- Xylazine, or "tranq," is an animal tranquilizer that has been circulating in the drug market.
- Tranq has been mixed with fentanyl and heroin, making powerful opioids even more dangerous.
- Overdoses involving tranq and fentanyl are especially deadly, the Biden administration said.
The White House announced Wednesday that a dangerous mixture of illicit drugs — the opioid fentanyl and the animal tranquilizer xylazine — pose an "emerging threat" in the US, making the ongoing drug overdose crisis even deadlier.
Unlike fentanyl, xylazine, also called "tranq," is not an opioid and it is never prescribed for human use. The tranquilizer is approved by the Food and Drug Administration for use in animals, but it has recently infiltrated the illegal drug supply in the US.
The FDA sounded the alarm on xylazine in November 2022, warning healthcare professionals that the tranquilizer had been implicated in fentanyl and heroin overdoses that may be especially lethal. That's because medications regularly used to reverse opioid overdoses — like the drug naloxone, which was recently made available over the counter — may not work on xylazine. Officials are calling the combination of the two drugs FAAX, for fentanyl-adulterated or -associated xylazine.
"While national overdose death numbers have flattened or decreased for seven straight months, xylazine is complicating efforts to reverse opioid overdoses with Naloxone and threatens progress being made to save lives and address the opioid crisis," the White House announcement said. Earlier this year, President Biden requested that $46.1 billion be set aside to tackle the nation's illicit drug crisis.
Here's what you need to know about xylazine, a growing danger in the US drug supply.
Most xylazine has been found in the south and west
Xylazine and fentanyl mixtures have been found in at least 48 states, according to the US Drug Enforcement Administration.
The recent White House announcement said that while forensic lab identifications of xylazine have risen across the country in recent years, it has been identified most notably in the south and west regions of the US.
Overdose deaths involving xylazine have increased by "by 1,127% in the south, 750% in the west, more than 500% in the Midwest, and more than 100% in the northeast," according to the announcement.
Some tranq users have reported flesh-eating wounds
One of the unique effects of xylazine in humans is the possibility of severe rotting skin ulcers that may develop far from the injection site.
Repeated injections with xylazine have led to necrotic sores unlike the typical infections associated with injection drug use, according to a November 2022 letter from the FDA to healthcare providers. While injection site infections are not uncommon for drug users, tranq-associated ulcers can appear anywhere on the body.
Clinicians who treated such ulcers in Philadelphia described them as "gnarly" and "like it's eating away your flesh from the inside out," according to an article published by STAT News in December 2022.
In its public safety alert, the DEA warned that severe wounds caused by tranq may lead to amputation.
New tools are needed to respond to the drug crisis
Symptoms of xylazine overdose may include slowed breathing and heart rate; confusion; slurred speech; constricted pupils; hypothermia; and low blood pressure, according to the FDA.
Routine toxicology screens do not detect xylazine, according to the FDA, so additional tests are needed to determine whether the tranquilizer was involved in a drug overdose.
Although opioid reversal drugs don't work on xylazine, healthcare providers should still administer naloxone as the first response to a suspected overdose. Xylazine involvement should be suspected if multiple doses of naloxone don't revive the patient, according to the FDA.
Recently, one company has started selling a brand of xylazine test strips, which people who use drugs can buy to test their drugs for xylazine. The company that produces them, BTNX, told STAT News that the strips would be sold for $200 per box of 100 test strips — a much higher price than similar test strips that can check for the presence of fentanyl in drugs.