Fentanyl and Xylazine: A Deadly Drug Cocktail Sweeping Across America

Sep 13, 2023


The U.S. Drug Enforcement Administration (DEA) has issued a stark warning to the American public about the increasing prevalence of fentanyl mixed with xylazine, a potent veterinary sedative. Xylazine, also known as “Tranq,” was originally intended for veterinary use and approved by the U.S. Food and Drug Administration for that purpose. However, its misuse in combination with fentanyl has created a deadly drug threat that is taking lives at an alarming rate. This article explores the grave implications of this drug mixture, its impact on public health, and the efforts being made to combat this crisis.

  1. The Rise of Fentanyl and Xylazine Mixtures

Administrator Milgram of the DEA has characterized the mixture of fentanyl and xylazine as the most lethal drug threat the United States has ever faced. Fentanyl, a powerful synthetic opioid, is already responsible for a significant portion of drug-related deaths. When combined with xylazine, the danger intensifies. According to the DEA, in 2022, approximately 23% of seized fentanyl powder and 7% of seized fentanyl pills contained xylazine.

  1. The Deadly Consequences

The combination of fentanyl and xylazine places users at a significantly higher risk of fatal drug poisoning. Unlike opioids, naloxone (Narcan), the opioid overdose reversal medication, does not reverse the effects of xylazine. Therefore, even though it is essential to administer naloxone in cases of suspected drug poisoning, it may not fully address the dangers posed by xylazine.

Moreover, individuals who inject drug mixtures containing xylazine are at risk of developing severe wounds, including tissue necrosis, which may ultimately lead to amputation. This adds a gruesome dimension to the already dire consequences of drug misuse.

  1. Alarming Statistics

The impact of fentanyl and xylazine mixtures on the opioid overdose crisis is staggering. According to the Centers for Disease Control and Prevention (CDC), between August 2021 and August 2022, 107,735 Americans died from drug poisonings, with 66% of those deaths involving synthetic opioids like fentanyl. The Sinaloa Cartel and Jalisco Cartel in Mexico, with the help of chemicals sourced largely from China, are the primary culprits behind the trafficking of fentanyl into the United States, exacerbating the crisis.

  1. The Role of Xylazine in the Opioid Epidemic

Xylazine, originally intended as a non-opioid veterinary tranquilizer, has now become a critical component in the evolving drug addiction and overdose crisis. Research indicates that people exposed to xylazine often use it knowingly or unknowingly in combination with other drugs, particularly illicit fentanyl.

Studies have shown that xylazine is frequently added to illicit opioids, such as fentanyl, to extend their euphoric effects. Additionally, many overdose deaths linked to both xylazine and fentanyl involve additional substances, including cocaine, heroin, benzodiazepines, alcohol, gabapentin, methadone, and prescription opioids.

  1. The Dangers of Polydrug Use

Xylazine, also known as “tranq,” is a central nervous system depressant that can induce drowsiness, amnesia, and severely slow down breathing, heart rate, and blood pressure. When opioids like fentanyl are combined with xylazine and other central nervous system depressants like alcohol or benzodiazepines, the risk of a life-threatening overdose dramatically increases.

  1. The Role of Naloxone

In cases of suspected xylazine overdose, experts recommend administering naloxone, primarily because xylazine is frequently mixed with opioids. However, due to xylazine not being an opioid, naloxone cannot fully address its impact on breathing. This has raised concerns that the growing prevalence of xylazine in the illicit opioid supply may render naloxone less effective for some overdoses. Emergency medical services should always be alerted in cases of suspected overdose.

  1. Repeated Xylazine Use and Health Complications

The repeated use of xylazine is associated with severe health complications, including skin ulcers, abscesses, and related issues. People report using xylazine or xylazine-containing drugs through various methods, including injection, snorting, swallowing, or inhaling.

  1. Ongoing Research and Response

NIDA-supported research is actively underway to understand emerging drug use patterns, changes in the illicit drug supply, and the use of xylazine and synthetic opioids across the United States. These efforts aim to provide critical insights into the crisis and inform strategies for addressing this growing threat to public health.


The combination of fentanyl and xylazine is proving to be a deadly cocktail that is exacerbating the opioid overdose crisis in the United States. The ease of access to these substances and their low cost make them an attractive option for those seeking a dangerous high. Efforts by the DEA, CDC, FDA, and other agencies to combat this crisis are essential for mitigating the devastating impact it has on individuals, families, and communities. Public awareness, education, and access to treatment and support services are crucial in addressing this ongoing and deadly threat to public health.