Opioids Mixed with Xylazine: Effects & Health Risks

Xylazine is a substance that is increasingly being found in illicit opioids (like fentanyl) and has been linked to rising numbers of overdoses.¹ According to the Centers for Disease Control and Prevention (CDC), the monthly percentage of illicitly manufactured fentanyl (IMF)-involved deaths where xylazine was detected rose by 276% in 21 jurisdictions, which includes 20 states and the District of Columbia, from January 2019 (2.9%) to June 2022 (10.9%).²

If you are concerned about xylazine or opioid misuse in yourself or a loved one, it is imperative to be aware of the dangers associated with xylazine. This article will offer information regarding what xylazine is, the risks of combining opioids and xylazine together, xylazine overdose, and how to seek treatment for opioid misuse or addiction.

What is Xylazine?

Xylazine is a non-opioid sedative drug that is found in approved medications used for veterinary purposes.¹ It is an animal tranquilizer that has painkilling and muscle relaxant properties.¹

First synthesized by Bayer Pharmaceuticals in 1962, xylazine was originally developed for its potential uses as a painkiller, sleep aid, and anesthetic in humans.³ However, due to serious side effects such as severe hypotension (low blood pressure) and central nervous system depression, clinical trials evaluating xylazine for use in humans were discontinued.³

Currently, xylazine is only FDA-approved for veterinary use in horses and Cervidae (which includes Fallow Deer, Mule Deer, Sika Deer, White-Tailed Deer and Elk) for specific purposes, including but not limited to, medical procedures, to calm uncontrollable animals, or for pain relief following surgery.⁴

Federal law states that xylazine is only allowed to be used on the order of a licensed veterinarian and it is not approved for human use.⁴ However, people can buy xylazine on the web in liquid and powder form, and they may not be required to prove legitimate need or that they are members of the veterinary profession.⁵

Additionally, xylazine is being added to illegally-trafficked fentanyl to increase its euphoric effects, which also makes fentanyl even it more deadly.^1,6  Illegally-trafficked xylazine is known as “tranq” on the illicit market.¹

Xylazine Effects

The effects of xylazine are not fully known because there haven’t been extensive studies in humans, however, subjective reports indicate that people can experience effects that are similar to those from opioids.⁵

Immediate xylazine effects may include:^1,5

• Amnesia.
• Drowsiness.
• Dry mouth.
• Hypertension (high blood pressure).
• Tachycardia (rapid heartbeat).

These effects may then be followed by:⁵

• Low blood pressure.
• Slowed heartbeat.
• Elevated blood sugar levels.
• Low body temperature.
• Coma.
• Respiratory depression.
• Irregular heart rate.

Xylazine and Opioids: An Increasingly Common Combo

As mentioned above, xylazine is being combined in illegal/counterfeit opioids, especially fentanyl or other synthetic opioids.⁵ According to the Drug Enforcement Administration (DEA), xylazine has made fentanyl, a highly potent opioid that is linked to numerous overdose fatalities, even more deadly, and it is exacerbating the opioid overdose epidemic.⁶

The DEA reports that 6 out of 10 fentanyl-laced fake prescription pills contain a potentially lethal dose of fentanyl.⁶ Furthermore, 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA in 2022 contained xylazine.⁷

In addition to illicit and prescription opioids, other drugs can also be adulterated with xylazine.⁵ In fact, most overdose deaths involving xylazine not only include opioids, but also other substances, such as benzodiazepines, alcohol, and gabapentin.¹

Risks and Dangers of Opioids with Xylazine

While researchers still have much to learn about the combined use of xylazine and opioids, there are known risks with this combination, including:

• Soft tissue injuries/tissue necrosis in association with injection use. People who inject xylazine can suffer from soft tissue injuries and necrosis (tissue death), which can lead to amputation.⁵
• Complications with opioid withdrawal management. Xylazine may complicate opioid withdrawal management in people who use xylazine and opioids, especially as medications that are traditionally used to treat opioid withdrawal (such as methadone or buprenorphine) do not appear to be useful for xylazine withdrawal.⁸
• Xylazine dependence and withdrawal. Some reports indicate that people can develop physical dependence on xylazine itself and suffer severe xylazine withdrawal symptoms, including seizures and chest pain, when they stop using it.^2,5
• Heightened CNS/respiratory depression. Although it is not an opioid, xylazine can cause dangerously slow breathing, as well as very low blood pressure, heart rate, and body temperature.⁸

Opioid & Xylazine Overdose

Overdose is one of the most significant risks related to opioid/xylazine use because it can be fatal.⁹ As xylazine overdose can be similar to opioid overdose, it is not always easy to identify in medical settings, and routine toxicology reports often do not test for xylazine.^8,9 Additionally, people often knowingly or unknowingly combine opioids with xylazine, which can complicate overdose treatment.¹

Xylazine can increase the potential for fatal overdoses when combined with other substances like fentanyl, but it can also cause fatality on its own.⁵ An overdose is a medical emergency, so you should always administer naloxone if available whether you think the person has used opioids or not and contact 911 right away.¹

Symptoms of xylazine overdose can include:⁹

• Respiratory depression.
• Low blood pressure.
• Slow heart rate.
• Low body temperature.

The DEA reports that all four US census regions experienced a dramatic increase in xylazine-positive overdoses from 2020 to 2021, with the South experiencing the highest leap from 116 xylazine-positive overdoses in 2020 to 1,423 in 2022.⁵ As some states/jurisdictions do not routinely conduct testing for xylazine in postmortem toxicology, it’s also likely that some xylazine/xylazine-involved overdoses have gone undetected.⁵

Is Xylazine Addictive?

Xylazine’s addiction potential is not yet fully understood.⁵ Generally speaking, the risks are understood to be those associated with polysubstance use (use of more than one substance at a time), as well as associated dangers of using xylazine, unbeknownst to the buyer, in illicit drugs purchased on the street.^5,10

As mentioned above, xylazine is increasingly present in fentanyl and other opioids.¹ Opioid addiction or addiction to other drugs that may be adulterated with xylazine, such as cocaine, is a significant concern.³ Opioid addiction can lead people to purchase unregulated and dangerous opioids on the street, which can contain deadly adulterants like xylazine.⁵

Additionally, as people who use xylazine also often use other substances, such as cocaine, heroin, benzodiazepines, and alcohol, they can suffer from the development of addiction to these substances.^1,3,5 Research shows that people who have one substance use disorder (the clinical diagnosis for addiction) have an increased susceptibility to developing dependence on additional substances.¹¹

Opioid Addiction Recovery in New England

If you or someone you care about are struggling with xylazine or opioid misuse or addiction, know that professional treatment can help. AdCare offers comprehensive, evidence-based treatment programs that are customized for your unique needs.

Rehab at AdCare might begin with detox, followed by a stay at our Rhode Island inpatient rehab facility or outpatient care, depending on what type of rehab you require. We offer a complete continuum of care to help people start the path to recovery from addiction and take back control of their lives.

If you’re ready to start the recovery process, please call our free, confidential helpline at to speak with one of our caring admissions navigators about your addiction treatment options. You can also learn more about rehab admissions and insurance coverage for addiction treatment, and easily verify your insurance today.