Xylazine in the U.S. Drug Supply: What You Need to Know

Xylazine Is Reshaping the Overdose Crisis

A veterinary sedative called xylazine, known on the street as “tranq,” has infiltrated the U.S. illicit drug supply at an alarming rate. The Drug Enforcement Administration (DEA) identified xylazine in fentanyl mixtures across 48 states by 2022. In 2023, the White House designated it an “emerging threat.” That designation continues to drive federal and state policy responses in 2025.

What makes xylazine dangerous is simple: naloxone does not reverse its effects. When someone overdoses on a fentanyl-xylazine combination, standard overdose response protocols fall short. This creates a deadly gap in emergency care.

What You Should Know

• Xylazine is a non-opioid sedative approved only for veterinary use
• Naloxone (Narcan) does not reverse xylazine’s respiratory depression
• The DEA found xylazine in fentanyl supplies across 48 states
• Necrotic skin wounds at injection sites are a signature health consequence
• New adulterants like medetomidine are emerging as replacements in some regions

The Health Consequences of Xylazine Exposure

Xylazine causes severe respiratory depression, profound sedation, and dangerously low blood pressure. People exposed to it report intense withdrawal symptoms that differ from opioid withdrawal. Many describe the experience as more painful and disorienting.

The most visible sign of xylazine use is necrotic skin lesions. These wounds develop at and away from injection sites, sometimes resulting in tissue death serious enough to require amputation. Medical professionals often lack training to treat these specific injuries.

“People who use drugs and encounter xylazine report overwhelmingly negative experiences, describing profound sedation and a lack of awareness among clinicians for treating xylazine-related conditions.” — Johns Hopkins Bloomberg School of Public Health

Shifting Trends Across the Country

Xylazine prevalence varies by region and continues to shift. In New England, xylazine-positive urine drug tests increased by over 100% between 2023 and 2024. Meanwhile, a 2025 study from Los Angeles showed significant increases in xylazine found in the local illicit fentanyl supply, confirming its spread to the West Coast.

Some areas report a decline. East Tennessee has seen a drop in xylazine-related overdoses. A Labcorp report from August 2025 found xylazine in fewer than 50% of fentanyl-positive samples nationally, its lowest level since the third quarter of 2022.

The decline comes with a caveat. Medetomidine, another veterinary sedative, has started appearing as a replacement. This pattern mirrors the broader trend of the drug supply constantly evolving.

How Federal Policy Is Responding

Federal agencies have launched several initiatives to address the xylazine threat.

• National Response Plan: The White House set a goal in July 2023 to reduce xylazine-positive drug poisoning deaths by 15% across at least three census regions by 2025
• Scheduling efforts: Congress and the DEA are working to classify xylazine as a controlled substance while preserving its legitimate veterinary use
• Research funding: Federal agencies have increased funding for xylazine detection and treatment research

Protecting Yourself and Your Community

If you or someone you know uses substances, awareness of xylazine contamination is critical. Fentanyl test strips do not detect xylazine. Specialized xylazine test strips are becoming more available through harm reduction organizations.

Naloxone should still be administered during a suspected overdose. Even though it does not reverse xylazine, it does reverse the opioid component of fentanyl-xylazine mixtures. Call 911 immediately, as xylazine overdoses require medical support for breathing and blood pressure management.

Getting Help Is the First Step

The increasingly dangerous drug supply makes treatment more important than it has ever been. If you or a loved one is struggling with substance use, contact a treatment provider today. Evidence-based programs offer safe, medically supervised care that accounts for the realities of today’s drug supply. Do not wait for a crisis to seek help.