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Oregon Health Authority

Xylazine

Xylazine

Xylazine is a powerful non-opioid sedative used in veterinary medicine. Xylazine is not approved or safe for human use in any amounts. When fentanyl or other opioids are mixed with xylazine, the effects on breathing can be life-threatening. Visit OHA's fentanyl webpage for more information on adulterated fentanyl with xylazine.

Many illicit drugs are mixed with multiple substances. Refer to OHA's Polysubstance webpage for more information on polysubstance use and overdose prevention. Xylazine may be mixed in with other illicit drugs for several reasons, including increasing drug weight or adding an effect. People who use drugs may not be aware of the presence of xylazine in their drug product. There are limitations to xylazine and fentanyl drug checking strips because illicit drugs are not evenly mixed. This means that fentanyl and/or xylazine may still be present in a drug product, even when a portion of the product tested with drug checking strips does not react. This is why it's best to assume that all non-prescription drugs that are not handed to you by a pharmacist are mixed with fentanyl, xylazine, or other drugs.

Fentanyl mixed (adulterated) with xylazine has been declared a emerging drug threat by the White House's Office of National Drug Control Policy.

​Xylazine use can lead to unresponsiveness, forgetfulness or memory loss, dangerously low blood pressure, slowed heart rate, and reduced breathing. Xylazine can also cause wounds and may lead to life-threatening infections that can cause conditions like endocarditis and sepsis. These wounds have been reported from injecting, smoking, and snorting xylazine, and they can develop quickly. Multiple wounds may form at the same time. Xylazine wounds can take a long time to heal and require prolonged medical care.

People using xylazine can develop a dependency and may be at risk of withdrawal. Withdrawal symptoms can include anxiety, irritability, restlessness, rapid heart rate, and high blood pressure. Xylazine withdrawal can become a critical medical event requiring hospitalization. Clinicians should be prepared to manage both xylazine and opioid withdrawal symptoms for individuals admitted for care.

Since xylazine is not an opioid, naloxone and other opioid overdose reversal medications do not reverse xylazine's effect on breathing in the event of an overdose. Xylazine mixed with fentanyl or other opioids can increase the chances for fatal overdose because both drugs slow and stop breathing.

The Food & Drug Administration issued a letter to healthcare professionals in November 2022 to provide clinical information about the risks of xylazine exposure in humans, possible withdrawal symptoms, and considerations for medical care.​

Xylazine is being incorporated into the illicit drug supply and is now geographically spread throughout the United States. Nationally, xylazine has frequently been found mixed with opioids (including fentanyl) and stimulants (including methamphetamine and cocaine). In Oregon, xylazine has been detected in a low percentage of counterfeit pills and powder fentanyl seized by law enforcement agencies.

Routine testing for xylazine by the Oregon State Medical Examiner began in 2020. Since then, xylazine has been found in a small but increasing amount of overdose deaths in Oregon. In 2020, there were two overdose deaths where xylazine was identified in the toxicology report, followed by nine in 2021, eleven in 2022, and ten so far in 2023. Oregon's 2023 data is preliminary and may change. The Oregon Health Authority expects to see a significant increase in xylazine-involved overdose deaths in 2024 once the data are finalized. So far, all overdose deaths in Oregon where xylazine was present also involved fentanyl.

​Preventing Xylazine Overdose

Follow the recommendations below to prevent a xylazine-related overdose.

  • Unless a pharmacist or your healthcare provider directly hands you a prescription pill, assume it is counterfeit and contains fentanyl, xylazine, and other substances.
  • Assume any pills from friends, social media, or the internet are counterfeit and contain fentanyl, xylazine, and other substances.
  • When using substances, start low and go slow, checking the strength and the effects of the substance.
  • Never use alone.
  • Always carry naloxone with you.
  • When using substances, have naloxone where it can be seen in case of overdose so that someone can use the naloxone on you.
  • Store prescription medications and illicit substances in a locked cabinet or container, out of reach of children, pets, and unauthorized individuals.
  • Test all the substances you are planning to use with fentanyl and xylazine test strips. You may be able to get drug testing strips at local syringe service programs or harm reduction program sites. Ask syringe service and harm reduction service providers how to correctly use fentanyl and xylazine drug testing strips.
Drug testing strips are a useful and effective harm reduction tool to prevent an overdose. When used correctly, xylazine test strips can tell you if your drugs contain xylazine but they cannot tell you how much xylazine there is. However, testing may not be 100% accurate, and you should assume that any illicit substance contains xylazine and other substances, including fentanyl. Learn more about fentanyl and xylazine test strips here. ​

Recognizing & Responding to Xylazine Overdose

When a person survives an overdose, it's because someone was present, recognized that the person was overdosing, and responded to help them.

People who use drugs and people who may witness an overdose should learn what an overdose looks like, carry naloxone, and know how to give naloxone to a person to reverse an opioid overdose. As xylazine becomes more common in Oregon's drug supply, it is increasingly important to know how to identify and respond to overdoses.

Signs of a xylazine overdose include:

  • Drowsiness
  • Slowed or difficulty breathing
  • Sedation or unconsciousness
  • Slow heart rate
  • Hypotension (low blood pressure)

 
Naloxone should be given in response to any suspected drug overdose. Naloxone will not reverse the effects of xylazine, but it does help reverse the effects of opioids such as fentanyl. Naloxone should still be given because xylazine is often used with fentanyl. Naloxone will not cause harm if opioids are not involved in an overdose. It is important to call 911 for additional medical treatment, especially since the effects of xylazine may continue after naloxone is given.

Rescue breaths are critical for people who have used xylazine because it causes breathing to slow down. Harm reduction experts also recommend rolling the person who has overdosed onto their side with their top knee bent, in the recovery position.

If you call police or 911 to get help for someone having a drug overdose, Oregon's Good Samaritan law protects you and the person who has overdosed from being arrested or prosecuted for drug-related charges or parole/probation violations based on information provided to emergency responders. Read the Good Samaritan law (pdf).

Learn more about responding to suspected drug overdoses on OHA's Naloxone Rescue for Opioid Overdose webpage.​

If you or someone you care about is struggling with substance use, please reach out for help. Speak with a healthcare provider or visit the links below for support and treatment resources. You are not alone.

If you have additional questions about xylazine, please contact the Injury & Violence Prevention Program at IVPP.General@odhsoha.oregon.gov​.