The increased rate of xylazine use across the country has raised public and medical concerns. Increasing this concern is the lack of research on the impact of xylazine and withdrawal on humans, especially the long-term damage and lack of reversal agents.
What Is Xylazine?
Xylazine, also known as “tranq,” is a veterinary tranquilizer that is newly combined with street drugs, most notably fentanyl.
It is typically used by injection, snorting, swallowing or inhaling. Xylazine is not approved for human use and can lead to fatal consequences.
Why It’s Mixed With Fentanyl
Simultaneous xylazine and fentanyl use is a new, deadly combination, resulting from low cost, ease of access and the increased euphoric effects when combined.
Xylazine extends the euphoric effects of fentanyl, increasing the addiction potential and thereby increasing profits for those selling the drugs.
Xylazine Withdrawal Symptoms
Despite its increased use, the understanding of xylazine withdrawal is currently limited, and no standard treatment has been established.
Providers who have recently treated people because of xylazine and fentanyl use have noted that xylazine increases the intensity of withdrawal symptoms, exhibited by five main characteristics:
- Hypertension
- Anxiety
- Agitation
- Autonomic dysregulation
- Lack of positive response to medication management
Medical providers have also noted a unique characteristic of xylazine and fentanyl: that withdrawal symptoms do not improve with sedatives or naloxone and instead seem to rebound.
This limits the ability of medical providers to support those detoxing from xylazine and prevent overdose deaths.
Since so little is known about xylazine’s effect on humans and since traditional medical treatment seems ineffective, the risk of using it is especially elevated.
Unique Complications (Skin Wounds, Sedation)
Xylazine is often missed, as rapid urine tests are regularly unable to detect the drug, thereby postponing proper treatment for those in need.
Adding to this danger, the combination of xylazine and fentanyl presents serious and life-threatening concerns, making medical care an urgent need:
- Prolonged toxicity
- Respiratory suppression
- Rapid and uncontrolled eye movements
- Cardiac arrest
- Lack of oxygen to the brain
- Death
Fentanyl and xylazine also present drug-specific side effects, including skin abscesses, necrosis and bone infections. These skin ulcers develop into a foul-smelling, significant infection that requires extensive medical management.
Detox and Medical Treatment
There are no known reversal agents for xylazine toxicity, and traditionally used medications for overdose show little effectiveness.
For this reason, detox support generally includes:
- Fluid resuscitation
- Blood pressure management
- Heart rate monitoring
- Mechanical ventilation
- Medication support
Medication management involves opioid replacement and symptom-specific medications, but efficacy is still limited. Some patients see mild improvement with clonidine, phenobarbital and tizanidine.
Some patients may require mechanical ventilation, as the drug causes the central nervous system to slow to a dangerous rate.
Medical support may also include antibiotics and wound care for any skin lesions present from xylazine use.
Harm Reduction and Overdose Risk
Awareness around the dangers of xylazine and fentanyl is critical to begin reducing harm, and emphasis should be made on noting the seriousness of overdose and the lack of effective medical care for those at risk of overdose.
The combination of xylazine and fentanyl proves especially dangerous since xylazine increases the respiratory depression of fentanyl, and there are no known antidotes, making this type of drug use a significant public health concern.
In an effort to mitigate deaths, certain harm reduction tactics have been suggested:
- Do not use drugs alone. Having someone around may help receive urgent medical care when needed.
- Have and use naloxone in case of suspected overdose. This will slow the effects of fentanyl.
- Try to avoid combination drugs, but if unable, begin slowly to see how your body responds.
- Use the same drug supplier if possible.
- Ensure safe injection habits, including clean syringes, never sharing needles, and sterilizing injection sites.
- Be prepared to contact emergency services if an overdose occurs. Naloxone will not reverse xylazine overdose.
FAQs
Is Xylazine an Opioid?
Xylazine is not classified as an opioid, but rather a non-narcotic sedative approved only for veterinary use
Does Narcan Work On Xylazine?
Narcan does not appear to reverse or improve the effects of xylazine. Xylazine is not an opioid central nervous suppressor, making all opioid antagonists ineffective, including Narcan.
What is Tranq Withdrawal Like?
Tranq withdrawal has been reported as particularly uncomfortable and potentially dangerous, as it intensifies the opioid withdrawal symptoms, making pain, nausea and anxiety more severe.
Can You Detox at Home?
Xylazine detox should not be done at home due to the severity of symptoms and the possibility of death. Medical management in a controlled setting is highly recommended.
How Dangerous is Xylazine?
Xylazine use and, by extension, overdose are considered quite dangerous, as it is not approved for human consumption and can cause significant central nervous depression that leads to death.