Opioids and Xylazine Misuse: Effects & Overdose Risks

Xylazine is a substance commonly found mixed with illicit opioids like fentanyl which can contribute to the risk of fatal opioid overdose.¹  According to the Centers for Disease Control and Prevention (CDC), out of 21 jurisdictions, the monthly percentage of illegally made fentanyl (IMF)-involved deaths with xylazine detected increased 276% from January 2019 (2.9%) to June 2022 (10.9%).²

This article will help you understand what xylazine is, its adverse effects, the risks of combining it with opioids, and how to find treatment for xylazine misuse and/or opioid addiction.

What Is Xylazine?

Xylazine is a non-opioid tranquilizer that is FDA-approved for use as a veterinary sedative, analgesic, and muscle relaxant.^3,4 It is not approved for human use.³ Xylazine is legally used for specific veterinary medicinal purposes, such as to calm hyperactive animals or to provide pain relief after injury or surgery.⁴

Originally developed in 1962, xylazine was evaluated for its potential uses as an analgesic, sleep aid, and anesthetic in humans.³ However, due to serious adverse effects, including severe hypotension and central nervous system (CNS) depression, clinical trials in humans were discontinued.³

Although xylazine is not approved for human use, it is increasingly being combined with illicitly manufactured opioids like fentanyl. While many people who use these substances may not be aware they are using drugs that have been cut with xylazine, others may intentionally misuse xylazine to augment certain effects of other drugs.¹

Xylazine Adverse Effects

As there haven’t been many studies on xylazine and humans, researchers do not yet have a complete picture of all of xylazine’s potential effects.^2,5

However, limited studies and anecdotal reports indicate that people have experienced several different effects from xylazine.² Some of the reported adverse effects of xylazine include:⁵

• Dry mouth.
• Drowsiness.
• Hypothermia (low body temperature).
• Hypertension (high blood pressure) and tachycardia (rapid heartbeat) followed by hypotension (low blood pressure) and bradycardia (slow heartbeat).
• Dysrhythmia (irregular heart rhythm).
• Reduced heart rate.
• Respiratory depression.
• Coma.

Xylazine Misuse With Opioids

Xylazine is increasingly being found mixed with other illicit drug sources; particularly illegally manufactured fentanyl.^1,3 Though not an opioid drug itself, xylazine is exacerbating the opioid overdose epidemic, as it can substantially increase the risk of overdose death when used in combination with fentanyl or other opioids.⁵

People who engage in opioid misuse should be aware that they may be using substances that contain xylazine.¹ Approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the Drug Enforcement Administration (DEA) in 2022 contained xylazine.⁶

Additionally, in a report from November 2022, the DEA warned that 6 out of 10 fentanyl-laced fake prescription pills contain a potentially lethal dose of fentanyl.⁶

In addition to fentanyl, other drugs may be adulterated with xylazine, including cocaine, other opioids like heroin, and other illicit substances.⁵

Is Xylazine an Opioid?

No, xylazine is not an opioid; however, it can result in dangerously slowed breathing and lowered blood pressure, heart rate, and body temperature. ⁷ It is reportedly added to illicit opioids like fentanyl or heroin in an effort prolong the length of the euphoric high.¹

Since it is a very low-cost substance, dealers will replace fentanyl or heroin with xylazine to save money.⁵

Dangers and Risks of Xylazine With Opioids or Other Drugs

Experts still have a lot to learn about the combined use of xylazine and other drugs, but there are some known risks, including:

• Soft tissue injuries/tissue necrosis in association with injection use. Injecting xylazine can lead to infections, rotting tissue, and tissue death that may result in an increased risk of limb loss compared to people who inject other drugs without xylazine.^5,7
• Risk of physiological dependence and withdrawal. Xylazine may result in dependence, leading to xylazine withdrawal symptoms, such as agitation, severe anxiety, chest pain, and seizures, when people stop using it.^5,8 Xylazine could also complicate opioid withdrawal management because it does not seem to respond to medications that are traditionally used to treat opioid withdrawal, such as methadone, buprenorphine, or naltrexone.⁷
• Heightened CNS/respiratory depression. As mentioned above, xylazine on its own can depress breathing, blood pressure, heart rate, and body temperature to critical levels, but this risk can be significantly increased when combined with opioids.^1,7
• Fatal overdose. Particularly in combination with fentanyl or other synthetic opioids, similar adverse pharmacological effects can synergize the risk of respiratory depression and related overdose deaths.⁵

Xylazine and Opioid Overdose

Overdose is the most significant risk related to opioid/xylazine use because it can be deadly.⁶ As mentioned above, xylazine can increase the potential for fatal overdoses when combined with other substances, including fentanyl.¹

Symptoms of xylazine overdose may be similar to opioid overdose symptoms. When xylazine and opioids are combined, overdose symptoms may include:^8,9

• Miosis (small or pinpoint pupils).
• Extreme sleepiness or sedation.
• Respiratory depression (dangerously slow breathing).
• Low blood pressure.
• Slowed heart rate.
• Ataxia (disorientation, stumbling, slurred speech).
• Diminished muscle reflexes.
• Unusual weakness.
• Loss of consciousness / coma.

Xylazine overdose rates are on the rise, and there are likely a number of xylazine/xylazine-involved overdoses that have gone undetected because xylazine is not routinely tested for in toxicology tests.^5,8

However, xylazine is increasingly present in samples seized by law enforcement agencies.⁶ For example, in samples from 8 syringe service programs in Maryland tested between 2021 and 2022, xylazine was found in almost 80% of drug samples that contained opioids.¹⁰ As such, xylazine is contributing to the opioid overdose epidemic.^1,6

Xylazine Addiction

As its misuse most often occurs in combination with other addictive drugs, xylazine’s own addictive potential is not fully understood. However, a 2023 article in the New England Journal of Medicine indicates that people may develop certain symptoms that are consistent with a xylazine-related substance use disorder.¹¹

The primary concerns at the present time are the risks associated with polysubstance use, as well as the presence of xylazine in illicit drugs, unbeknownst to buyers.^1,11

As xylazine is increasingly mixed with fentanyl and other opioids, developing an opioid addiction or addiction to other drugs that may be adulterated with xylazine is of concern.¹¹

Should a person develop an opioid addiction, it may lead to purchasing unregulated and dangerous opioids on the street. This can increase the likelihood a person will consume drugs containing the deadly adulterant xylazine.¹⁰

Xylazine Misuse & Recovery in Florida

Recovery First is a leading provider of addiction treatment, offering wraparound care that includes different levels of rehab to meet your needs.

Your recovery journey might start with detox to help you safely withdraw from opioids and xylazine, followed by a stay at our inpatient rehab near Miami, and/or treatment at our outpatient rehab, depending on what is best for you.¹²

Our customized programs and individualized treatment plans take into account all of your individual needs to help you get started on the path to recovery.