Xylazine and Opioids: Effects and Overdose Risk

Xylazine is a non-opioid animal sedative increasingly found mixed with illicit drugs.¹ In recent years, xylazine mixed with opioids—particularly illicitly manufactured fentanyl—has increased and is significantly contributing to the overdose epidemic.¹ The Centers for Disease Control and Prevention (CDC) reports that among 21 jurisdictions, the monthly percentage of deaths involving illicitly manufactured fentanyl with xylazine detected increased by 276% between January 2019 and June 2022.²

Learning more about the emerging threat of xylazine can help keep you or a loved one safe. This page will help you learn the dangers of xylazine, including the risks of xylazine mixed with opioids, and how to get help for xylazine use or opioid addiction.

What Is Xylazine?

Xylazine is a non-opioid analgesic (pain reliever), with sedative properties and is not used in human medicine.^{3, 4} Anecdotal reports indicate that people who use xylazine can experience similar effects to opioids.⁵

Xylazine and drugs that may contain it can be consumed in various ways, such as inhaling, injecting, snorting, or swallowing.¹ However, xylazine is only indicated for specific purposes in animals, including use as a veterinary tranquilizer, analgesic, and muscle relaxant—it is not FDA-approved for use in humans.⁴

Because it is accessible, inexpensive, and can increase sedative effects, xylazine is increasingly added to different drugs, mainly illicit opioids, like fentanyl and heroin, but has also been found in other drugs, including cocaine.^{4, 5} Illicit xylazine is sometimes referred to by street names like ‘tranq’ or ‘tranq dope.’⁴

When xylazine is combined with other drugs that depress the central nervous system (CNS), people can experience dangerous additive effects, including severe respiratory depression, which increases the risk of overdose.⁴ In 2023, the White House’s Office of National Drug Control Policy declared fentanyl mixed with xylazine to be an “emerging threat” due to its impact on the opioid overdose crisis.^{4, 6}

A significant concern is that people who use street drugs such as fentanyl may not be aware that the substances they purchase have been cut with xylazine.⁴ The U.S. Drug Enforcement Administration (DEA) reports that approximately 23% of fentanyl powder and 7% of fentanyl pills seized in 2022 contained xylazine.⁶ Although many instances of xylazine use are unintentional, some people intentionally use xylazine because it can increase the duration of euphoric effects associated with opioids.¹

Effects and Risks of Xylazine Use

Xylazine has not been extensively studied in humans, although clinical trials have found its use resulted in adverse effects, which is why it was deemed unsafe for use in humans.⁴ While researchers do not yet fully understand the effects of xylazine in humans, anecdotal reports indicate that people can experience certain effects associated with xylazine use.^{4, 5}

Some of the potential effects and risks of xylazine can include:⁵

• Dry mouth.
• Drowsiness.
• High blood pressure and rapid heart rate followed by low blood pressure and slow heart rate.
• Irregular heartbeat.
• Hyperglycemia (high blood sugar).
• Hypothermia (low body temperature).
• Respiratory depression.
• Coma.

Xylazine use can lead to physiological dependence, which can cause severe withdrawal symptoms that resemble symptoms of opioid withdrawal when a person abruptly reduces or stops use.⁴ This can prompt a person to seek out xylazine to prevent withdrawal.⁴

Xylazine Mixed With Opioids

Xylazine is rarely found on its own; most xylazine in the U.S. is detected in the presence of opioids, mainly fentanyl.⁷ People who use illicit opioids such as fentanyl should be aware of the potential effects and risks of this dangerous combination. Although there is still much to learn, researchers do know that the combination of xylazine and opioid use can be lethal.⁶

On its own, xylazine can cause respiratory depression. When combined with opioids, the additive effects of each substance increase significantly. This can increase the risk of sustaining injury to the nerves or muscles as a person may stay in the same position for an extended period due to prolonged sedation.⁴ It also increases the risk of a fatal overdose.^{4, 5}

People who inject xylazine or drugs mixed with xylazine experience more injuries to their soft tissue than those who inject drugs without xylazine. These injuries can lead to necrotic tissue that may require amputation.⁵ However, this effect is not always associated with injection and can also occur in people who snort or smoke drugs that contain xylazine as well.⁴

Both xylazine and opioids can cause withdrawal symptoms. People receiving medications for opioid use disorder (OUD), such as buprenorphine or methadone, may need additional support for xylazine withdrawal.⁴

Xylazine and Overdose Risk

An overdose occurs when a person has taken enough of a substance to cause potentially life-threatening symptoms.⁸ An overdose is the most severe risk associated with xylazine, as well as with the combination of xylazine and opioids because it can be fatal.⁵

Xylazine is frequently mixed with opioids, but is also sometimes combined with alcohol and benzodiazepines.⁴ Using xylazine with these substances can increase the already-present risk of profound respiratory depression, which further increases the risk of overdose.⁴

An overdose is a medical emergency.⁴ If you or someone else are experiencing an overdose, it is important to call 911 immediately and administer naloxone if available, as xylazine is frequently combined with opioids. Naloxone (Narcan, Kloxxado, RiVive) is a medicine that can restore a person’s breathing and reverse other opioid overdose symptoms, but it will not affect xylazine overdose alone.^{1, 8}

Xylazine overdose symptoms may resemble symptoms of an opioid overdose.⁵ Symptoms may include:³

• Poor or no muscle reflex.
• Weakness.
• Impaired coordination.
• Slurred speech.
• Profound sedation or sleepiness.
• Difficulty waking.
• Shallow or slowed breathing.
• Constricted or pinpoint pupils.
• Coma.

Getting Help for Xylazine Use

If you or a loved one are struggling with xylazine use, treatment can help you safely stop using substances and start the path to recovery. Treatment may begin with detox to help you more comfortably and safely withdraw from xylazine and other substances.⁹ Following detox, you may transition to ongoing treatment to address the underlying causes of addiction.⁹ Treatment can take place in different settings, including:⁹

• Inpatient addiction treatment, where you live onsite at a treatment facility, receive around-the-clock care and participate in different types of therapy.
• Outpatient addiction treatment, where you travel to a treatment facility during the day but live at home or in a type of recovery housing. You may be able to maintain responsibilities at home, school, or work.

If you’re struggling with xylazine and opioid use misuse or addiction, or you know someone who is, please contact American Addiction Centers at to learn more about addiction treatment options.

You can also look at the facilities listed below to see if they provide the program you are looking for:

• California: Laguna Treatment Center
• Florida: Recovery First Treatment Center
• Florida: River Oaks Treatment Center
• Nevada: Desert Hope Treatment Center
• Mississippi: Oxford Treatment Center
• Texas: Greenhouse Treatment Center

Does Insurance Cover Opioid Addiction Rehab?

For those who have insurance, using health insurance to pay for rehab should cover at least some of the cost of addiction treatment. Coverage may vary depending on your needs and insurance plan.

American Addiction Centers (AAC) is a leading provider of treatment for xylazine and opioid misuse and addiction, with rehabs located across the nation that offer different levels of care and customized treatment plans to suit all needs. If you’re ready to take the next step, you can find a rehab near you using our rehab directory, or call AAC at to learn more about your rehab options. You can also learn more about using health insurance to pay for rehab or verify your insurance over the phone or using the short form below. To find out if your policy covers rehab, click here, or fill out the form below. Your information is kept 100% confidential.

American Addiction Centers maintains a strong partnership with a large group of insurance companies at our addiction treatment facilities. Start the journey to recovery and find out instantly using the form below if your health insurance provider may be able to cover all or part of the cost of rehab and associated therapies.