Xylazine, a new scourge in the drug addiction crisis
Not too long ago, a Boston-born man in his early 50s was referred to our addiction treatment clinic in Boston after he discovered that Percocet pills — powerful opioid painkillers — he had obtained from the streets had been laced with some other potent substance. He reached out to his primary care physician for help, but for a variety of reasons his appointment was delayed. Ten days later, he was found unconscious in his apartment and was pronounced dead from an unintentional overdose.
The man was yet another victim of opioid use disorder, a national crisis that killed 2,357 people in Massachusetts last year — a record that could be broken this year. Increasingly, those victims are dying from accidental overdoses, most of which are linked to “street drugs” that are created and distributed through illegal channels. Street drugs are often laced with additional contaminants to make them more powerful or addictive. One of those contaminants is particularly alarming to us: Xylazine, an animal tranquilizer and nonopioid sedative whose effects on humans health officials are only beginning to understand.
In April, the White House declared Xylazine — also known as “tranq” — to be an “emerging threat to the nation.” A 2023 Centers for Disease Control and Prevention report noted that Xylazine was present in 23 percent of fentanyl powder and 7 percent of fentanyl pills. Fentanyl is itself a powerfully deadly opioid that is a major cause of opioid overdoses. Between 2019 and 2022, the presence of Xylazine in fentanyl overdose deaths more than tripled to 11 percent and continues to rise rapidly, disproportionately affecting the most marginalized individuals. In Massachusetts, Xylazine was connected to overdoses as early as 2021, and by 2022 it was present in 28 percent of opioid samples tested by the Massachusetts Drug Supply Data Stream.
Tranq’s rapid emergence comes from its inexpensive cost, wide availability, and ability to prolong the euphoric effect of opioids. In other words, it is a “cheap filler” for illicit opioids that makes the product more addictive and increases profit for suppliers. Tranq can easily be purchased online through pharmaceutical distributors catering to veterinarians. It is not a federally controlled substance and is not approved by the FDA for human use. Most users are unaware that Xylazine is in their drug supply even as it is being increasingly mixed into cocaine, heroin, and other drugs, as well as fentanyl, according to the Drug Enforcement Agency.
Like opioids, tranq is a sedative that can lead to low blood pressure, slow heart rate, decreased breathing, and unresponsiveness; when mixed with opioids, the effect is even stronger. This means that in the wrong dosage, it can cause people to stop breathing. Tranq has also been linked to severe skin, muscle, and bone infections. One user explains that Xylazine “made me sleep weird” and “put me out for six hours” while others describe an experience with their “skin on fire, teeth felt like they were going to fall out” and “causing holes (ulcers) where injected.”
Yet despite its growing prevalence, health officials still know little about how to detect, manage, and treat Xylazine intoxication. We lack data on how the body processes it or its physical effect on the human body. We also lack tools to detect it. Perhaps most importantly, there is no treatment for Xylazine misuse or overdose. With opioids, we have a well-established, though underutilized, agent called naloxone — better known by its brand name Narcan — that can quickly reverse the deadly effects of opioid overdose. But there are no such reversal agents for Xylazine. There are not even clear guidelines for doctors to follow when they encounter potential Xylazine-overdose cases.
Currently, when a person is suspected of Xylazine intoxication, the only recommendations available to doctors include administering naloxone to reverse the opioid component, close monitoring, and providing critical care support, including breathing tubes and CPR as needed. But as Xylazine-related fatalities rise, health officials need to know much more about the drug’s impact.
The White House’s declaration of Xylazine as an emerging threat is an important catalyst for identifying and mobilizing this crisis. National and local experts continue to take the lead on research and other initiatives. The federal government introduced two bills to increase funding for research and to formalize Xylazine’s status as a controlled substance, which would make it harder to acquire.
States have issued alerts for Xylazine and are training clinicians and first responders. In Massachusetts, several efforts are underway to help quantify the extent of Xylazine’s infiltration in the drug supply and identify individuals who may be at risk of Xylazine overdose. RIZE, an independent nonprofit foundation, has announced a plan to collaborate with the Massachusetts Drug Supply Data Stream to improve the accuracy of Xylazine detection strips, an essential step toward tracking Xylazine’s impact. These are all important steps toward developing effective treatments.
On a more granular level, we are hopeful our clinical experiences on the front line illuminate victims’ stories and give voice to the millions of Americans suffering from opioid use disorder. The opioid epidemic is ever evolving. We urge people to spread the word about this deadly new contaminant and contribute to these initiatives in whatever way they can, so as to prioritize our nation’s most vulnerable populations amid this devastating crisis.
Tranq’s rapid emergence comes from its inexpensive cost, wide availability, and ability to prolong the euphoric effect of opioids.