--- title: "Xylazine: The Zombie Drug" description: "Imagine for a moment that you're walking down the street late at night. You find yourself having to cut through a dark alley to get home, when out stumbles what can only be described as a real-life zombie. Missing limbs, flesh still decaying on the bone, as they menacingly shuffle towards you.\n\nOf course, zombies aren't real, but the substance used to turn people into these shambling husks is.\n\nIt's called *Xylazine.*\n\nIt has been sweeping across United States streets wreaking havoc everywhere it goes. Whether being taken on its own or being used to bulk out other drugs, it's dangerous, highly addictive, and forms a fatal partnership with one of the *deadliest* illegal substances in the world.\n\nBut what threats does this new narcotic hold? What is being done to combat its spread? And what is it that seems to make its victims both envy the dead and imitate them?\n\nIt might just be the fastest growing, and scariest new drug in the world.\n\n## Xylazine – Everything You Need to Know\n\nOk, so what actually is Xylazine, and where did it come from?\n\nIt's a veterinary tranquiliser, pain reliever, and a depressant of the central nervous system. Basically it's a very strong sedative used on animals for medical procedures. If you know *anything* about drugs both legal and illegal, you will know it can be common for certain animal medicines to be abused by humans. Ketamine is famously a horse tranquiliser, and fentanyl was used to knock out elephants prior to both substances' more notorious and illegal uses.\n\nAnd Xylazine is no different. But what is different, is that unlike a lot of the drugs terrorising American streets today, it's not an opioid, which actually makes its growth amidst the current US opioid crisis even more concerning.\n\nNot a huge amount is known about the drug's early days. It was synthesized for the first time in 1962 by the German company Bayer, operating in the Western half of the country at the time. It was originally thought it could be a human medication, but clinical trials were shelved after it caused nasty side effects like a dramatically slowed heartrate and very low blood pressure.\n\nBecause, you know, the whole sedative thing.\n\nSo it was shelved for human use, but it seemed to work well on certain animals, especially larger ones like horses and cattle. So from the 1970s onwards it would see use as a general veterinary tranquiliser, and it's very good at it, with it still being used for this purpose today. And this gives it its nickname on the streets, \"tranq.\"\n\nHowever, over the years it would slowly start to integrate itself into illegal narcotic supply routes. It was legally attainable after all and had some pretty strong effects, so it would only be a matter of time before somebody thought; \"Gee, I wonder if this will get me high.\"\n\nNobody seems to know where or when the first instances of the abuse of xylazine was, but by the early 2000s the tranquiliser was pretty common in places like Puerto Rico just off the US mainland. By the late 2000s it had reached the notorious drug markets of Philadelphia and New York. It remained in obscurity as the opioid crisis in the US continued to rise throughout the 2010s, and now in the 2020s, it is just starting to see widespread use as it goes more mainstream amongst hard drug culture.\n\nSo, what has caused this relatively recent rise in popularity? Well there are a lot of factors at play here.\n\nOne, is that it's really easy to get a hold of. It isn't that difficult to find online as a totally legal substance with legitimate veterinary uses, and so it had a more underground legal high status. Legal highs are often misinterpreted as \"safer\" by people who see less legal risk in using them, but that's not the case when it comes to health risks. In reality the law is always playing catchup to ban dangerous substances before they can affect wider public health, and *some* of them slip through the cracks like Xylazine.\n\nAnother reason it has seen a rise in popularity is because it's both cheap and profitable. Addiction is a race to the bottom when it comes to prices, and because Xylazine is already mass produced it's pretty cheap to buy outright. But it's also very profitable. Xylazine is a sedative, and as a depressant it is often used to cut other narcotic substances to make them cheaper by bulking them out, but while crucially ensuring potency stays high.\n\nThis is referred to often as \"tranq dope.\" And depending on the dose and co-narcotic the high can last up to eight hours after taking it. It can be injected, ingested, or snorted, even smoked. Any method for chasing the xylazine dragon is available to people, which only makes it more amenable to drug users.\n\nThe high is very similar to the opioid kind of high with the way it slows brain activity, relaxes muscles, and makes people feel drowsy yet euphoric. This means it can be used to *\"enhance\"* the effects of other drugs, either in terms of duration or strength. Drugs like fentanyl are cut using substances like xylazine, which creates a deadly combination that is rapidly worsening the opioid crisis because of increased chance of overdose on multiple substances. But it's not just fentanyl, xylazine is used to cut many drugs for potent chemical combinations, whether in THC vapes, heroin, or speed balling cocaine, xylazine can be part of many chemical cocktails.\n\nUnless you have access to facilities or equipment that can let you test your drugs, a lot of dope ends up being tranq dope because it's cheaper, making drug suppliers greater profits. According to the *New York Times*, when tranq first entered Philadelphia's open-air drug markets in the late noughties, a bag of mostly pure heroin was about $10 dollars, tranq dope was *five.* It's easy to see how addicts of a substance like heroin quickly fell into it, just like how heroin itself is cheaper than prescription pain pills. When the heroin trade from Afghanistan was cut by the Taliban by 95% after retaking control around 2021, other synthetic opioids like fentanyl and their accompanying drugs like xylazine suddenly had a gap in the market to fill. And such powerful drugs were all too ready to take over people's lives.\n\nBecause that's the other thing about tranq, it's *hopelessly* addictive. The way people describe their experiences with it remind you of the way people talk about heroin addiction, where people want to escape but they can't seem to find the strength to do so, because tranq and its many associated drugs have too tight a hold on them. One user who was interviewed by the *New York Times* on her story stated:\n\n> \"It was the beginning of my pregnancy, Xylazine is so addictive, so physically addictive, you just can't stop.\"\n\nPretty scary stuff. And this is reportedly owing to the very powerful withdrawal effects that xylazine has on people who use it. Early research suggests substance use disorder symptoms and withdrawal symptoms may be more intense for those taking xylazine with fentanyl versus fentanyl alone. One user said:\n\n> \"It's like the flu times a hundred. I was throwing up a lot. I was just in a rotating pit of hell. So I was using.\"\n\nOne of the many tragedies about xylazine, is that those who are well-versed in tranq would prefer not to take it.\n\nIn 2022, an anonymous series of surveys on Reddit were conducted in the seven subreddits identified as having the highest number of Reddit posts related to xylazine, with respondents reporting their patterns of use. Of the 61 respondents, 74% reported that they do not seek out to buy or acquire drugs that contained xylazine. Yes, the sample size is small, but it does appear to reflect general attitudes about tranq, that many people got into it by accident as a result of unwanted additives. When combined with fentanyl in particular, it appears to have a *devastating* one-two punch that is leading to increasing number of overdose deaths every single year. But how many are we looking at here? What is the scale of this problem?\n\nWell, unfortunately, it's growing *fast.*\n\n## Die-Lazine – Addiction, Withdrawal, And Rotting Flesh\n\nSo, we know where it came from and how it's come to have a reputation both as a powerful sedative and an extra ingredient people didn't ask for. But you can't see how dangerous xylazine is until you see the numbers, and particularly the way they're trending upwards.\n\nIn just three years between 2018 and 2021, the number of xylazine-involved overdose deaths in the US rose from a relatively small 102 to a staggering 3,468. That is a 32-fold increase in just 36 months.\n\nThe DEA has seized xylazine and fentanyl mixtures in *48* of 50 states. The DEA often tests the drugs it confiscates to find out what they're made of and try and stay one step ahead of an ever-evolving designer drug market. The DEA found in 2022 that 23% of fentanyl powder and seven percent of fentanyl pills contained xylazine country-wide.\n\nOne study from 10 US cities showed xylazine was involved in less than one percent of drug overdose deaths in 2015. By 2020 it was *seven percent.*\n\nAnother report from the CDC's State Unintentional Drug Overdose Reporting System (or SUDORS) announced that the monthly percentage of deaths involving illegally made fentanyl with xylazine increased from just three percent in January of 2019 to a staggering 11% in June 2022.\n\nWe don't have more recent metrics to describe the true scale of the crisis today, but you can see *just how quickly* that xylazine has started to make its influence truly known.\n\nOk, so other than being a bit like the opioids around at the moment in its effects, and the fact that it's monumentally addictive, what does xylazine actually do to your body to contribute to those increasing numbers of overdose deaths?\n\nWell let's start with what it's described to do. It's a sedative so it makes you drowsy by slowing brain activity, and those same side effects we mentioned earlier in the failed clinical trials reappear here. An extremely slow heart rate and dangerously low blood pressure are both reported in xylazine victims. This also tends to slow down breathing to the extent that it can even be difficult to breathe depending on the dose and what else someone has taken alongside xylazine. In fentanyl, this is what creates that potentially lethal combination as fentanyl already slows the body's vital functions. Take too much and someone can easily go into respiratory arrest where they stop breathing entirely, and after that people don't tend to last very long.\n\nIt can also lead to loss of physical sensation in the body, as well as a total loss of consciousness. In that same anonymous Reddit survey we mentioned earlier, 48 respondents reported unwanted effects from xylazine; 81% reported increased overdoses, and 17% reported increased emergency room visits.\n\nNow the bodily effects we've mentioned so far are merely the trends identified in patients who had xylazine in their system so it's fair to say that this isn't an exhaustive list of symptoms overall. This is especially so as it's hard to know what to attribute to xylazine and what to attribute to other substances because they're so frequently taken together.\n\nBut it only gets truly gruesome when the skin lesions start to appear. Repeated xylazine use is associated with skin wounds like ulcers and abscesses that typically appear on the site of injection. However, they often appear elsewhere on the body, and some clinicians report that these wounds happen even when people smoke or snort xylazine but do not inject it.\n\nOver time these can get badly infected, leading to patches of skin and tissue necrotising to the extent it starts rotting off of somebody's own body. This is not dissimilar to the Russian gas station heroin alternative, Krokodil, which appears to have a similar necrotic effect. The reality is in the US, when health insurance is so expensive, and many drug addicts are left homeless on the street, there's nothing they can do to stop their wounds getting infected. If they're lucky they might just need antibiotics, but if they're not rare cases have seen people who have had to have limbs amputated when infection has reached the bone.\n\nTracey McCann, an American user interviewed about her experience of this phenomenon said:\n\n> \"I'd wake up in the morning crying because my arms were dying.\"\n\nAnd that's not hyperbole either. Doctors are reportedly constantly perplexed by how xylazine causes wounds so extreme that they initially resemble chemical burns.\n\nMs. McCann's tranq-scorched forearms reportedly stank of rotting flesh, whilst they oozed and itched constantly. When public restrooms are one's only source of clean water, you can see how hard it would be to keep on top of such a massive infection. This ulceration and rotting of the skin where limbs need to be amputated, combined with that drowsy shambling that many opioid and xylazine users experience is what has caused people to equate them with the undead, with many referring to xylazine as \"the zombie drug.\"\n\nAnd when you consider that's all before you even touch the fentanyl, you can see how xylazine acts like an accelerant for a person's physical and mental decline.\n\nThe scale of the opioid crisis in general in the US makes the response to xylazine worse as well. Often when people are found having overdosed in the US today it tends to be opioids, but both opioid and xylazine overdoses look and act very similar. Now first responders and users alike are taught to utilise overdose reversing drugs for opioids like naloxone, also known as Narcan. But giving someone who, for example, has overdosed on a mixture of fentanyl and xylazine, naloxone might not necessarily reverse things. As Xylazine isn't an opioid, naloxone doesn't reverse its effects, meaning a person can continue to overdose from the residual xylazine still in their system and still die.\n\nThe antidote for xylazine is tolazoline, which is commonly used to reverse the effects necessary to complete a surgical operation, but that's just not something most people who aren't vets have laying around like they might with Narcan. Throw on top that people might not even know that they've taken any xylazine at all because of how it's commonly added to other substances, as well as the fact that xylazine can help enhance other substance's effects which masks its presence, and it can be a very quick way to land in your local paper's obituary.\n\nSo, what's being done about all this, are crackdowns on xylazine coming? And can the genie even be put back in the bottle?\n\n## Harm Reduction – The Future of Xylazine?\n\nThe last several years of xylazine's rise to prominence on the drug market has started to see some backlash from legislators in the Western world. In April of 2023, the White House designated xylazine combined with fentanyl as an 'emerging drug threat', which has enabled the implementation of an action plan and funding at the federal level to tackle the risks it poses. This also typically precedes a drug being scheduled as a controlled substance by the federal government.\n\nIt's hard to totally outlaw xylazine because it has legitimate and important uses, but labelling something a controlled substance will hopefully lead to more police oversight and tighter purchasing controls for individuals. Several states like Ohio and Pennsylvania have already rendered it a controlled substance, whilst Mexico and Canada have started to track imports of it into their countries. In July of 2023 the White House also released a National Response Plan to address the emerging threat of fentanyl mixed with xylazine. So across the board in places like the US it is finally starting to be seen as the serious threat to public health that it is. It doesn't help that it exists in a legal grey area, but the more mainstream xylazine gets the more likely that grey area will be ironed out by legislation.\n\nOther countries have started keeping tabs on xylazine also. Countries in Asia do already ban it outright, and it was just scheduled as a class C drug in the UK in 2025.\n\nIt's not just the harsh punishments that come with such labels either. Labelling something as a controlled substance can also release funding for things like clinics and education programs for communities to combat the issues xylazine causes. Harm reduction policies in the US are pretty minimal, but the pressure is growing from advocates in some parts of the country for things like supervised injection sites, where people can use in safer conditions and even have their drugs tested. Xylazine test strips are slowly becoming more readily available so people can at least make sure their drugs are safe one way or another. At the moment only two of these clinics for xylazine exist in the US, both are based in New York City. Such facilities can also help educate people to help them understand the damage that a substance like xylazine can do to a person, especially over time.\n\nBut at present it's a losing battle. The trends on xylazine continue to go upwards whilst it spreads into more and more countries every year, mainly as a heroin and fentanyl hanger-on.\n\nFor example, according to Dr Caroline Copeland from the School of Cancer & Pharmaceutical Sciences, xylazine has already broken into the UK drug market, potentially exposing thousands upon thousands of people to its harmful effects. The first death in the UK reported as directly involving xylazine was in May 2022. The BBC reported on the death a year later that the individual died at home, and had a history of using narcotics. According to a report on the person's death from the *Journal of Forensic and Legal Medicine*, this person had xylazine, cocaine, fentanyl, and heroin in their system at the time of death, and that they were likely to have purchased heroin not knowing it was laced with xylazine, leading to predictably grim results.\n\nOthers believe it's a losing battle.\n\nShawn Westfahl is an outreach worker with Prevention Point Philadelphia who works in Kensington, the neighbourhood at the epicentre of the city's massive open-air drug trade. When asked what can be done to help the xylazine problem in the area, he stated:\n\n> \"It's too late for Philly. Philly's supply is saturated. If other places around the country have a choice to avoid it, they need to hear our story.\"\n\nMeanwhile people continue to suffer, a lot of the time from a drug they may not have even realised they were taking at all, let alone addicted to. Healthcare staff and people's families continue to fight for their loved ones and patients, but there is never enough money, equipment, or help to deal with the scale of the opioid crisis as a whole. Xylazine is simply another arm of the trade that makes things *infinitely* more complicated to untangle.\n\nJoseph D'Orazio, an expert in toxicology and addiction medicine at Temple University Hospital in Philadelphia which treats dozens of xylazine users daily, stated:\n\n> \"Most people tell me, 'I wish I could find dope that didn't have xylazine,' But what gets put out there on the street is what people have to use.\"\n\nThere simply isn't enough research yet, there's not enough funding, there's not enough media recognition. When it comes to xylazine, there's simply not enough of anything to go around. It appears that the xylazine threat will continue to grow. This is *going to get worse* before it gets better.\n\nBut how many thousands more will lose their battle with addiction before that happens? Your guess is as good as ours.\n\nStay safe out there.\n\n## Key Takeaways\n\n- Xylazine, a veterinary tranquilizer, is increasingly used recreationally and mixed with other drugs, exacerbating the opioid crisis.\n- The drug is highly addictive and causes severe withdrawal symptoms, often leading to continued use.\n- Xylazine use is linked to severe skin lesions and tissue necrosis, earning it the nickname 'zombie drug'.\n- Overdose deaths involving xylazine have surged, with a 32-fold increase from 2018 to 2021 in the US.\n- Efforts to combat xylazine include legislative actions and harm reduction strategies, but challenges remain significant.\n\n## Frequently Asked Questions\n\n### What is Xylazine?\n\nXylazine is a veterinary tranquilizer, pain reliever, and depressant of the central nervous system. It is a strong sedative used on animals for medical procedures.\n\n### How did Xylazine become a street drug?\n\nXylazine was originally synthesized for human use but was shelved due to severe side effects. It was then used as a veterinary tranquilizer. Over time, it started to be abused by humans and integrated into illegal narcotic supply routes.\n\n### What are the effects of Xylazine on the body?\n\nXylazine slows brain activity, relaxes muscles, and makes people feel drowsy yet euphoric. It can also cause an extremely slow heart rate, dangerously low blood pressure, and difficulty breathing. Repeated use can lead to skin wounds, ulcers, and abscesses that can become infected and necrotic.\n\n### Why is Xylazine often referred to as the 'zombie drug'?\n\nXylazine is referred to as the 'zombie drug' due to the drowsy, shambling behavior it induces in users, combined with the severe skin lesions and tissue necrosis that can occur with repeated use.\n\n### How does Xylazine contribute to the opioid crisis?\n\nXylazine is often used to cut other narcotic substances, making them cheaper and more potent. This creates a deadly combination, especially when mixed with fentanyl, leading to an increased risk of overdose and death.\n\n### What are the withdrawal symptoms of Xylazine?\n\nWithdrawal symptoms from Xylazine are reported to be intense, often described as feeling like the flu times a hundred, with severe nausea, vomiting, and overall physical distress.\n\n### What is being done to combat the spread of Xylazine?\n\nThe White House designated xylazine combined with fentanyl as an 'emerging drug threat' in April 2023, enabling federal action plans and funding. Several states and countries have started to track and control its import and use, and harm reduction policies are being discussed and implemented in some areas.\n\n### How does Xylazine affect overdose reversal efforts?\n\nNaloxone, commonly used to reverse opioid overdoses, does not reverse the effects of Xylazine. The antidote for Xylazine is tolazoline, which is not widely available outside of veterinary settings, making overdose reversal more challenging.\n\n### What is the current scale of the Xylazine problem?\n\nBetween 2018 and 2021, the number of xylazine-involved overdose deaths in the US rose from 102 to 3,468. The DEA has seized xylazine and fentanyl mixtures in 48 of 50 states, and its presence in drug overdose deaths has been increasing rapidly.\n\n### How is Xylazine used in combination with other drugs?\n\nXylazine is often used to cut other drugs like fentanyl, heroin, and cocaine to make them cheaper and more potent. It can be injected, ingested, snorted, or smoked, making it versatile for drug users.\n\n## Sources\n\n- [Original Into the Shadows video: Xylazine: The Zombie Drug](https://www.youtube.com/watch?v=XTTR2gK8qoQ)\n- [Hero image source](https://images.rawpixel.com/editor_1024/czNmcy1wcml2YXRlL3Jhd3BpeGVsX2ltYWdlcy93ZWJzaXRlX2NvbnRlbnQvbHIvdXB3azYxNzMyNDExLXdpa2ltZWRpYS1pbWFnZS1rb3dyMnU1dC5qcGc.jpg) by openverse, cc0.\n\n## Related Coverage" url: https://intotheshadows.pub/article/xylazine-the-zombie-drug.md canonical: https://intotheshadows.pub/article/xylazine-the-zombie-drug datePublished: 2026-06-27 dateModified: 2026-06-27 author: - name: Simon Whistler url: https://intotheshadows.pub/author/simon-whistler publisher: Into the Shadows image: "https://media.intotheshadows.pub/cdn-cgi/image/width=1600,height=900,fit=cover,quality=80,format=auto/articles/XTTR2gK8qoQ/hero.jpg" type: Article contentHash: 26ad49ef67f7dc84eb798926440a3bf363d4e77215274b1eb67bd66383a520f4 tokens: 5828 summaryUrl: https://intotheshadows.pub/article/xylazine-the-zombie-drug.md.summary.md --- Imagine for a moment that you're walking down the street late at night. You find yourself having to cut through a dark alley to get home, when out stumbles what can only be described as a real-life zombie. Missing limbs, flesh still decaying on the bone, as they menacingly shuffle towards you. Of course, zombies aren't real, but the substance used to turn people into these shambling husks is. It's called *Xylazine.* It has been sweeping across United States streets wreaking havoc everywhere it goes. Whether being taken on its own or being used to bulk out other drugs, it's dangerous, highly addictive, and forms a fatal partnership with one of the *deadliest* illegal substances in the world. But what threats does this new narcotic hold? What is being done to combat its spread? And what is it that seems to make its victims both envy the dead and imitate them? It might just be the fastest growing, and scariest new drug in the world. ## Xylazine – Everything You Need to Know Ok, so what actually is Xylazine, and where did it come from? It's a veterinary tranquiliser, pain reliever, and a depressant of the central nervous system. Basically it's a very strong sedative used on animals for medical procedures. If you know *anything* about drugs both legal and illegal, you will know it can be common for certain animal medicines to be abused by humans. Ketamine is famously a horse tranquiliser, and fentanyl was used to knock out elephants prior to both substances' more notorious and illegal uses. And Xylazine is no different. But what is different, is that unlike a lot of the drugs terrorising American streets today, it's not an opioid, which actually makes its growth amidst the current US opioid crisis even more concerning. Not a huge amount is known about the drug's early days. It was synthesized for the first time in 1962 by the German company Bayer, operating in the Western half of the country at the time. It was originally thought it could be a human medication, but clinical trials were shelved after it caused nasty side effects like a dramatically slowed heartrate and very low blood pressure. Because, you know, the whole sedative thing. So it was shelved for human use, but it seemed to work well on certain animals, especially larger ones like horses and cattle. So from the 1970s onwards it would see use as a general veterinary tranquiliser, and it's very good at it, with it still being used for this purpose today. And this gives it its nickname on the streets, "tranq." However, over the years it would slowly start to integrate itself into illegal narcotic supply routes. It was legally attainable after all and had some pretty strong effects, so it would only be a matter of time before somebody thought; "Gee, I wonder if this will get me high." Nobody seems to know where or when the first instances of the abuse of xylazine was, but by the early 2000s the tranquiliser was pretty common in places like Puerto Rico just off the US mainland. By the late 2000s it had reached the notorious drug markets of Philadelphia and New York. It remained in obscurity as the opioid crisis in the US continued to rise throughout the 2010s, and now in the 2020s, it is just starting to see widespread use as it goes more mainstream amongst hard drug culture. So, what has caused this relatively recent rise in popularity? Well there are a lot of factors at play here. One, is that it's really easy to get a hold of. It isn't that difficult to find online as a totally legal substance with legitimate veterinary uses, and so it had a more underground legal high status. Legal highs are often misinterpreted as "safer" by people who see less legal risk in using them, but that's not the case when it comes to health risks. In reality the law is always playing catchup to ban dangerous substances before they can affect wider public health, and *some* of them slip through the cracks like Xylazine. Another reason it has seen a rise in popularity is because it's both cheap and profitable. Addiction is a race to the bottom when it comes to prices, and because Xylazine is already mass produced it's pretty cheap to buy outright. But it's also very profitable. Xylazine is a sedative, and as a depressant it is often used to cut other narcotic substances to make them cheaper by bulking them out, but while crucially ensuring potency stays high. This is referred to often as "tranq dope." And depending on the dose and co-narcotic the high can last up to eight hours after taking it. It can be injected, ingested, or snorted, even smoked. Any method for chasing the xylazine dragon is available to people, which only makes it more amenable to drug users. The high is very similar to the opioid kind of high with the way it slows brain activity, relaxes muscles, and makes people feel drowsy yet euphoric. This means it can be used to *"enhance"* the effects of other drugs, either in terms of duration or strength. Drugs like fentanyl are cut using substances like xylazine, which creates a deadly combination that is rapidly worsening the opioid crisis because of increased chance of overdose on multiple substances. But it's not just fentanyl, xylazine is used to cut many drugs for potent chemical combinations, whether in THC vapes, heroin, or speed balling cocaine, xylazine can be part of many chemical cocktails. Unless you have access to facilities or equipment that can let you test your drugs, a lot of dope ends up being tranq dope because it's cheaper, making drug suppliers greater profits. According to the *New York Times*, when tranq first entered Philadelphia's open-air drug markets in the late noughties, a bag of mostly pure heroin was about $10 dollars, tranq dope was *five.* It's easy to see how addicts of a substance like heroin quickly fell into it, just like how heroin itself is cheaper than prescription pain pills. When the heroin trade from Afghanistan was cut by the Taliban by 95% after retaking control around 2021, other synthetic opioids like fentanyl and their accompanying drugs like xylazine suddenly had a gap in the market to fill. And such powerful drugs were all too ready to take over people's lives. Because that's the other thing about tranq, it's *hopelessly* addictive. The way people describe their experiences with it remind you of the way people talk about heroin addiction, where people want to escape but they can't seem to find the strength to do so, because tranq and its many associated drugs have too tight a hold on them. One user who was interviewed by the *New York Times* on her story stated: > "It was the beginning of my pregnancy, Xylazine is so addictive, so physically addictive, you just can't stop." Pretty scary stuff. And this is reportedly owing to the very powerful withdrawal effects that xylazine has on people who use it. Early research suggests substance use disorder symptoms and withdrawal symptoms may be more intense for those taking xylazine with fentanyl versus fentanyl alone. One user said: > "It's like the flu times a hundred. I was throwing up a lot. I was just in a rotating pit of hell. So I was using." One of the many tragedies about xylazine, is that those who are well-versed in tranq would prefer not to take it. In 2022, an anonymous series of surveys on Reddit were conducted in the seven subreddits identified as having the highest number of Reddit posts related to xylazine, with respondents reporting their patterns of use. Of the 61 respondents, 74% reported that they do not seek out to buy or acquire drugs that contained xylazine. Yes, the sample size is small, but it does appear to reflect general attitudes about tranq, that many people got into it by accident as a result of unwanted additives. When combined with fentanyl in particular, it appears to have a *devastating* one-two punch that is leading to increasing number of overdose deaths every single year. But how many are we looking at here? What is the scale of this problem? Well, unfortunately, it's growing *fast.* ## Die-Lazine – Addiction, Withdrawal, And Rotting Flesh So, we know where it came from and how it's come to have a reputation both as a powerful sedative and an extra ingredient people didn't ask for. But you can't see how dangerous xylazine is until you see the numbers, and particularly the way they're trending upwards. In just three years between 2018 and 2021, the number of xylazine-involved overdose deaths in the US rose from a relatively small 102 to a staggering 3,468. That is a 32-fold increase in just 36 months. The DEA has seized xylazine and fentanyl mixtures in *48* of 50 states. The DEA often tests the drugs it confiscates to find out what they're made of and try and stay one step ahead of an ever-evolving designer drug market. The DEA found in 2022 that 23% of fentanyl powder and seven percent of fentanyl pills contained xylazine country-wide. One study from 10 US cities showed xylazine was involved in less than one percent of drug overdose deaths in 2015. By 2020 it was *seven percent.* Another report from the CDC's State Unintentional Drug Overdose Reporting System (or SUDORS) announced that the monthly percentage of deaths involving illegally made fentanyl with xylazine increased from just three percent in January of 2019 to a staggering 11% in June 2022. We don't have more recent metrics to describe the true scale of the crisis today, but you can see *just how quickly* that xylazine has started to make its influence truly known. Ok, so other than being a bit like the opioids around at the moment in its effects, and the fact that it's monumentally addictive, what does xylazine actually do to your body to contribute to those increasing numbers of overdose deaths? Well let's start with what it's described to do. It's a sedative so it makes you drowsy by slowing brain activity, and those same side effects we mentioned earlier in the failed clinical trials reappear here. An extremely slow heart rate and dangerously low blood pressure are both reported in xylazine victims. This also tends to slow down breathing to the extent that it can even be difficult to breathe depending on the dose and what else someone has taken alongside xylazine. In fentanyl, this is what creates that potentially lethal combination as fentanyl already slows the body's vital functions. Take too much and someone can easily go into respiratory arrest where they stop breathing entirely, and after that people don't tend to last very long. It can also lead to loss of physical sensation in the body, as well as a total loss of consciousness. In that same anonymous Reddit survey we mentioned earlier, 48 respondents reported unwanted effects from xylazine; 81% reported increased overdoses, and 17% reported increased emergency room visits. Now the bodily effects we've mentioned so far are merely the trends identified in patients who had xylazine in their system so it's fair to say that this isn't an exhaustive list of symptoms overall. This is especially so as it's hard to know what to attribute to xylazine and what to attribute to other substances because they're so frequently taken together. But it only gets truly gruesome when the skin lesions start to appear. Repeated xylazine use is associated with skin wounds like ulcers and abscesses that typically appear on the site of injection. However, they often appear elsewhere on the body, and some clinicians report that these wounds happen even when people smoke or snort xylazine but do not inject it. Over time these can get badly infected, leading to patches of skin and tissue necrotising to the extent it starts rotting off of somebody's own body. This is not dissimilar to the Russian gas station heroin alternative, Krokodil, which appears to have a similar necrotic effect. The reality is in the US, when health insurance is so expensive, and many drug addicts are left homeless on the street, there's nothing they can do to stop their wounds getting infected. If they're lucky they might just need antibiotics, but if they're not rare cases have seen people who have had to have limbs amputated when infection has reached the bone. Tracey McCann, an American user interviewed about her experience of this phenomenon said: > "I'd wake up in the morning crying because my arms were dying." And that's not hyperbole either. Doctors are reportedly constantly perplexed by how xylazine causes wounds so extreme that they initially resemble chemical burns. Ms. McCann's tranq-scorched forearms reportedly stank of rotting flesh, whilst they oozed and itched constantly. When public restrooms are one's only source of clean water, you can see how hard it would be to keep on top of such a massive infection. This ulceration and rotting of the skin where limbs need to be amputated, combined with that drowsy shambling that many opioid and xylazine users experience is what has caused people to equate them with the undead, with many referring to xylazine as "the zombie drug." And when you consider that's all before you even touch the fentanyl, you can see how xylazine acts like an accelerant for a person's physical and mental decline. The scale of the opioid crisis in general in the US makes the response to xylazine worse as well. Often when people are found having overdosed in the US today it tends to be opioids, but both opioid and xylazine overdoses look and act very similar. Now first responders and users alike are taught to utilise overdose reversing drugs for opioids like naloxone, also known as Narcan. But giving someone who, for example, has overdosed on a mixture of fentanyl and xylazine, naloxone might not necessarily reverse things. As Xylazine isn't an opioid, naloxone doesn't reverse its effects, meaning a person can continue to overdose from the residual xylazine still in their system and still die. The antidote for xylazine is tolazoline, which is commonly used to reverse the effects necessary to complete a surgical operation, but that's just not something most people who aren't vets have laying around like they might with Narcan. Throw on top that people might not even know that they've taken any xylazine at all because of how it's commonly added to other substances, as well as the fact that xylazine can help enhance other substance's effects which masks its presence, and it can be a very quick way to land in your local paper's obituary. So, what's being done about all this, are crackdowns on xylazine coming? And can the genie even be put back in the bottle? ## Harm Reduction – The Future of Xylazine? The last several years of xylazine's rise to prominence on the drug market has started to see some backlash from legislators in the Western world. In April of 2023, the White House designated xylazine combined with fentanyl as an 'emerging drug threat', which has enabled the implementation of an action plan and funding at the federal level to tackle the risks it poses. This also typically precedes a drug being scheduled as a controlled substance by the federal government. It's hard to totally outlaw xylazine because it has legitimate and important uses, but labelling something a controlled substance will hopefully lead to more police oversight and tighter purchasing controls for individuals. Several states like Ohio and Pennsylvania have already rendered it a controlled substance, whilst Mexico and Canada have started to track imports of it into their countries. In July of 2023 the White House also released a National Response Plan to address the emerging threat of fentanyl mixed with xylazine. So across the board in places like the US it is finally starting to be seen as the serious threat to public health that it is. It doesn't help that it exists in a legal grey area, but the more mainstream xylazine gets the more likely that grey area will be ironed out by legislation. Other countries have started keeping tabs on xylazine also. Countries in Asia do already ban it outright, and it was just scheduled as a class C drug in the UK in 2025. It's not just the harsh punishments that come with such labels either. Labelling something as a controlled substance can also release funding for things like clinics and education programs for communities to combat the issues xylazine causes. Harm reduction policies in the US are pretty minimal, but the pressure is growing from advocates in some parts of the country for things like supervised injection sites, where people can use in safer conditions and even have their drugs tested. Xylazine test strips are slowly becoming more readily available so people can at least make sure their drugs are safe one way or another. At the moment only two of these clinics for xylazine exist in the US, both are based in New York City. Such facilities can also help educate people to help them understand the damage that a substance like xylazine can do to a person, especially over time. But at present it's a losing battle. The trends on xylazine continue to go upwards whilst it spreads into more and more countries every year, mainly as a heroin and fentanyl hanger-on. For example, according to Dr Caroline Copeland from the School of Cancer & Pharmaceutical Sciences, xylazine has already broken into the UK drug market, potentially exposing thousands upon thousands of people to its harmful effects. The first death in the UK reported as directly involving xylazine was in May 2022. The BBC reported on the death a year later that the individual died at home, and had a history of using narcotics. According to a report on the person's death from the *Journal of Forensic and Legal Medicine*, this person had xylazine, cocaine, fentanyl, and heroin in their system at the time of death, and that they were likely to have purchased heroin not knowing it was laced with xylazine, leading to predictably grim results. Others believe it's a losing battle. Shawn Westfahl is an outreach worker with Prevention Point Philadelphia who works in Kensington, the neighbourhood at the epicentre of the city's massive open-air drug trade. When asked what can be done to help the xylazine problem in the area, he stated: > "It's too late for Philly. Philly's supply is saturated. If other places around the country have a choice to avoid it, they need to hear our story." Meanwhile people continue to suffer, a lot of the time from a drug they may not have even realised they were taking at all, let alone addicted to. Healthcare staff and people's families continue to fight for their loved ones and patients, but there is never enough money, equipment, or help to deal with the scale of the opioid crisis as a whole. Xylazine is simply another arm of the trade that makes things *infinitely* more complicated to untangle. Joseph D'Orazio, an expert in toxicology and addiction medicine at Temple University Hospital in Philadelphia which treats dozens of xylazine users daily, stated: > "Most people tell me, 'I wish I could find dope that didn't have xylazine,' But what gets put out there on the street is what people have to use." There simply isn't enough research yet, there's not enough funding, there's not enough media recognition. When it comes to xylazine, there's simply not enough of anything to go around. It appears that the xylazine threat will continue to grow. This is *going to get worse* before it gets better. But how many thousands more will lose their battle with addiction before that happens? Your guess is as good as ours. Stay safe out there. ## Key Takeaways - Xylazine, a veterinary tranquilizer, is increasingly used recreationally and mixed with other drugs, exacerbating the opioid crisis. - The drug is highly addictive and causes severe withdrawal symptoms, often leading to continued use. - Xylazine use is linked to severe skin lesions and tissue necrosis, earning it the nickname 'zombie drug'. - Overdose deaths involving xylazine have surged, with a 32-fold increase from 2018 to 2021 in the US. - Efforts to combat xylazine include legislative actions and harm reduction strategies, but challenges remain significant. ## Frequently Asked Questions ### What is Xylazine? Xylazine is a veterinary tranquilizer, pain reliever, and depressant of the central nervous system. It is a strong sedative used on animals for medical procedures. ### How did Xylazine become a street drug? Xylazine was originally synthesized for human use but was shelved due to severe side effects. It was then used as a veterinary tranquilizer. Over time, it started to be abused by humans and integrated into illegal narcotic supply routes. ### What are the effects of Xylazine on the body? Xylazine slows brain activity, relaxes muscles, and makes people feel drowsy yet euphoric. It can also cause an extremely slow heart rate, dangerously low blood pressure, and difficulty breathing. Repeated use can lead to skin wounds, ulcers, and abscesses that can become infected and necrotic. ### Why is Xylazine often referred to as the 'zombie drug'? Xylazine is referred to as the 'zombie drug' due to the drowsy, shambling behavior it induces in users, combined with the severe skin lesions and tissue necrosis that can occur with repeated use. ### How does Xylazine contribute to the opioid crisis? Xylazine is often used to cut other narcotic substances, making them cheaper and more potent. This creates a deadly combination, especially when mixed with fentanyl, leading to an increased risk of overdose and death. ### What are the withdrawal symptoms of Xylazine? Withdrawal symptoms from Xylazine are reported to be intense, often described as feeling like the flu times a hundred, with severe nausea, vomiting, and overall physical distress. ### What is being done to combat the spread of Xylazine? The White House designated xylazine combined with fentanyl as an 'emerging drug threat' in April 2023, enabling federal action plans and funding. Several states and countries have started to track and control its import and use, and harm reduction policies are being discussed and implemented in some areas. ### How does Xylazine affect overdose reversal efforts? Naloxone, commonly used to reverse opioid overdoses, does not reverse the effects of Xylazine. The antidote for Xylazine is tolazoline, which is not widely available outside of veterinary settings, making overdose reversal more challenging. ### What is the current scale of the Xylazine problem? Between 2018 and 2021, the number of xylazine-involved overdose deaths in the US rose from 102 to 3,468. The DEA has seized xylazine and fentanyl mixtures in 48 of 50 states, and its presence in drug overdose deaths has been increasing rapidly. ### How is Xylazine used in combination with other drugs? Xylazine is often used to cut other drugs like fentanyl, heroin, and cocaine to make them cheaper and more potent. It can be injected, ingested, snorted, or smoked, making it versatile for drug users. ## Sources - [Original Into the Shadows video: Xylazine: The Zombie Drug](https://www.youtube.com/watch?v=XTTR2gK8qoQ) - [Hero image source](https://images.rawpixel.com/editor_1024/czNmcy1wcml2YXRlL3Jhd3BpeGVsX2ltYWdlcy93ZWJzaXRlX2NvbnRlbnQvbHIvdXB3azYxNzMyNDExLXdpa2ltZWRpYS1pbWFnZS1rb3dyMnU1dC5qcGc.jpg) by openverse, cc0. ## Related Coverage