A veterinary sedative often mixed with other illicit drugs is helping to fuel the nation’s overdose epidemic, but it also leaving unsuspecting users with skin ulcers and necrotizing wounds.
Xylazine is a non-opioid tranquilizer approved for animal use. Xylazine is not approved for use in people. But it has made its way into the unregulated supply of illicit drugs, including heroin, fentanyl and other drugs. The U.S. Drug Enforcement Agency has seized xylazine and fentanyl mixtures in 48 of 50 states. The agency’s laboratory system reported that about 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA in 2022 contained xylazine. Xylazine can be mixed with other drugs either to enhance drug effects or increase street value by increasing the weight of the product.
Xylazine can cause serious, recalcitrant skin ulcers and necrotizing wounds, according to the Pennsylvania Department of Health. Stigma about the drug – known as tranq, tranq dope, sleep cut, or zombie drug – can prevent some people from seeking treatment for the wounds. Left untreated, the wounds can become infected and in some cases require amputation.
Katharine Neill Harris, a fellow in drug policy at Rice University’s Baker Institute for Public Policy, said stigma about the drug prevents some from seeking treatment. She said most drug users don’t want xylazine, but don’t have tools or resources to test for it.
“One of the things with xylazine that gets a lot of attention is the skin sores that people get from using it. There’s all these pictures and horror stories related to that,” she said. “We need more research to figure out exactly why the drug seems to cause skin sores because we’re not entirely sure right now.”
But they are treatable, Harris said.
“They’re actually quite easy to treat if treated early enough,” she said.
Some wounds require regular cleaning with soap and water. In other cases, antibiotics may be needed, according to the Pennsylvania Department of Health.
The stigma is a challenge.
“And that in itself becomes a huge barrier to people getting help for those for those wounds that are entirely treatable,” she said. “And again, if treated, they can help avoid amputation.”
She said health care providers at all levels – including emergency responders and other frontline health care workers – need to be aware of the problem and empathetic toward it “so that people don’t feel so ashamed that they kind of hide and don’t get the help that they need.”
In July, the White House Office of National Drug Control Policy outlined a plan to reduce xylazine-positive drug deaths by 15% in most of the country. The plan focuses on testing; data collection; evidence-based prevention, harm reduction and treatment; supply reduction; and scheduling and research. The goal is a 15% reduction – compared to 2022 as the baseline year – of xylazine-positive drug poisoning deaths in at least three of four U.S. census regions by 2025.
The U.S. Centers for Disease Control and Prevention reported the monthly percentage of illegally manufactured fentanyl-involved deaths with xylazine detected increased by 276% – from 2.9% to 10.9% – between January 2019 and June 2022.
