PUBLISHED ON 07/12/24
Xylazine 101: Harm Reduction and Wound Care Xylazine (also known as tranq) is an animal tranquilizer that is becoming a common cut in street drugs in North America. Usually found mixed with fentanyl or heroin, it causes very heavy sedation and can also cause complicated injection-related wounds. Some people have reported losing consciousness or blacking out for 4-6 hours at a time. People also report dry mouth, dizziness, weakness, nausea, trouble breathing, high blood sugar (hyperglycemia), slow heart rate, and memory loss. Since it is a relatively new addition to the drug supply, harm reductionists and people who use drugs are still learning about it and its short- and long-term effects.
Xylazine + Overdose
A xylazine overdose can look similar to an overdose from other sedating drugs (opioids, benzos, alcohol). Respiratory depression, or slowed or stopped breathing, is extremely dangerous — just a few minutes of little-to-no oxygen can cause permanent brain damage. Since xylazine is not an opioid, naloxone will not reverse its effects. In most parts of the US, however, xylazine appears alongside fentanyl. If someone is experiencing an overdose you should still: 1. Administer one dose of naloxone and focus on rescue breathing. 2. If the person doesn’t start breathing on their own in 3-5 minutes, administer a second dose of naloxone. 3. Continue rescue breathing until the person is breathing again. A person who is experiencing complications from xylazine use may not respond to naloxone in the ways you are used to. They may not come to right away and will often remain unconscious, or in a very heavy nod. This is because even if the naloxone is working on the opioids in their system, the xylazine might still be keeping them sedated. If someone is breathing, do not administer more naloxone. Too much naloxone may cause someone to go into precipitated withdrawal, which could induce vomiting. If someone is throwing up while unconscious it is possible for them to aspirate their vomit, which can be life threatening. To avoid the risk of choking on vomit, place the unconscious, but breathing person in the rescue or recovery position and keep an eye on them until they regain consciousness. If their breathing slows or stops again, continue to administer rescue breaths. If you have a pulse oximeter, you can use it to monitor their blood oxygen levels and heart rate. Ideally, a blood oxygen level should be between 95-100%, while a healthy heart rate falls between 60100 BPM. Pulse oximeters can be purchased over the counter at your local pharmacy. Keep in mind that pulse oximeters can fail to give a reading or give an incorrect reading on people with darker skin complexions or if the individual has nail polish on their nails.
Xylazine Withdrawal
We are still learning about the effects of Xylazine withdrawal. It can be especially difficult to pinpoint these effects because Xylazine is most often found in conjunction with other drugs. We don’t have medications like buprenorphine or suboxone for Xylazine, but there are other medications that can help treat the withdrawal side effects, if they become dangerous or unmanageable for you. Xylazine withdrawal can sometimes cause very high blood pressure, with accompanying symptoms of confusion, chest pain, and shortness of breath. In extreme cases, you might want to visit a hospital, where they might treat your symptoms with clonidine, a drug that will help balance your blood pressure. Less severe symptoms include anxiety, restlessness, vomiting, heart palpitations, chills, fatigue, and irritability, which can usually be managed at home.
Harm Reduction Tips
Xylazine test strips are now available. Xylazine is almost exclusively seen in drugs that are sold as fentanyl or heroin. If these are your drugs of choice, you might consider testing your bag. If your sample tests positive for xylazine and you still choose to use it, start with a smaller dose than normal — the sedative effects can be very overpowering! Consider smoking, boofing, or snorting your drugs — preliminary research shows that Xylazine-associated wounds might be less likely to form via these routes of administration. Make sure that the people you are using with are prepared to give rescue breaths and know not to give you too much naloxone. And, as always, try not to use alone.
Wound Care
One of the least-understood complications of xylazine are the large, painful wounds that it can cause. Particularly mysterious, is the fact that these wounds sometimes appear far away from your injection site. These wounds may start out looking like burns, scrapes, or pimples. Commonly found on your arms and legs, they quickly get progressively worse, leading to dying (necrotic) skin and tissue and deep, weeping wounds. They might look different on darker skin but still have the same deep pain when they start to develop. It is important to know that xylazine-related wounds should be treated differently