Xylazine (Tranq)

Xylazine was first synthesized by Bayer in 1962 and then approved as an animal medicine by the FDA in 1972. It is a non-opioid used for its sedative, pain relieving with muscle relaxant properties in animal (veterinary) medicine. Xylazine is not controlled under the Controlled Substances Act. It is not approved by the FDA for use in humans as the substance can lead to serious side effects such as low blood pressure, respiratory and cardiovascular depression, and skin ulcers and lesions.  

Tranq is often mixed into opioids like fentanyl and heroin to increase their euphoric effects. This mixture is usually referred to as “tranq dope.” Since tranq has a similar appearance to heroin and fentanyl, it is difficult to determine which drugs and how much of them you are consuming. In fact, 22 percent of drug users who tested positive for xylazine had no idea they had taken it.  

In April 2023, the White House designated tranq as an “emerging drug threat”, the first time that the White House’s Office of National Drug Control Policy has ever identified a substance for that designation, a mark of the gravity of the danger that it considers to be posed by the drug. In 2021, tranq showed up in about 90 percent heroin and fentanyl supplies in Philadelphia and since then the drug has spread to other regions of the country. The DEA has seized the drug mixture in 48 of the 50 states, and in 2022, about 23 percent of seized fentanyl powder and 7 percent of fentanyl pills contained xylazine. 

Some popular names for xylazine include: 

• Tranq
• Tranq dope
• Sleep-cut
• Philly dope
• Zombie drug

Xylazine comes as a liquid solution for injection and may also appear in the form of a white or brown powder. It is highly soluble in water and other polar solvents. In some cases, xylazine may also be available in the form of tablets or capsules, especially for oral administration to animals. These tablets or capsules can vary in size, shape, and color depending on the manufacturer.  

People report using xylazine or xylazine-containing drugs by injecting, snorting, swallowing, or inhaling. When people use xylazine intravenously, the drug is often mixed with fentanyl and heroin, heated in a spoon or other receptacle, and injected into a vein or muscle. 

Tranq produces extremely strong sedative effects that may make a person remain unconscious for hours at a time. It has rapid onset within minutes and can last eight hours or longer depending upon the dose, the way it was taken, and whether it was combined with an opioid or other drug(s).   

When taken in large doses or with opioids, xylazine can lead to drowsiness, heavy sedation, and loss of consciousness. The short-term effects of xylazine include:  

• Blurred vision 
• Dry mouth 
• Low blood pressure 
• Reduced heart rate 
• Weak reflexes 
• Respiratory depression 
• Disorientation 
• Drowsiness 
• Slurred speech 
• Risk of overdose 

Xylazine is not FDA-approved for human use because it causes dangerously low blood pressure, slows breathing and heart rates that can be fatal. Injecting xylazine can also cause damage to tissue around the injection site, which leads to large sores and skin lesions that have resulted in amputations in severe cases.  

While xylazine on its own is already dangerous, the combination of the drug with other substances increases the likelihood of an overdose, particularly if those other substances are opioids or depressants like alcohol, benzodiazepines, and sedatives. When xylazine is taken alongside any of these types of drugs, it exacerbates side effects leading to drowsiness, loss of consciousness, and potentially even death. 

Prolonged use of xylazine can lead to physical and psychological dependence, as well as a range of physical health problems. These can include respiratory problems, liver and kidney damage, and cognitive impairment.  Other symptoms can be: 

• Rapid Cognitive Decline
• Extreme anemia 
• Drastic weight loss 
• Slow heart rate 
• Low blood pressure 
• Chronic fatigue 
• Pinpoint pupils 
• Lesions and ulcers 
• Migraines 

Since the drug has only recently made its way into drug supplies, more research and education are needed to understand the long-term effects of tranq misuse.  

People can develop a physiological dependence upon xylazine if they use it repeatedly for several days or weeks in a row. Below are typical signs of addiction: 

• Physical and Behavioral Changes: An individual addicted to xylazine may exhibit noticeable physical and behavioral changes. They may appear lethargic or excessively sleepy, and their speech may be slurred. Behavioral changes can include secretive or deceptive behavior, withdrawal from social activities, and a decline in performance at work or school. They may also exhibit a loss of interest in previously enjoyed hobbies or activities. 
• Compulsive Drug-Seeking Behavior: Addiction often leads to compulsive drug-seeking behavior. Individuals addicted to xylazine may spend a significant amount of time and money obtaining and using the drug. This leads to strained relationships and failing to complete responsibilities  
• Withdrawal Symptoms and Tolerance: When attempting to quit or reduce xylazine use, individuals may experience withdrawal symptoms such as restlessness, anxiety, insomnia, tremors, and cravings. 

Unlike common opioids such as fentanyl or heroin, there’s no simple antidote for tranq exposure and overdose. The average dose in fatal cases was 1,200 mg, compared to 525 mg in non-fatal cases. Some of the most common overdose signs to look out for are: 

• Respiratory depression or difficulty breathing 
• Slow heart rate 
• Blue or pale skin 
• Confusion or disorientation 
• Unresponsiveness or loss of consciousness 
• Dilated pupils 
• Muscle weakness or loss of coordination 
• Seizures 
• Nausea and vomiting 

Since it is not an opioid, xylazine does not respond to naloxone. However, it is still important to administer naloxone to anyone who is overdosing because xylazine is often mixed with opioid drugs and the opioids may respond to the naloxone.  

Since tranq heavily impacts normal breathing, recent guidance from the Philadelphia Department of Public Health also encourages overdose responders to provide supplemental oxygen and employ “airway management” techniques — essentially, manipulating the head, neck, and body to ensure breathing isn’t blocked. 

If you suspect an overdose, it is crucial to call 911 or emergency services immediately.  

Treatment for xylazine addiction involves a comprehensive approach that addresses both the physical and psychological aspects of the disorder. Many individuals may come to treatment with wounds and skin lesions from tranq use and it is important to sterilize them to prevent infection from spreading. It is suggested that those recovering from tranq abuse enter a medical-assisted detox that ensures safety by providing a supervised environment where healthcare professionals can monitor and manage withdrawal symptoms. They can intervene if complications arise and provide appropriate medical interventions to minimize discomfort and risk. 

Common xylazine withdrawal symptoms include: 

• Restlessness and agitation 
• Anxiety and panic attacks 
• Insomnia or disturbed sleep patterns 
• Tremors or shakiness 
• Sweating and chills 
• Nausea and vomiting 
• Diarrhea or stomach cramps 
• Muscle aches and pains 

When xylazine is mixed with opioids it can complicate addiction treatment, so it is crucial to address both the substance use disorders at once along with any other co-occurring disorders to increase the likelihood of a successful outcome.  

While detox addresses the physical aspect of addiction, it is important that individuals confront the drug’s psychological and behavioral impact. Therapeutic approaches like cognitive behavioral therapy (CBT) used in residential programs and outpatient programs can help individuals identify and modify unhealthy thought patterns and habits related to xylazine use. It can also assist in developing healthy coping mechanisms and relapse prevention strategies. 

Those recovering from xylazine addiction can benefit from different therapeutic activities. People who used “tranq dope,” a combination of xylazine and opioids, to relieve chronic pain may find benefit in acupuncture or full body massages. Another option to calm an anxious mind is meditation, which improves focus and guides individuals into finding mental and emotional balance. 

Learn about additional holistic therapies by visiting our Wellness page.