The emergence of Xylazine in the illicit drug supply has become a significant public health concern, often associated with the term “zombie drug.” This nickname reflects the severe effects observed in individuals who use it, particularly profound sedation and debilitating skin wounds. Xylazine’s infiltration into drug markets presents new challenges for public health and medical communities.
What Xylazine Is
Xylazine is a non-opioid compound primarily developed for veterinary use as a sedative, muscle relaxant, and analgesic. It gained approval for animal use, commonly in horses, cattle, and other mammals. The U.S. Food and Drug Administration (FDA) has not approved Xylazine for human use due to its potent central nervous system depressant effects.
Despite its veterinary designation, Xylazine has increasingly appeared as an adulterant in the illicit drug supply. It is frequently mixed with fentanyl and other opioids, and sometimes with stimulants or benzodiazepines. This mixing often occurs without the knowledge of the person using the substance, making it particularly hazardous. Xylazine is sometimes referred to as “tranq” or “tranq dope” when found in combination with opioids.
The Physical and Neurological Impact
When used by humans, Xylazine acts as a central nervous system depressant, leading to profound sedation, drowsiness, and a significant slowing of breathing, heart rate, and blood pressure. This can result in prolonged periods of unconsciousness or unresponsiveness, sometimes lasting several hours. The extreme sedation can also cause amnesia.
A distinguishing and severe effect of Xylazine use is the development of painful, difficult-to-treat skin lesions. These can manifest as ulcers, abscesses, or areas of dead tissue (necrosis). These wounds often appear on the extremities, even away from injection sites, and can worsen rapidly. The drug’s vasoconstrictive properties, which restrict blood flow, contribute to these severe skin issues, hindering wound healing and increasing infection risk.
Xylazine’s presence in illicit drugs significantly increases the risk of overdose, especially when combined with opioids. This combination creates a synergistic effect, meaning their combined depressant impact on the central nervous system and respiratory system is greater than the sum of their individual effects. While Xylazine alone may not cause the severe respiratory depression seen with opioids, its profound sedating effects can lead to airway compromise and suffocation.
Individuals who regularly use Xylazine can also experience severe withdrawal symptoms when they stop. These symptoms are distinct from opioid withdrawal and may include anxiety, irritability, restlessness, and potentially severe hypertension. Muscle pain and stiffness are also commonly reported during Xylazine withdrawal.
Responding to the Xylazine Crisis
Detecting Xylazine can be difficult, as it is not typically included in routine immunoassay toxicology screens and is rapidly eliminated from the body. More specialized analytical techniques are required for accurate detection in biological samples.
Naloxone, a medication used to reverse opioid overdoses, does not reverse the effects of Xylazine because Xylazine is not an opioid. However, since Xylazine is almost always found in combination with opioids like fentanyl, administering naloxone is still recommended during a suspected overdose to counteract the opioid’s effects. Even after naloxone administration, a person may remain sedated due to Xylazine’s lingering effects.
Harm reduction strategies are being implemented to address the risks associated with Xylazine. These include increasing awareness among individuals who use drugs about Xylazine’s presence in the illicit supply and its dangers. Testing for Xylazine presence in drug supplies, using readily available test strips, is another strategy to inform users.
Managing the severe skin lesions caused by Xylazine requires specialized wound care. This often involves cleaning wounds daily with soap and water, keeping them moist, and covering them with clean bandages to promote healing and prevent infection. In some cases, medical intervention such as debridement to remove dead tissue or antibiotics for infections may be necessary, and severe cases can lead to amputation. Treatment for Xylazine withdrawal primarily involves supportive care, as there is no specific antidote for its effects. Medical professionals may also manage co-occurring opioid withdrawal symptoms.