Emerging Threats

What is Xylazine?

Xylazine is a potent sedative that is approved for use in veterinary medicine, usually to put animals under during veterinary surgeries. In humans, it is a central nervous system depressant, meaning that it slows brain and nervous system activity, which can cause a decrease in breathing rate, heart rate, and a lowering of blood pressure, causing sedation and sleepiness [1]. Xylazine is not approved for human use but is now increasingly found in the United States drug supply. As a result of its impact on the opioid crisis, xylazine is now classified as an emerging threat [2].

The presence of xylazine in drugs has increased in every region of the United States: 

“One study from 10 US cities showed xylazine was involved in less than 1% of drug overdose deaths in 2015 and in nearly 7% in 2020. In samples from eight syringe service programs in Maryland tested between 2021 and 2022, xylazine was found in almost 80% of drug samples that contained opioids.5 In Philadelphia, Pennsylvania, xylazine was found in 31% of heroin and/or fentanyl overdose deaths in 2019.” - Center of Disease Control

Xylazine Use

• Xylazine is commonly used in combination with other substances, knowingly or (more frequently) unknowingly, such as: Fentanyl, heroin, benzodiazepines, alcohol, opioids, and cocaine [3].
• Xylazine can be administered intravenously (into veins), intramuscularly (into muscles), subcutaneously (into the skin), or orally (through the mouth). These many different forms of administration come from the fact that xylazine can be found in multiple different forms. It can be found in a white crystalline substance, a powder, and a liquid, since it is extremely soluble in water [4].

Toxicity and Effects of Xylazine

• While xylazine can be used alone, it is most commonly used in combination with other illicit drugs, creating an even more toxic substance. Exposure to xylazine has often required medical attention to treat the various symptoms that the use of this drug causes.
• Some of the effects of xylazine are drowsiness, slow breathing, slow heart rate, dangerously low blood pressure, blurred vision, disorientation, staggering, coma, miosis (constriction of the pupils), and hyperglycemia, which is high blood sugar [3].

Overdose

• Since xylazine is not an opioid, naloxone (Narcan) cannot reverse the effects and there is no approved antidote for a xylazine overdose. 
• Naloxone should still be administered because xylazine is usually combined with opioids, so it may reduce the effects of the possible opioids in the individual's system [1].
• However, xylazine overdose should be suspected in individuals that are presenting like an opioid overdose, but are poorly/not at all responsive to naloxone. 
• An overdose presents itself in individuals as unconsciousness, very constricted pupils, severely slowed breathing, an extremely low heart rate, and cold/clammy skin [5].

What can you do as a community member?

• Take all substance use seriously.
• Have a conversation with your children about how you never really know what you are taking when using substances that are not prescribed from a doctor or coming from a pharmacy.
• Seek support if you or a loved one may be at risk.
• Xylazine test strips are used to test substances for the presence of xylazine in a drug supply. A positive result from a test strip indicates the presence of xylazine. Click here to get xylazine test strips.
• Warn our youth and anyone who may be using substances about the dangers of the potential deadly effects.
• Take one of our many Naloxone trainings - sign up for our email list here to receive information on them.
• Get involved with community organizations like MTAC to help spread our message.

Sources

McAward, A. (2021). Xylazine, an Emerging Adulterant. Tactical and Law Enforcement Medicine. [1]

Salmassi, M. (2023, June 16). Xylazine: Increasing The Risk of Overdose. Partnership to End Addiction. [2]

Soback, S. (n.d.). Xylazine. FAO/WHO. [3]

What You Should Know About Xylazine. Centers for Disease Control and Prevention. (2023, July 17). [4]

Xylazine in LA County. County of Los Angeles Public Health. (n.d.). [5]

Xylazine in the Drug Supply. National Harm Reduction Coalition. (2022, October). [6]

Xylazine. Drug Enforcement Administration. (2023, May). [7]