Department of Health
Xylazine: What Clinicians Need to Know What is Xylazine: • Xylazine is a non-opioid used as a sedative, anesthetic, muscle relaxant, and analgesic for animals, but it is not FDAapproved for use in humans.i It was not approved for human use due to severe CNS depressant effects. • Xylazine is a strong synthetic alpha2-adrenergic agonist, synthesized in 1962 as an analgesic, hypnotic, and anesthetic.ii It has chemical properties similar to other drugs like clonidine and may have similar clinical effects. • Xylazine has increasingly been found in the illicit drug supply, frequently mixed with fentanyl.iii • It may be referred to as “tranq,” or “tranq dope” when combined with heroin or fentanyl.
Xylazine Source and Preparation and Route of Administration: • Xylazine comes as a liquid solution for injection in 20 mg/mL, 100 mg/mL, and 300 mg/mL strengths for veterinary use. The liquid solution can be salted or dried into a powder. In the illicit drug supply, it can appear as a white or brown powder. Because it can be mixed into other powders or pressed into pills, it can be difficult to identify based on appearance. • The routes of administration include intravenous, intramuscular, intranasal, and oral; there is currently no information on vaping or smoking. • It has rapid onset within minutes and can last 8 hours or longer depending upon the dose, the way it was taken, and whether it was mixed with an opioid or other drug(s).iv
Xylazine Trends: • Xylazine has long been noted in the street opioid supply of Puerto Rico. In the late 2000s, it emerged in Philadelphia and has been found more recently in many regions, including New York State (NYS). • While the full national scope of overdose deaths involving xylazine is unknown, research and testing have shown that overdose deaths involving xylazine rose nearly 20 fold between 2015 and 2020 in all major US regions where xylazine testing was being conducted. • The highest xylazine prevalence in autopsies has been observed in Philadelphia (involved in 25.8% of deaths), followed by Maryland (19.3%), and Connecticut (10.2%). Illicitly manufactured fentanyl (IMF) was present in 98.4% of overdose deaths involving xylazine.v • In 2021, 91% of samples of purported heroin or fentanyl from Philadelphia also contained xylazine, making it the most common adulterant in the local drug supply.vi • Data are forthcoming from NYS, but there are reports of the presence of xylazine in the local drug supplies in various parts of the state, including NYC, Onondaga County, Monroe County, and Long Island. It is thought to be an increasing presence.
Xylazine Effects: • Xylazine is a central nervous system depressant that can cause drowsiness, amnesia, and slow breathing, heart rate, and blood pressure at dangerously low levels. • At very high doses, or with other central nervous system depressants, xylazine can cause: • Loss of physical sensation, • Loss of consciousness, • Intensification of the effects of other drugs, which can complicate overdose presentation and treatment.