Xylazine and fentanyl: What to know about this deadly mixture

Understand the dangers of xylazine and fentanyl mixtures. Learn about symptoms, risks, and how Suboxone can aid in treatment for opioid use disorder.

Ophelia team
Fentanyl + Xylazine
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Fact checked by
Ashley Mazei, NP

On its own, fentanyl is a powerful synthetic opioid that’s among the most common drugs involved in fatal overdoses. When laced with other drugs like xylazine, fentanyl becomes even more dangerous. It’s essential to understand the risks of fentanyl mixed with xylazine, especially as xylazine-laced drugs are appearing more frequently in illegal drugs in the United States.  

What is xylazine?

Xylazine, also known by the street name “tranq,” is a strong sedative and pain reliever that the Food and Drug Administration (FDA) has approved for animal use only. The FDA has not approved its use in humans for any purpose, so it is only available on the illicit drug market. Despite this, a growing number of overdose deaths are linked to xylazine, most commonly in combination with other drugs. People may knowingly or unknowingly use xylazine since it is not always clear whether the drug is present. 

Xylazine is not an opioid, it’s a tranquilizer that affects the central nervous system (CNS). Misusing xylazine can lead to severe CNS depression, which may be life-threatening. These extreme side effects are the reason why the FDA did not approve xylazine for human use.  

Symptoms of xylazine exposure

The symptoms of xylazine exposure can appear similar to those of opioid use, making it more difficult to treat patients accurately. These side effects include:

  • Difficulty breathing
  • Slowed heart rate
  • Drowsiness
  • Blurry vision
  • Extremely low blood pressure
  • Amnesia
  • Irregular heartbeat
  • Xylazine wounds that can become infected

Xylazine wounds are some of the more jarring side effects since their exact cause is unknown. These wounds, which often present as lesions or abscesses, are dangerous because they may require special treatment and take a long time to heal. Infection is also a major risk. Left untreated, the skin tissue can die. People experiencing these wounds often need intensive treatment or hospital stays, but that care is not always accessible.

In more extreme cases, exposure to xylazine can lead to a coma or death. 

Why is fentanyl laced with xylazine?

It’s increasingly common to find xylazine mixed into illegal drugs like heroin, cocaine, and, most notably, fentanyl. The Drug Enforcement Agency (DEA) has seized drugs that combined fentanyl and xylazine in 48 out of 50 states. Additionally, the DEA found that around 23% of fentanyl powder contained xylazine, as did 7% of fentanyl pills in 2022. 

Mixing xylazine into fentanyl can make the effects of the opioid stronger and more long-lasting. Illegal drug producers and distributors may also add xylazine to boost the value of their drugs by increasing their weight. Either way, the result is a mixture that can be even more dangerous than either of the drugs used separately. 

What are the symptoms and side effects of xylazine and fentanyl together?

Using a mixture of fentanyl and xylazine may lead to side effects, including:

  • Increased risk of losing consciousness
  • Increased risk of opioid overdose
  • Suffocation
  • More extreme central nervous system depression

Because xylazine and fentanyl combined make people more likely to lose consciousness, they’re also more susceptible to danger while using the two drugs together. This combination puts people at a higher risk of violence, sexual assault, and robbery. 

Can the effects of xylazine be reversed with naloxone?

Another component of the dangers of xylazine-laced fentanyl is that it can make treating opioid overdoses more difficult. Naloxone is the drug first responders use to treat patients and reverse an opioid overdose. Because xylazine is not an opioid, naloxone may not have any effect on it, complicating treatment. If someone has xylazine in their system, it may be more difficult to reverse their opioid overdose. 

However, administering naloxone is still the right response in the case of suspected overdoses. Opioid overdoses and xylazine exposure are similar and easily confused, so there’s no way to know with certainty which of them a patient is experiencing. Even if the patient was exposed to xylazine in fentanyl, naloxone can still improve opioid overdose symptoms. 

Call emergency services immediately if you suspect an overdose and administer naloxone if you have it available. If the patient does not respond to the naloxone dose, start rescue breathing. Perform CPR if the patient has no pulse and you are trained to do so. 

Does Suboxone® help with xylazine-laced fentanyl misuse?

Suboxone is one of the leading medications for addiction treatment (MAT) used to treat opioid use disorder (important safety information). As xylazine has grown more prevalent, a common question is whether Suboxone helps with xylazine-laced fentanyl misuse. 

The answer is yes: Suboxone can help with xylazine-laced fentanyl misuse as part of a broader treatment plan. Many people are only exposed to xylazine through their opioid use. By treating opioid use disorder (OUD), you reduce the risks of xylazine misuse. Note that in the unlikely case that someone is using xylazine without any opioids, Suboxone would not be the right treatment option. 

Accessible, personalized treatment for OUD

Receiving MAT for opioid misuse can reduce your risks of exposure to xylazine by helping you remove fentanyl and other opioids from your life. Ophelia provides personalized opioid treatment online to help you access care from the privacy and comfort of your own home. If our clinicians determine Suboxone is right for you during a care provider call, Ophelia will send a prescription to your local pharmacy. 

From there, you can start Suboxone and the rest of your personalized treatment plan, including follow-ups with your dedicated care team. Our team is available 7 days a week, so you can fit appointments into your schedule as needed. Set up your welcome call to see if Ophelia is the right choice for you. 


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