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Understanding Xylazine: Risks, Overdoses, and Harm Reduction

xylazine

Clinically Reviewed by: Charee Marquez, LMFT

Understanding Xylazine: Uses, Effects, Risks

In recent years, the overdose crisis has escalated dramatically, exacerbated by the emergence of new and dangerous substances in the illicit drug supply. Among these, xylazine—a veterinary tranquilizer—has been increasingly detected in overdoses involving synthetic opioids like fentanyl. The presence of xylazine in the drug supply poses significant challenges for both medical professionals and harm reduction organizations. This blog delves into the complex landscape of drug overdose deaths, specifically those involving xylazine, and explores the multifaceted efforts by the Office of National Drug Control Policy and other agencies to combat this growing threat. The U.S. Drug Enforcement Administration (DEA) has been actively involved in issuing Public Safety Alerts and seizing dangerous drug mixtures, including fentanyl mixed with xylazine.

Being exposed to xylazine, especially when mixed with other drugs like fentanyl, poses severe health risks, as naloxone does not reverse its effects. As we examine the intersection of xylazine use, opioid overdoses, and the broader overdose crisis, we will highlight key harm reduction strategies, the role of national drug control policy, and the urgent need for innovative solutions to protect public health.

What is Xylazine?

Xylazine is a veterinary medication primarily used as a sedative, muscle relaxant, and analgesic (pain reliever) in animals, particularly in horses, cattle, and other large mammals. It is not approved for use in humans. Xylazine works by depressing the central nervous system and is often used in combination with other anesthetics for surgical procedures in animals.

In recent years, xylazine has gained attention due to its illicit use in humans, often as an adulterant in street drugs like heroin, fentanyl, and cocaine. This can pose significant health risks, as xylazine can cause severe respiratory depression, bradycardia (slow heart rate), hypotension (low blood pressure), and even death. Its effects are not reversible with naloxone, the standard treatment for opioid overdoses, which complicates medical intervention. The trafficking of fentanyl pills mixed with xylazine has led to a heightened risk of fatal drug poisoning, as highlighted by the DEA’s Public Safety Alert regarding the lethality of fentanyl-laced fake prescription pills.

Due to these risks, there is increasing concern and research into xylazine’s impact on public health and its role in the opioid crisis.

 

Xylazine Composition

  • Active Ingredient: Xylazine hydrochloride (C12H16N2S)
  • Molecular Formula: C12H16N2S
  • Molecular Weight: 220.34 g/mol
  • Excipients: Solvents, preservatives, and stabilizers (varies by manufacturer)
  • Structure: Contains a thiophene ring and is an alpha-2 adrenergic agonist

Note: Used primarily in veterinary medicine as a sedative, muscle relaxant, and analgesic.

 

Xylazine Types and Dosages

Types of Xylazine

  1. Injectable Solution: The most common form, used for intravenous (IV), intramuscular (IM), or subcutaneous (SC) administration.
  2. Oral Form: Less common, typically used in specific formulations for easier administration in certain animal types.
  3. Transdermal Patches: Experimental and less common, designed for controlled release over time.

Typical Dosages

Horses

  • Sedation and Analgesia: 0.5 to 1.1 mg/kg IV or 1.1 to 2.2 mg/kg IM.
  • Pre-anesthetic: 0.5 to 1 mg/kg IV.

Cattle

  • Sedation: 0.05 to 0.3 mg/kg IV or IM.
  • Analgesia: 0.1 to 0.3 mg/kg IV or IM.

Dogs and Cats

  • Sedation and Analgesia: 1.1 to 2.2 mg/kg IM.
  • Pre-anesthetic: 0.5 to 1 mg/kg IM or IV.

Other Animals

  • Dosages: Vary widely based on species, size, and intended use. Always follow veterinary guidelines and specific product instructions.

Important Considerations

  • Species Sensitivity: Different animals have different sensitivities to xylazine. Dosage adjustments are necessary.
  • Monitoring: Close monitoring of cardiovascular and respiratory functions is essential due to potential side effects like bradycardia and respiratory depression.
  • Combination Use: Often used in combination with other anesthetics or sedatives for enhanced effect and safety. Dosage adjustments may be required when used in combination therapy.

 

Xylazine Uses

Veterinary Uses

Sedation:

  • Used to calm animals during diagnostic procedures, handling, and transport.
  • Commonly used in horses, cattle, dogs, cats, and other animals.

Analgesia (Pain Relief):

  • Provides pain relief during minor surgical or diagnostic procedures.
  • Often used in combination with other anesthetics for enhanced pain management.

Muscle Relaxation:

  • Facilitates muscle relaxation during surgical procedures.
  • Helps in procedures that require minimal movement from the animal.

Pre-anesthetic:

  • Administered before general anesthesia to reduce the amount of other anesthetics needed.
  • Improves the safety and efficacy of anesthesia by providing initial sedation and relaxation.

 

Illicit Human Use (Not Approved)

Adulterant in Street Drugs:

  • Xylazine is sometimes mixed with drugs like heroin, fentanyl, and cocaine to enhance or prolong their effects.
  • This illicit use poses significant health risks, including severe respiratory depression and cardiovascular complications.
  • The trafficking of xylazine and fentanyl mixtures has increased, leading to higher risks of fatal drug poisoning. Injecting these mixtures can cause severe wounds and tissue necrosis, potentially resulting in amputation.

Important Considerations

  • Species-Specific Sensitivity: Different animals react differently to xylazine, and dosages must be adjusted accordingly.
  • Side Effects: Potential side effects include bradycardia (slow heart rate), hypotension (low blood pressure), respiratory depression, and hyperglycemia (high blood sugar).
  • Reversal Agents: Yohimbine and atipamezole are commonly used to reverse the effects of xylazine in animals, mitigating sedation and other side effects.

Always consult a veterinarian for proper usage, dosage, and monitoring when using xylazine in animals. Its use in humans is highly dangerous and illegal.

 

Xylazine Brand Names and Street Names

Brand Names

  1. Rompun
  2. Anased
  3. Sedazine
  4. Chanazine

They Street Names

  1. Tranq
  2. Tranq Dope
  3. Zombie Drug

 

Xylazine Onset and Duration

Onset

  • Intravenous (IV): 3-5 minutes
  • Intramuscular (IM): 10-15 minutes

Duration

  • Sedation: 1-2 hours
  • Analgesia: 15-30 minutes
  • Muscle Relaxation: 1-2 hours

The effects can vary based on the dosage and the animal’s species and condition.

 

How Long Does Xylazine Stay in Your System?

Xylazine has an approximate half-life of 30 to 50 minutes in animals, although this can vary depending on the species and individual metabolic rates. The half-life represents the time it takes for the concentration of xylazine in the bloodstream to decrease by half. Given this relatively short half-life, xylazine is typically metabolized and eliminated from the body within 24 to 48 hours after administration. However, the exact duration can be influenced by factors such as the dosage administered, the animal’s health, and the method of administration (intravenous, intramuscular, etc.). In the case of illicit human use, these factors could vary widely, potentially affecting how long the drug remains detectable in the system.

 

How Long is Xylazine Detectable in Your System?

The detectability of xylazine in the system depends on several factors, including the dosage, frequency of use, and the individual’s metabolic rate. While specific detection windows can vary, general guidelines are as follows:

  1. Blood: Xylazine can be detected in the blood for up to 24-48 hours after administration.
  2. Urine: Detection in urine may extend slightly longer, potentially up to 72 hours post-administration, depending on the sensitivity of the test.
  3. Tissue Samples: In veterinary and forensic contexts, xylazine might be detectable in tissue samples for several days to weeks after administration, depending on the method of analysis.

Given the variability in individual metabolism and the specifics of the detection method used, these times are approximate. For precise detection times, specialized testing and analysis are required.

 

How Does Xylazine Work in the Brain and Body?

Brain:

  • Alpha-2 Adrenergic Agonist: Xylazine stimulates alpha-2 adrenergic receptors, which decreases the release of norepinephrine and dopamine, leading to sedation, analgesia, and muscle relaxation.
  • Central Nervous System Depression: Results in calming effects and reduced perception of pain.

Body:

  • Cardiovascular System: Causes bradycardia (slow heart rate) and hypotension (low blood pressure).
  • Respiratory System: Can lead to respiratory depression, reducing the rate and depth of breathing.
  • Musculoskeletal System: Induces muscle relaxation, aiding in surgical and diagnostic procedures.

Xylazine’s effects are similar to those of other sedatives and analgesics, making it useful in veterinary medicine but potentially dangerous when misused.

 

Effects of Xylazine on the Body

  1. Cardiovascular System:
  • Bradycardia: Slowed heart rate.
  • Hypotension: Lowered blood pressure.
  • Potential arrhythmias: Irregular heartbeats.
  1. Respiratory System:
  • Respiratory depression: Reduced breathing rate and depth, which can be severe in an overdose involving xylazine.
  • Potential hypoxia: Decreased oxygen levels in the blood.
  1. Central Nervous System:
  • Sedation: Calming and drowsiness.
  • Analgesia: Pain relief.
  • Muscle relaxation: Reduced muscle tension.
  1. Gastrointestinal System:
  • Decreased motility: Slower digestive processes, which can lead to constipation.
  1. Endocrine System:
  • Hyperglycemia: Increased blood sugar levels due to inhibition of insulin release.
  1. Miscellaneous:
  • Diuresis: Increased urine production in some animals.
  • Salivation and vomiting: Particularly in some animal species.

 

Xylazine Legal Status

Veterinary Use:

  • Approved for Veterinary Use: Xylazine is approved for use in animals in many countries, including the United States, under the regulation of agencies like the FDA.

Human Use:

  • Not Approved for Human Use: Xylazine is not approved for human use and is considered illegal for such purposes.

Illicit Use:

  • Controlled Substance: While not classified as a controlled substance in all jurisdictions, its possession and use outside of veterinary contexts can lead to legal consequences due to its potential for misuse and associated health risks.

 

Side Effects and Risks of Xylazine

  1. Cardiovascular System:
  • Bradycardia: Slowed heart rate.
  • Hypotension: Low blood pressure.
  • Arrhythmias: Irregular heartbeats.
  1. Respiratory System:
  • Respiratory Depression: Reduced breathing rate and depth.
  • Hypoxia: Decreased oxygen levels in the blood.
  1. Central Nervous System:
  • Sedation: Drowsiness and lethargy.
  • Ataxia: Loss of coordination and balance.
  • Coma: In severe cases of overdose.
  1. Gastrointestinal System:
  • Nausea and Vomiting: Common side effects.
  • Constipation: Due to decreased gut motility.
  1. Endocrine System:
  • Hyperglycemia: Elevated blood sugar levels.
  1. Miscellaneous:
  • Increased Salivation: Particularly in some animal species.
  • Diuresis: Increased urine production.
  • Injection Site Reactions: Swelling, pain, and inflammation.

Risks:

  • Overdose: Can lead to severe respiratory and cardiovascular depression, potentially fatal. In cases of opioid overdose, naloxone may be administered, but the effects of xylazine may continue, necessitating additional medical treatment.
  • Drug Interactions: Can have dangerous interactions with other sedatives or depressants.
  • Illicit Use: Poses significant health risks and legal consequences when used outside of veterinary contexts.

Proper dosing and monitoring are essential to mitigate these risks, especially in a veterinary setting.

 

Why is Xylazine called “Tranq”?

“Tranq” is short for tranquilizer, reflecting xylazine’s strong sedative properties. The term is often used in the context of its illicit use in street drugs.

 

How is Xylazine used illicitly?

Xylazine is sometimes mixed with drugs like heroin, fentanyl, and cocaine to enhance their effects, which can lead to severe health risks and complications.

 

What are the effects of Xylazine on humans?

In humans, xylazine can cause sedation, respiratory depression, bradycardia (slow heart rate), hypotension (low blood pressure), and potentially life-threatening complications.

 

What should you do if someone is overdosing on Xylazine?

Seek immediate medical attention. Supportive care, such as maintaining airway and breathing, is crucial. While there is no specific antidote for xylazine, reversing agents like yohimbine can mitigate some effects in veterinary settings.

 

Is Xylazine Addictive?

Xylazine is not classified as an addictive substance in the same way as opioids or stimulants. However, it can be habit-forming due to its sedative and muscle relaxant effects. In the context of illicit use, particularly when mixed with other drugs like opioids, there is a risk of psychological dependence. Users may repeatedly seek out xylazine-containing mixtures for their combined effects, which can lead to a pattern of misuse.

While xylazine itself may not cause classic addiction, its use, particularly in combination with other substances, poses significant health risks and can contribute to a cycle of substance abuse.

 

Can You Overdose Involving Xylazine?

Yes, you can overdose on xylazine. An overdose can result in severe and potentially life-threatening symptoms due to its profound effects on the central nervous system, cardiovascular system, and respiratory system.

Symptoms of Xylazine Overdose

  1. Respiratory Depression: Severely reduced breathing rate and depth, which can lead to respiratory failure.
  2. Bradycardia: Extremely slow heart rate.
  3. Hypotension: Critically low blood pressure.
  4. Loss of Consciousness: Deep sedation or coma.
  5. Ataxia: Severe loss of coordination and muscle control.
  6. Hypothermia: Dangerously low body temperature.

Emergency Response

If an overdose involving xylazine is suspected, immediate medical intervention is required. Treatment may include:

  • Supportive Care: Maintaining airway and breathing, providing oxygen, and monitoring cardiovascular function.
  • Reversal Agents: While there is no specific antidote for xylazine, agents like yohimbine or atipamezole can be used to counteract its effects in animals.

 

Can Xylazine Cause Psychosis?

Xylazine is not typically associated with causing psychosis. Its primary effects are sedation, analgesia, and muscle relaxation. However, in the context of illicit use, particularly when combined with other substances, there may be an increased risk of adverse mental health effects, though psychosis specifically is not a common outcome. It’s important to note that misuse of any drug can potentially lead to unpredictable effects, including psychological disturbances.

 

Can Xylazine Cause Psychiatric Symptoms?

Xylazine is primarily known for its sedative and analgesic effects, but it can cause psychiatric symptoms, particularly when misused or in combination with other substances. Potential psychiatric symptoms may include:

  • Confusion: Difficulty thinking clearly or focusing.
  • Disorientation: Feeling lost or unsure of one’s surroundings.
  • Agitation: Restlessness and irritability.
  • Anxiety: Increased levels of worry or fear.
  • Hallucinations: Seeing or hearing things that aren’t there, though this is less common.

 

Xylazine and Fentanyl Mixtures: Interactions with Other Substances

  1. CNS Depressants:
  • Examples: Alcohol, benzodiazepines, opioids.
  • Effects: Enhanced sedation, respiratory depression, increased overdose risk. The U.S. Drug Enforcement Administration (DEA) has issued warnings about the deadly drug threat posed by fentanyl mixed with xylazine. Recent incidents of fentanyl pills seized highlight the severe health risks and the ineffectiveness of naloxone in reversing xylazine’s effects, increasing the risk of fatal drug poisoning.
  1. Anesthetics:
  • Examples: Ketamine, propofol.
  • Effects: Potentiated anesthetic effects, deeper sedation, prolonged recovery.
  1. Cardiovascular Medications:
  • Examples: Beta-blockers, calcium channel blockers.
  • Effects: Exaggerated hypotension, bradycardia, cardiovascular instability.
  1. Stimulants:
  • Examples: Cocaine, amphetamines.
  • Effects: Masking of stimulant overdose symptoms, delayed treatment.
  1. Alpha-2 Adrenergic Agonists:
  • Examples: Clonidine, dexmedetomidine.
  • Effects: Synergistic sedation, severe hypotension, bradycardia.

 

Understanding the Dangers of Xylazine

Xylazine poses significant dangers, especially when used outside of its intended veterinary context. As a powerful sedative and muscle relaxant, xylazine can cause profound central nervous system depression, leading to severe respiratory depression, bradycardia (slow heart rate), and hypotension (low blood pressure). These effects are particularly hazardous when xylazine is combined with other CNS depressants like opioids, alcohol, or benzodiazepines, increasing the risk of overdose and death. Additionally, its use as an adulterant in illicit drugs can complicate overdose treatment, as xylazine is not responsive to naloxone, the antidote for opioid overdoses. Chronic misuse can lead to physical dependence, and while not typically associated with classic addiction, it can still contribute to a cycle of substance abuse. The lack of human medical approval and the potential for severe side effects underscore the importance of strict regulation and awareness of the dangers associated with xylazine misuse.

 

Xylazine Addiction

Xylazine is not classified as addictive like opioids or stimulants, but it can be habit-forming due to its sedative and muscle relaxant effects. When combined with opioids, users may develop psychological dependence, leading to repeated misuse. While xylazine itself doesn’t cause intense cravings or compulsive behavior, its misuse poses significant health risks and can worsen the dangers of other substances. Chronic use leads to tolerance and physical dependence, with withdrawal symptoms upon cessation. Addressing xylazine misuse is crucial due to its role in broader substance abuse issues.

 

Xylazine Withdrawal and Mental Health Treatment Options

  1. Detoxification
  • Description: Medical supervision to safely manage withdrawal symptoms.
  • Duration: Typically lasts a few days to a week.
  • Goals: Stabilize the individual, manage acute withdrawal symptoms.
  1. Inpatient Rehabilitation
  • Description: Intensive residential treatment providing comprehensive care.
  • Duration: Usually 30-90 days.
  • Goals: Address physical dependence, psychological support, relapse prevention.
  1. Outpatient Programs
  • Description: Treatment while living at home, attending scheduled therapy sessions.
  • Types: Partial hospitalization (PHP), intensive outpatient programs (IOP).
  • Goals: Flexible support for recovery while maintaining daily responsibilities.
  1. Counseling and Therapy
  • Individual Therapy: One-on-one sessions with a therapist to address personal issues.
  • Group Therapy: Supportive environment with others facing similar challenges.
  • Family Therapy: Involves family members to improve communication and support.
  1. Medication-Assisted Treatment (MAT)
  • Description: Use of medications to manage withdrawal symptoms and reduce cravings.
  • Examples: Methadone, buprenorphine for opioid addiction; naltrexone for alcohol and opioid addiction.
  • Goals: Stabilize brain chemistry, reduce cravings, support long-term recovery.
  1. Mental Health Services
  • Description: Address co-occurring mental health disorders like depression, anxiety, PTSD.
  • Approaches: Psychiatric evaluation, medication management, specialized therapies (CBT, DBT).
  1. Support Groups
  • Examples: Alcoholics Anonymous (AA), Narcotics Anonymous (NA), SMART Recovery.
  • Goals: Provide peer support, share experiences, offer ongoing encouragement.
  1. Holistic and Complementary Therapies
  • Examples: Yoga, meditation, acupuncture, art therapy.
  • Goals: Promote overall well-being, reduce stress, enhance recovery process.
  1. Aftercare and Relapse Prevention
  • Description: Ongoing support after formal treatment ends.
  • Approaches: Continued therapy, support groups, sober living environments.
  • Goals: Maintain sobriety, prevent relapse, support long-term recovery.

 

Does Insurance Cover Addiction Treatment?

Yes, many insurance plans cover addiction treatment, but the extent of coverage can vary widely based on the type of insurance, the specific plan, and the treatment provider. Here are some key points to consider:

Private Health Insurance

  • Coverage: Most private health insurance plans cover a range of addiction treatment services, including detoxification, inpatient rehabilitation, outpatient programs, counseling, and medication-assisted treatment (MAT).
  • Network Providers: Coverage is often better when using in-network providers. Out-of-network services may have higher out-of-pocket costs.
  • Pre-Authorization: Some plans require pre-authorization for certain treatments, meaning you need approval from the insurer before starting treatment.

Medicaid and Medicare

  • Medicaid: Offers comprehensive coverage for addiction treatment, including inpatient and outpatient services, counseling, and MAT. Coverage and specific services can vary by state.
  • Medicare: Covers certain aspects of addiction treatment under Part A (hospitalization), Part B (outpatient services), and Part D (prescription medications). Coverage includes counseling, psychotherapy, and certain medications for substance use disorders.

Employer-Sponsored Insurance

  • Employee Assistance Programs (EAPs): Many employers offer EAPs, which provide confidential counseling and referral services for employees dealing with substance abuse.
  • Health Benefits: Employer-sponsored health insurance often includes coverage for addiction treatment, similar to private insurance plans.

Affordable Care Act (ACA)

  • Essential Health Benefits: The ACA requires all health insurance plans sold on the Health Insurance Marketplace to cover mental health and substance use disorder services as essential health benefits. This includes behavioral health treatment, counseling, and inpatient services.

Military Insurance

  • TRICARE: Covers substance use disorder treatment for active-duty service members, retirees, and their families. Coverage includes inpatient and outpatient services, counseling, and MAT.

Important Considerations

  • Plan Details: Review your specific insurance plan details to understand the coverage limits, copayments, deductibles, and any pre-authorization requirements.
  • Treatment Providers: Verify that the treatment providers and facilities are covered under your insurance plan to minimize out-of-pocket costs.
  • Coverage Limits: Be aware of any coverage limits, such as the number of therapy sessions or the length of inpatient stays that are covered.

 

Common Insurance Plans Used for Addiction and Mental Health Treatment

  1. Private Health Insurance Plans
  • Blue Cross Blue Shield
  • Aetna
  • Cigna
  • UnitedHealthcare
  • Humana
  1. Employer-Sponsored Insurance
  • Group Health Plans: Varies by employer, often includes major insurers like those listed above.
  • Employee Assistance Programs (EAPs): Provides initial counseling and referral services.
  1. Government-Sponsored Insurance
  • Medicaid: State-specific plans, such as Medi-Cal in California or MassHealth in Massachusetts.
  • Medicare: Parts A, B, and D provide coverage for different aspects of addiction and mental health treatment.
  1. Marketplace Insurance Plans (Affordable Care Act)
  • Health Insurance Marketplace Plans: Coverage varies, but all must include mental health and substance use disorder services.
  • State Exchanges: Plans offered through state exchanges, which must meet ACA requirements.
  1. Military Insurance
  • TRICARE: Coverage for active-duty service members, retirees, and their families.
  1. Specialized Insurance Programs
  • Behavioral Health Insurance Providers: Companies that specialize in mental health and addiction treatment coverage, often offered as an additional benefit.

Important Considerations

  • Coverage Verification: Always verify the specific coverage details, as benefits can vary widely within each insurance provider.
  • In-Network Providers: Using in-network providers typically results in lower out-of-pocket costs.
  • Pre-Authorization: Some plans require pre-authorization for certain types of treatment.

Consulting with your insurance provider or a healthcare navigator can help clarify the specific benefits available under your plan for addiction and mental health treatment.

 

Conclusion

Understanding the dangers of xylazine is crucial in the fight against the ongoing overdose crisis. The presence of xylazine in the drug supply, particularly in fentanyl mixtures, has led to a significant increase in overdose deaths. Harm reduction organizations are at the forefront of addressing these challenges, providing essential medical care and wound care to patients exposed to xylazine. The DEA’s reports of the widespread threat from illicitly manufactured fentanyl and xylazine underscore the need for comprehensive national drug control policy measures. By improving xylazine detection, enhancing the drug overdose reporting system, and implementing effective harm reduction strategies, we can mitigate the risks associated with xylazine use and protect the lives of people who use drugs. As we move forward, it is imperative to continue raising awareness and developing targeted interventions to reduce the tragic toll of overdoses involving xylazine.

 

Seeking Treatment? We Can Help!

Xylazine poses significant risks to individuals’ health, well-being, and overall quality of life. Understanding the complexities of this synthetic drug, including its composition, effects, dangers, and recovery pathways, is crucial for making informed decisions about substance use and seeking help when needed.

At California Prime Recovery, as an in-network provider we work with most insurance plans, such as:

If you or a loved one are struggling with mental health challenges or substance abuse, reach out to California Prime Recovery today. Our team of compassionate professionals is here to support your journey towards lasting well-being. Give us a call at 866-208-2390

Also, check out our blogs posted weekly on Medium.

FAQs

Xylazine is a veterinary sedative, muscle relaxant, and analgesic used primarily in large animals like horses and cattle. It is not approved for human use.
Xylazine is not classified as addictive in the traditional sense, but its misuse can lead to psychological dependence and contribute to a cycle of substance abuse.
Yes, an overdose of xylazine can be life-threatening, causing severe respiratory depression, bradycardia, hypotension, and loss of consciousness.
Xylazine’s effects can last for several hours, but it is typically detectable in the blood for up to 24-48 hours and in urine for up to 72 hours.
Side effects include sedation, respiratory depression, bradycardia, hypotension, nausea, vomiting, and hyperglycemia. Long-term misuse can lead to more severe health issues.

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