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Xylazine (Tranq): What It Is, the Risks, and How to Respond
Xylazine, known on the street as tranq or tranq dope, is a veterinary sedative that has spread through the US illicit drug supply, almost always mixed into fentanyl and other opioids. It is not an opioid, so naloxone does not reverse its effects, and it causes heavy sedation, dangerously slow breathing and severe skin wounds that can appear even away from injection sites. This page explains what xylazine is, why it raises overdose risk, how to respond when someone has been exposed, what withdrawal looks like, and how treatment is adapting.
Quick answers
What is xylazine?
Xylazine is a sedative approved only for veterinary use. It has been found mixed into illicit fentanyl, heroin, cocaine and counterfeit pills across the United States, often without the buyer knowing. On the street it is called tranq or tranq dope.
Why is it so dangerous?
It deepens sedation and slows breathing, and because it is not an opioid, naloxone does not reverse its effects. It also causes severe skin wounds and ulcers, sometimes far from any injection site, that can become infected without treatment.
Should I still give naloxone?
Yes. Xylazine is almost always found with opioids, and naloxone will reverse the opioid part of the overdose. Give naloxone, call 911, and provide rescue breathing, because the person may stay unresponsive from the xylazine even after the opioid is reversed.
Where do I start?
Call the SAMHSA National Helpline at 1-800-662-4357, free and confidential, 24 hours a day, or search licensed programs on FindTreatment.gov. For an active emergency, call 911.
What xylazine is, in plain terms
Xylazine is a tranquilizer approved by the FDA for use in animals only, mainly to sedate horses and cattle for procedures. It was never approved for people, and it has no accepted medical use in humans. Over the past several years it has moved from a regional contaminant to a fixture of the illicit opioid supply, because it is cheap, easy to obtain and extends the sedating effect of fentanyl.
Most people who are exposed to xylazine did not seek it out. It is added to fentanyl and heroin as a cutting agent, and it has also shown up in cocaine, methamphetamine and counterfeit prescription pills. That means a person can develop xylazine dependence and xylazine wounds without ever knowing the word.
Why it is called tranq
- Tranq or tranq dope: the common street names for xylazine itself or for fentanyl cut with it.
- Sleep cut: a name used in some cities for the same mixture.
- The mixture is sold under the same names as fentanyl, so buyers frequently have no way to tell it is present.
What xylazine does to the body
Xylazine is a central nervous system depressant. It slows brain activity, heart rate and breathing, and its effects last far longer than fentanyl's. People exposed to it describe heavy, unrousable sedation lasting hours, followed by severe withdrawal when it wears off.
| Area | What xylazine does | Why it matters |
|---|---|---|
| Breathing | Slows and shallows breathing | Raises the risk of fatal overdose, especially combined with opioids |
| Heart and blood pressure | Drops heart rate and blood pressure | Adds cardiovascular collapse risk on top of opioid sedation |
| Skin and tissue | Causes wounds and ulcers, including away from injection sites | Wounds can progress to deep tissue damage and infection |
| Sedation | Hours of heavy, difficult-to-reverse sedation | A person may stay unresponsive after naloxone reverses the opioid |
| Dependence | Physical dependence develops with repeated exposure | Withdrawal is severe and not yet managed by a standard protocol |
The wounds are different from ordinary injection-site sores
Xylazine-associated wounds can be deep, fast-progressing ulcers that appear on the legs, arms and other sites regardless of how the drug was taken, including in people who snort or smoke it. Untreated, they can reach muscle and bone. They need early wound care, and they are treatable; many harm reduction programs and emergency departments now manage them routinely. The CDC guidance on xylazine covers what clinicians and the public should know.
How to respond to a suspected xylazine overdose
Because xylazine travels with opioids, the first response is the same as any opioid overdose, with one addition: rescue breathing matters more, because naloxone may not wake the person fully.
- Call 911 immediately, then give naloxone. If the first dose does not help within two to three minutes, give another.
- Give rescue breaths: one slow breath every five seconds, since the person's breathing may stay dangerously slow from the xylazine.
- Place the person on their side to protect their airway if they are breathing but unresponsive.
- Stay with them until help arrives; the sedation can outlast the naloxone.
- Do not leave the person to sleep it off. A xylazine-involved overdose can deepen over time.
Dependence and withdrawal
Regular exposure to xylazine produces physical dependence. Withdrawal is described as severe: anxiety, agitation, racing heart, high blood pressure, and intense distress that standard opioid withdrawal medications alone do not fully control. Treatment teams increasingly manage it with a combination of opioid medication for the opioid dependence plus supportive medications targeted at the xylazine symptoms.
- Buprenorphine or methadone still treat the opioid dependence that almost always accompanies xylazine exposure.
- Clinicians may add medications such as clonidine or other sedatives to manage the xylazine-specific agitation and blood pressure spikes.
- Medically supervised withdrawal is strongly recommended rather than stopping abruptly at home, because the symptom picture is complex.
- Wound care should be part of the treatment plan, not an afterthought; untreated wounds are a common reason people leave care early.
If you use opioids regularly and suspect xylazine is in your supply, tell your treatment provider. It changes how withdrawal should be managed, and it is information they need, not information that will be held against you. Our page on opioid addiction and treatment covers the opioid side of the picture in depth.
How treatment is adapting
Treatment for xylazine exposure is really treatment for opioid use disorder with added layers. The evidence base is young, but the core approach is established: start medication for opioid use disorder, manage xylazine withdrawal symptoms supportively, treat wounds early, and address the anxiety and trauma that often sit underneath.
- Medication for opioid use disorder: methadone and buprenorphine reduce overdose death risk and remain the foundation of care.
- Integrated wound care: programs that treat wounds on site keep people engaged in treatment longer.
- Low-barrier and harm reduction services: syringe service programs, test strips, naloxone and non-judgmental care reach people earlier.
- Therapy and support: counseling, peer support and structured programs help once the immediate medical picture stabilizes.
How to get help today
- For an emergency, call 911. For an overdose, give naloxone and provide rescue breaths.
- Call the SAMHSA National Helpline at 1-800-662-4357. Free, confidential, 24 hours a day.
- Search FindTreatment.gov for programs near you that offer medication for opioid use disorder.
- Ask specifically about wound care and experience with xylazine when you call a program.
- If you use drugs, get naloxone and xylazine test strips from a local harm reduction or syringe service program before you need them.
Frequently asked questions
Does naloxone work on xylazine?
No, not on the xylazine itself, because xylazine is not an opioid. You should still always give naloxone in a suspected overdose, because xylazine is almost always mixed with opioids and naloxone reverses the opioid. The person may remain sedated from the xylazine afterward, which is why calling 911 and giving rescue breaths are essential.
Why do drug suppliers add xylazine to fentanyl?
It is inexpensive and it extends the sedating effect of short-acting fentanyl, which stretches supply and mimics a longer-lasting opioid. The people buying the drug almost never benefit from or consent to the addition.
Can you get xylazine wounds if you do not inject?
Yes. Wounds and ulcers have been reported in people who snort or smoke xylazine-contaminated drugs, and they can appear on parts of the body far from any point of use. Any unexplained, worsening wound in someone who uses street drugs deserves medical assessment.
Is xylazine withdrawal fatal?
Xylazine withdrawal is not usually considered directly life threatening the way alcohol or benzodiazepine withdrawal can be, but it is severe and distressing, with agitation, rapid heart rate and high blood pressure. Because it almost always occurs alongside opioid withdrawal, medically supervised withdrawal is strongly recommended.
How do I know if xylazine is in my drugs?
There is no way to tell by look, taste or smell. Xylazine test strips are available from many harm reduction and syringe service programs and can detect it in a small sample before use. Fentanyl test strips detect only fentanyl and its analogs, not xylazine.
Is there a medication for xylazine addiction?
There is no approved medication specifically for xylazine dependence. Treatment focuses on the accompanying opioid use disorder with methadone or buprenorphine, adds supportive medications for xylazine withdrawal symptoms, and treats wounds and mental health needs at the same time.
Talk to someone this week
A doctor or trained helpline counselor can help you choose a safe next step. Support is free and confidential.
Call 1-800-662-4357Sources
- CDC, What you should know about xylazine
- FDA, alert on xylazine in illicit drugs
- DEA, xylazine fact sheet
- SAMHSA National Helpline, 1-800-662-HELP
- FindTreatment.gov, federal treatment locator
This page is for information only and does not replace advice from a qualified clinician who knows your history. In the United States, call or text 988 for the Suicide and Crisis Lifeline.