in illicit fentanyl and heroin, producing sedation beyond typical opioid effects. Reddit commentors also report that, unlike opioids, xylazine’s effects cannot be reversed with naloxone (Narcan).
Public Health Impacts
Reddit commentors report experiencing extreme sedation characterized by sudden “blackouts” lasting hours, often waking in dangerous positions or locations with no memory of the time elapsed. Many commenters describe wounds and necrotic tissue developing at injection sites that are slow to heal and prone to infection, with some reporting tissue damage even from intranasal use.
Discussants note that xylazine creates its own distinct withdrawal syndrome separate from opioid withdrawal, with symptoms including dangerous blood pressure fluctuations, severe anxiety and panic, intense sweating and temperature dysregulation, and muscle spasms or seizures in severe cases. Commentors report that these withdrawals can be life-threatening, with some individuals requiring ICU admission.
How is it being discussed?
Reddit commentors demonstrate high awareness of xylazine contamination and actively work to identify and avoid it. Many discussants report purchasing and using xylazine test strips to screen their drugs, with users often testing multiple batches and sharing results with their communities. Commentors describe attempting to identify xylazine by characteristic effects including extreme dry mouth, unusual sedation patterns, and a distinctive taste or smell, though many note these indicators are unreliable.
Discussants actively seek xylazine-free drug sources, with users trading information about which geographic areas or vendors have cleaner supplies. The substance is discussed extensively in the context of treatment challenges. Reddit users with desires to cease drug ingestion express fear and confusion about managing dual withdrawal from both opioids and xylazine. Some discussants report that healthcare providers and detox facilities are unprepared to manage xylazine withdrawal, leading to inadequate treatment.
Many reddit commenters who have ingested opioids consistently for a long period of time describe xylazine contamination as uniquely dangerous compared to previous adulterants, with some stating it has finally motivated them to pursue substance cessation after years of use.
Drug Terms:
Xylazine, Tranq, Tranq Dope
RECENT PUBLICATIONS
Bulletin of the American College of Surgeons
Surgeons handle new and alarming pathology—Xylazine wounds
Caution: This article contains graphic images of severe necrotic wounds. Reader discretion is advised.
A recently published article in the Bulletin of the American College of Surgeons by Newman highlights the complications faced by surgeons treating wounds caused by xylazine use. The article reports that xylazine is being found to be a contaminant in the illicit fentanyl supply. Xylazine use can lead to severe, necrotic wounds that can cause amputations and severe necrotizing fasciitis. The article emphasizes the need for surgeons to understand and effectively treat these wounds.
Substance Use & Misuse
“Everybody’s liking it”—Intentional use of xylazine in fentanyl among people who use drugs
A recently published study in Substance Use & Misuse by Hill et al. explores the intentional use of xylazine among people who use drugs (PWUD). A mixed methods study was conducted in Connecticut from August to November 2024; among the 114 participants, 56 reported lifetime exposure to xylazine. notable proportion of people used xylazine despite knowing the potential risks.
Drug and Alcohol Dependence
Assessing an ICD-10 code approach for estimating xylazine-involved overdose deaths in the United States
A recently published study in Drug and Alcohol Dependence by Friedman et al. assessed the use of ICD-10 codes to estimate xylazine-involved deaths in the US. The study presented data that overdose deaths rose significantly between 2018 and 2021 and compared data from CDC Wonder with the National Vital Statistics System and the State Unintentional Drug Overdose Reporting System to estimate trends in xylazine-involved deaths through the first quarter of 2024. Results indicated that xylazine-involved deaths doubled between 2021 and 2024. The authors indicated that the use of ICD-10 codes T42.7 and T46.5 for xylazine-involved deaths provides a more accurate and up-to-date method for tracking and responding to this issue.
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If you miss or want to learn more about NDEWS Original Content, you can find our archived content on the NDEWS website:
• NDEWS Hotspot Alerts using substance-related EMS data
• NDEWS Rapid Street Reporting (RSR) survey data reports
• NDEWS Web Monitoring Team Reddit Alerts
• NDEWS Sentinel Site Reports
• Previous issues of the NDEWS Weekly Briefings
The Weekly Briefing is a newsletter published each week by the National Drug Early Warning System (NDEWS) Coordinating Center, which is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (MPI: Cottler (contact), Co-Is: Goldberger, Nixon, Striley), NYU Langone Health (MPI: Palamar), and Florida Atlantic University (Co-I: Barenholtz). Any item may be reproduced provided the source is acknowledged.