Xylazine: Effects, Misuse and Treatment

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Page Clinically Reviewed on 18 July 20241 April 2025 by Kerry Canning, MBChB | Medical Editor

Xylazine, a non-opioid sedative for animals, is increasingly misused and is often combined with illicit opioids such as fentanyl. Also known as tranq, xylazine exerts sedative, muscle relaxing and pain-relieving effects. Although approved by the United States Food and Drug Administration (FDA) for use in animals, it has no approved human use. As a central nervous system depressant, use of this drug can cause drowsiness, altered brain function, reduced blood pressure and slower heart and breathing rates.¹  

These effects can be life-threatening, particularly when other substances, such as sedatives and opioids, have been combined with xylazine. In such cases, the effects of xylazine can be heightened leading to a fatal overdose. In 2022, the first drug-related death associated with xylazine was recorded in the UK by the National Programme on Substance Abuse Deaths (NPSAD).²

Misuse of xylazine is dangerous and potentially life-threatening. It is therefore vital to be able to recognise and respond promptly to the symptoms of overdose. Seeking medical aid can effectively manage symptoms and can be life-saving.

Key Takeaways

1. Xylazine, also known as tranq, is a veterinary tranquilliser that is increasingly misused for its depressive effects on the central nervous system is commonly added to other drugs, such as opioids like fentanyl, during manufacturing, meaning that it can be taken without the user knowing  
2. Xylazine can be injected, snorted, inhaled or swallowed
3. Misuse can lead to painful and difficult-to-treat skin sores and increases the risk of overdose, particularly when multiple substances have been used  Health risks of xylazine exposure include cardiovascular complications, respiratory depression and the risks associated with needle-sharing behaviours such as HIV and hepatitis C infection Overdose reversal medicines like naloxone and nalmefene will not reverse the effects of xylazine but should always be used in the event of an overdose, as opioids are commonly combined with xylazine¹ 
4. Treatment for xylazine addiction, like that offered at Castle Craig, can involve medical detox, therapy and ongoing support for long-term recovery

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What is Xylazine?

Xylazine is used in veterinary medicine as a sedative. It has no approved use in humans but is being increasingly misused due to its central nervous system effects. Individuals often use xylazine without realising, as it is combined with other illicit drugs during the manufacturing process. Xylazine can be injected, snorted, inhaled or swallowed. It can also be taken alongside other substances, most commonly opioids like fentanyl which is known as tranq dope. 

The use of xylazine slows down brain activity, leading to the relaxation of muscles, slower breathing and heart rates and reduced blood pressure.¹ These effects can be life-threatening and reports indicate that any dose can result in fatal consequences. Misuse of xylazine is a growing concern, with the FDA having issued a statement to alert healthcare professionals on the increasing prevalence of xylazine in illicit drug overdoses in 2022. In the same year, the first drug-related death associated with xylazine was reported in the UK.² 

As most individuals are exposed to xylazine through the use of fentanyl, an opioid drug, it is recommended that in the event of an overdose, opioid overdose reversal medications should be used. These will not reverse the effects of xylazine but can effectively manage other overdose symptoms.

How Are People Exposed to Xylazine?

A primary route of exposure to xylazine is through the illicit drug market, where it’s often combined with other recreational drugs, particularly opioids like fentanyl. This means that many users are unknowingly exposed to the harmful effects of xylazine through other illicit substances.¹

In the US, the Drug Enforcement Administration (DEA) seized fentanyl and xylazine mixtures in 48 of 50 states. DEA reports indicate that, in 2022, approximately 23% of seized fentanyl powder and 7% of seized fentanyl pills contained xylazine.³ Another route of exposure is through deliberate misuse and/or combination with illicit substances. Some individuals utilise xylazine to intentionally prolong or enhance the effects of other drugs such as fentanyl.¹ 

Xylazine Misuse in the UK

Records indicate that xylazine first emerged on the illicit drug market in Puerto Rico in the early 2000s. Since then, it has been found in the US, Canada and the UK. It is currently a growing issue, with reports indicating a 20-fold increase in fatal overdoses linked to xylazine between 2015 and 2020. 

In the UK, the first fatal overdose associated with xylazine was reported in 2022, marking the emergence of xylazine in the UK drug supply. This emphasises a need to closely examine the composition of European illicit drug market products. It also highlights the importance of recognising symptoms of xylazine misuse and seeking urgent medical aid to help prevent tragic consequences.² 

Is Xylazine Legal?

In the UK, xylazine, medetomidine and detomidine are medicines licensed for veterinary use as sedatives, pain relievers and muscle relaxants in animals. Only dexmedetomidine (an active component of medetomidine)⁴ is approved by the Medicines and Health Care Products Regulatory Agency (MHRA) for human use in critical care settings. 

Currently, xylazine, medetomidine and detomidine are not controlled under the Misuse of Drugs Act 1971. However, due to their psychoactive effects, they are likely to be subject to the 2016 Psychoactive Substances Act (PSA). These are veterinary medications and exempted substances and activities listed within the PSA only include products approved for human use and application. This therefore means that import, supply, possession with intent to supply and possession in a custodial institution for human use are likely to be offences under the PSA.⁵

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Government Response to Xylazine

In response to the rising detection of xylazine in overdoses and deaths in Scotland, Rapid Action Drug Alerts and Response (RADAR) issued an alert. This alert emphasised that the unregulated drug supply was becoming more toxic and less predictable due to increases in new synthetic drugs. 

The latest RADAR report data suggests that nitazenes, novel synthetic opioids that emerged in Scotland in 2022, were detected in 12 deaths during post-mortem examination between October and December 2023. During this same period, xylazine was detected in five deaths.⁶ 

Given the toxic effects of xylazine, in isolation and in combination with other substances, the Advisory Council on the Misuse of Drugs (ACMD) recently recommended that xylazine be added to class C of the Misuse of Drugs Act 1971. The UK government has since accepted this recommendation and intends to introduce complementary legislation in due course.^7,8 

The UK government has also accepted ACMD recommendations to enhance the supply of public health information on xylazine, through channels such as FRANK, a national anti-drug advisory service. The toxic effects of xylazine and its potential presence in illicit substances were included as important points to emphasise. Awareness of these issues within harm reduction services, such as drug treatment and rehabilitation centres, will also be increased through these recommendations.

ACMD also recommended that responsible agencies be vigilant to aid the detection of xylazine and related substances. The UK government will continue to actively monitor these substances through analysis of submitted or seized drugs and patient and post-mortem toxicology.⁸

Effects of Xylazine Use

Xylazine is a central nervous system depressant. This means the drug can slow brain activity, making an individual feel drowsy or lethargic. It can also hinder abilities to think clearly or react quickly. 

Repeated exposure to xylazine can lead to serious health complications, including painful and difficult-to-manage skin sores. If left untreated, these wounds can expand and become infected, leading to areas of dead tissue that may necessitate amputation. These sores can appear at injection sites or elsewhere on the body. They require ongoing pain and wound management by healthcare professionals to help prevent progression to amputation. 

If an individual is injecting xylazine and sharing needles, they are at increased risk of several health consequences. This includes an increased risk of developing other infections, such as heart valve infections (infective endocarditis), HIV and hepatitis C.¹

The long-term effects of xylazine misuse can be extremely severe and can lead to irreversible damage or, in some cases, death. Understanding these health risks is crucial in protecting yourself or a loved one from the harmful and potentially fatal effects of xylazine. 

What Are the Health Risks Associated With Xylazine?

Xylazine use poses significant risks to general health and well-being. This includes severe cardiovascular and respiratory complications and the risk of fatal overdose. 

The health consequences of xylazine misuse are severe, and include:¹

These risks are a harsh reality for many individuals. If you or someone you know has been misusing xylazine, it is never too late to reach out for help. Contact us today if you are experiencing any of these negative health effects. We can arrange treatment within 48 hours of an initial call and provide support to aid in long-term recovery.

What To Do in the Event of a Xylazine Overdose

In the critical event of a xylazine overdose, knowing the appropriate steps to take can potentially save a life. Considering the potentially fatal effects of xylazine, it’s essential to be prepared. Recognising the signs of a xylazine overdose is the first step. These may include extreme sedation, slow heart rate, low blood pressure and difficulty breathing.²

If you suspect someone has overdosed on xylazine, it is vital to take the following steps:¹

1. Administer an opioid overdose reversal medication, such as nalmefene or naloxone
2. Call 911 or other emergency services immediately for medical assistance 
3. Try to keep the person awake and responsive, if possible
4. If the person is unconscious, check that they are breathing
5. If the person stops breathing, give rescue breaths and place them in the recovery position; on their side with their head supported Do not leave the person alone while waiting for help to arrive

Once in the hospital, the individual will receive specific treatment based on their condition. It’s important to remember that xylazine overdose is serious and can be life-threatening if not treated promptly. It’s therefore crucial to be vigilant and act quickly as this can be life-saving.

If you are searching for advice for a friend or family member who is in crisis, please call the emergency services. The information on this page is not intended as a substitute for medical intervention.

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How is Xylazine Addiction Treated?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) sets out specific criteria for diagnosis of substance use disorders (SUDs). This text does not currently include a specific diagnosis associated with xylazine use, however, its continued use can lead to several significant health consequences that require medical management.

Continued use of xylazine can result in severe skin sores, which can be difficult to manage, particularly if they have grown or become infected. Effective, ongoing wound care, often involving cleaning, antibiotics and dressings, is vital in preventing infection. Monitoring for signs of infection, such as redness, swelling and discharge at the wound site, is also a very important aspect of wound care. If any of these signs develop, it is vital to seek urgent medical attention.

Physical dependence and withdrawal symptoms can occur when an individual reduces or stops using xylazine. Symptoms of withdrawal can include anxiety, agitation, sweating, elevated blood pressure and increased heart rate. Guidelines have yet to be established for managing these effects, however, case reports indicate that other alpha-2-agonists, like clonidine, can be beneficial.⁹

Additional research is required to fully examine the addictive potential of xylazine.¹ Addressing its continued use requires individualised treatment plans that can feature addiction therapies like medical detox, therapy and ongoing support for maintaining recovery. Approaches to treatment depend on the individual and patterns of misuse but can feature:¹⁰

• Medical treatment and/or detox: This can be particularly useful if xylazine is being misused alongside other substances, like heroin and other opioids. In these instances, a medical detox and/or substitute drugs, such as methadone, can be utilised to mitigate opioid withdrawal symptoms
• Therapy: Talking therapies, such as Cognitive Behavioural Therapy (CBT), in individual or group settings can help an individual to recognise how their thoughts and feelings are influencing their behaviour. This can help individuals to respond differently to triggers and instil healthier habits  
• Ongoing support: Support can come from various sources, including healthcare providers, support groups and loved ones. They can provide the motivation and accountability needed to maintain sobriety and lead a healthier life

Another important aspect of xylazine addiction management is the application of harm reduction strategies. These vital steps can help individuals avoid complications from xylazine use and include^1,9: 

• Carry overdose reversal medications like naloxone or nalmefene
• Check drugs for the presence of xylazine, using xylazine test strips, which are available commercially and through some harm reduction organisations 
• Use sterile needles and avoid reusing or sharing needles 
• Monitor and promptly treat skin sores 
• Avoid using alone 
• Avoid mixing substances 
• Use in a safe and comfortable space as deep sedation can typically last between 4–8 hours 
• After use, move the limbs to improve circulation and prevent clots

Treatment at Castle Craig

At Castle Craig, we exercise a thorough and compassionate approach to support individuals living with xylazine addiction. Our renowned facility understands the complexities of drug addiction, particularly the insidious nature of chronic xylazine misuse. Our professional medical team has extensive awareness of the polysubstance overdose crisis and recognises that xylazine can be just one component of a multifaceted problem.

Treatment at Castle Craig is tailored to the individual. Our interventions don’t solely focus on the physical aspects of addiction but also explore the mental and emotional facets. Here’s what sets Castle Craig apart:

• Provision of a safe and supportive environment for recovery.
• A team consisting of highly trained professionals who specialise in addiction recovery
• Application of a holistic approach to address the addiction and its underlying causes
• Provision of ongoing support to prevent relapses
• Appreciation of the importance of family involvement in the recovery process

We have successfully helped many patients to overcome their drug dependence. The compassionate approach at Castle Craig not only provides immediate assistance but also provides tools for maintaining sobriety long after leaving our care.