The godfather later admitted that he had intended to sexually assault the boy after poisoning him with xylazine. To be diagnosed with a substance use disorder, a person must meet specific diagnostic criteria for continued, compulsive substance use despite negative consequences. NIDA conducts and supports research to better understand how often and to what extent people who use xylazine experience withdrawal and substance use disorder symptoms. Yes, repeated exposure to xylazine may lead to dependence, addiction and withdrawal symptoms, which may include agitation, vision changes, disabling migraines or severe anxiety when doses are decreased or stopped. These side effects may lead to continued abuse and undermine any efforts to treat an ongoing opioid use disorder (OUD).
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Examples of other depressants are opioids (including fentanyl), alcohol, and benzodiazepines. However, early research does not indicate that xylazine combined with opioids increases odds of fatal overdose. NIDA-funded research found that people with xylazine and fentanyl in their systems at the time of overdose had lower rates of heart attack and coma than those who tested positive for opioids alone. The same study found that people with xylazine in their bodies at the time of opioid overdose were no more likely to die from opioid overdose without xylazine in their systems. If you suspect someone has overdosed on xylazine, call emergency medical services right away. While there is no treatment for xylazine itself, other treatments may be used.
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When people take xylazine with fentanyl, it is not clear if xylazine increases the risk of fatal overdose. However, extreme sedation from xylazine can cause people to stop breathing. Most overdose deaths linked to both xylazine and fentanyl also involved other substances, including cocaine, heroin, benzodiazepines, alcohol, gabapentin, and prescription opioid medications. This means that it makes people drowsy, slows brain activity, relaxes muscles, and slows heart rate and breathing. Reports suggest that xylazine is used in combination with other drugs, particularly illicitly manufactured fentanyl, as well as drugs like methamphetamine, cocaine, and benzodiazepines (“downers”). Taking xylazine with other substances that slow the nervous system may increase the chance of overdose.
Pa. Health Department distributing 50K care kits to treat xylazine-related wounds
For that reason, it is important that people who use drugs do not use alone if they can help it so someone is present to provide aid if necessary. It’s also critical that anyone who believes that they are in the presence of an individual who is experiencing an overdose administer naloxone and, if breathing has stopped, administer rescue breathing immediately. Some individuals may knowingly consume xylazine, while others may not be aware that it is present in the substances they use. The effects of fentanyl wear off faster than other opioids (around 2 hours), so xylazine is sometimes added to extend the effects of fentanyl and stave off withdrawal.
It is usually identified in mixtures that contain fentanyl or fentanyl analogues. The wounds can also become necrotic, and Kacinko said they can progress to cause soft tissue injury. Chemical evidence shows that the xylazine being found is “purely made,” which Zagorski said was “very uncommon for the illicit drug supply, especially at this scale.” When responding to an overdose, administering naloxone and giving “rescue breaths” can reverse the effects of fentanyl in a person’s system. If xylazine is also involved, the naloxone may keep the person alive by resuming their breathing, but they may remain sedated and unconscious.
How can communities reduce harms of xylazine and opioids/fentanyl mixed with xylazine?
- Xylazine, commonly referred to as tranq, is a drug adulterant – a substance intentionally added to a drug product to enhance its effects.
- Texts will be sent when a bad drug batch is detected, when a neighborhood sees a spike in overdose or when police conduct a drug seizure in an area — a move that research has shown disrupts the drug supply and increases overdose.
- In humans, xylazine extends the half-life of fentanyl, the effects of which typically last only one to three hours.
- Anyone in need of naloxone or fentanyl test strips is asked to visit the nearest NaloxBox or have supplies delivered directly to you.
It is not an opiate, but those effects combined with an opiate can stop someone’s breathing, causing an overdose. “There’s very little research out there about how it behaves in humans. We’re seeing really rough wounds. … We aren’t going to be able to understand how to prevent or treat these issues if we don’t know what’s going on.” Sue docusate: uses interactions mechanism of action drugbank online said she hopes xylazine curbing efforts will make use of existing harm reduction organizations and syringe service programs, rather than trying to address xylazine or fentanyl in silos. “That’s why you need naloxone to be oversaturated in communities because the reality is, our drug supply has become quite contaminated,” Dittmore said.
Xylazine was reported to be involved in 19% of all fatal drug overdose deaths in Maryland in 2021, and 10% of Connecticut overdose deaths in 2020. Xylazine also constricts blood vessels, causes disease of the small vessels, and lowers heart rate and blood pressure. Together, these effects restrict blood flow to the outermost reaches of our vascular system — namely, our skin and soft tissue. Tissue that is starved of oxygen and nutrients due to this restricted blood flow eventually become necrotic and slough away. So, exposure to xylazine via any route, not just injecting, can lead to small areas of tissue necrosis scattered across the body and prevent healing of other skin injuries like cuts and insect bites. Harm reduction workers caution people never to use alone, to be aware of the risk of tainted drugs, get professional wound care for skin ulcers and abscesses, use Narcan in case someone has ingested it with fentanyl and call 911.
Xylazine itself is a central nervous system sedative that causes drowsiness, amnesia, slow breathing, decreased heart rate, and decreased blood pressure. It is thought that when used in combination with opioids like fentanyl, it can elongate the effects of the high. In November 2022, the FDA issued an alert warning healthcare professionals about xylazine being mixed with opioids like fentanyl and heroin and the risks to patients exposed to xylazine. The U.S. Food and Drug Administration has approved it for veterinarian use in animals as a sedative or pain reliever. “It is not safe for humans,” an FDA alert to healthcare providers November 2022 states. Illicit formulations of liquid and powdered xylazine are available for purchase from online retailers for less than $20 per kilogram, making the drug an attractive option for illicit drug manufacturers.
Anyone in need of naloxone or fentanyl test strips is asked to visit the nearest NaloxBox or have supplies delivered directly to you. Anyone in need of naloxone or fentanyl test strips, can also request them to be shipped for free through Overdose Lifeline’s website. The kits include products needed to properly treat wounds, such as sanitizing https://sober-house.org/alcohol-use-disorder-symptoms-and-causes/ wipes, gloves, sponges, ointment and bandages. In my opinion, this diversity of thought is good because it prompts more rigorous investigation into what’s really going on. But following the published literature and evidence as it has emerged, and working directly with people who use drugs, has convinced me of the connection.
Xylazine has been a part of Puerto Rico’s illegal opioid scene since the early 2000s and made its way to Philadelphia shortly after. It first showed up in Philadelphia’s toxicology reports in 2006, and was found in over 90% of drug samples tested in the city in 2021, according to Substance Use Philly. Now, as part of her work, Beddis runs a streetside https://sober-home.org/ecstasy-detox-symptoms-timeline-medications-and/ wound care clinic that offers aid to people in need. Veterinarians regularly use it to tranquilize (sedate), relieve pain, or as a muscle relaxant for animals like dogs, cats, and horses. As a veterinary medication, xylazine is not FDA-approved for any human use. It is not currently a controlled substance under the federal Controlled Substances Act.
Because xylazine is often combined with an opioid, a medicine used to treat opioid overdose, called naloxone, may be used. Medicines used to treat low blood pressure and low heart rate also may be used to treat the symptoms of xylazine use and withdrawal. Although it is not intended for human use, xylazine is a common contaminant of illicit drugs in the U.S. Xylazine use causes sleepiness and a slow respiratory rate and might result in development of necrotic skin wounds (skin wounds with dead tissue).
Melanie Beddis, the director of programs at Savage Sisters Recovery, a Philadelphia nonprofit, said that she has experienced these wounds herself. A recent import alert from the Food and Drug Administration aims to restrict unlawful importing of xylazine, but Zagorski said that it’s unclear where xylazine is coming from, with no obvious culprit or single source of the substance. In addition to clean syringes, these programs often offer treatment medication, mental health services, hot meals, and more.
Dittmore said that even though the naloxone will reverse the opioid overdose, a person may still be experiencing xylazine effects and may seem drowsy or out of it. It’s immediately recognizable by the gruesome, scaly wounds that emerge on users’ skin, and can even cause injuries to their lungs. And in some parts of the United States, experts say it’s in as much as 90% of the drug supply. If you recognize an opioid overdose, administer naloxone and promptly call 911. Xylazine doesn’t get into the body intradermally, so it’s not possible to overdose on the drug by touching it while caring for an overdose. With the emerging threat designation, the Office of National Drug Control Policy (ONDCP) said it would bolster its efforts to improve testing, treatment, and care for xylazine.