Xylazine and Novel Substances

New laws established in the 2023 legislative session in Minnesota include the decriminalization of drug checking equipment, including xylazine test strips.

Drug checking allows people who use drugs to have insight into what substances are present in their drugs, providing critical information that can help decrease their risk of overdose. Xylazine test strips, for example, can alert people to the presence of xylazine in their drugs. Check the Syringe Service Program Network Calendar to find a harm reduction provider that supplies xylazine test strips (an "X" next to the organization's name indicates xylazine test strip availability).

Fentanyl test strips are also legal for public use and distribution in Minnesota. Expanded access to drug checking is a priority of the Office of National Drug Control Policy.

Xylazine is increasingly found as a common adulterant in fentanyl. Xylazine is a long-acting sedative, but it is not an opioid. Using xylazine in combination with opioids like fentanyl can result in synergetic effects that may increase the risk of overdose and death. Although xylazine does not respond directly to naloxone because it is not an opioid, the opioids that xylazine is combined with will respond to naloxone. In the event of a suspected overdose, administer naloxone every time, no matter what.

Health Effects

Xylazine is a veterinary sedative that is not approved for human use.

Short Term Health Effects

• Fatal overdoses
• Respiratory issues
• Slow heart rate
• Drowsiness
• Prolonged sedation

Long Term Health Effects

• Severe Skin Wounds
• Necrosis (death of body tissue)
• Skin infections
• Extreme withdrawal symptoms
• Anemia (blood condition)

The full national scope of overdose deaths involving xylazine is not known, but research indicates that xylazine began increasing in the drug supply in the northeast before spreading south and westward across the United States. Xylazine has been found in the drug supply of 48 states.

On April 12, 2023, the Biden Administration declared fentanyl adulterated with xylazine as an emerging drug threat. A xylazine response plan was released, highlighting several strategies that will be put in place to combat the rising number of xylazine-involved overdoses. The plan focuses on several strategies including the expansion of testing capabilities and evidence-based prevention services.

The Centers for Disease Control and Prevention (CDC) has recently released a xylazine resource page that highlights several harm reduction and overdose prevention resources.

Xylazine prolongs the fast-acting effects of fentanyl, which gives people who use it more time to secure another dose before withdrawal symptoms begin. However, the risks that come with xylazine are profound, and anyone who uses opioids or any illicit substances must take care to protect themselves with the following steps:

• Always administer naloxone.
  • Although xylazine does not respond directly to naloxone because it is not an opioid, the opioids that xylazine is combined with will still respond to naloxone. In the event of a suspected overdose, administer naloxone every time, no matter what. To find naloxone, visit the Minnesota Naloxone Finder.
• Test your drugs.
  • Xylazine test strips can detect xylazine in your drug supply before you take it. They are available from local harm reduction organizations listed on the Syringe Service Program Network Calendar or online from national organizations like DanceSafe or BTNX. Fentanyl test strips are also available for public use.
• Ask yourself: “Was that tranq?
  • Many people who use xylazine are likely not aware they are taking it, but some may deliberately use it to extend an opioid high. Unlike fentanyl alone, xylazine often causes severe memory loss and unconsciousness for long periods of time. While people who regularly use opioids are often able to work or perform essential day-to-day tasks, the same is not true about xylazine, which can make it far more difficult to function normally.
• Don’t use drugs alone.
  • The extreme sedative power of xylazine significantly increases the chance that someone under its influence will lose consciousness for long periods. If this happens to someone in an unsafe environment, they may be abused, robbed, or taken advantage of in other ways.
  • Whenever possible, never use alone or in the presence of people you do not trust. Always have a safety plan and ensure someone near you is ready to use naloxone. If you do use alone, call the “Never Use Alone” 24 hour hotline (Never Use Alone Inc. – 800-484-3731).
• Take care of your wounds.
  • Xylazine use dramatically increases the risk of developing serious wounds, both at injection sites and elsewhere on and inside the body. What may start out as track marks can turn into life-threatening wounds that result in amputations, infections, or death. Do not wait to seek medical attention for wounds or track marks. Everyday counts.
• Watch out for withdrawal.
  • Xylazine withdrawal is different than opioid withdrawal, and there are far fewer options available to treat it. Symptoms of withdrawal from xylazine include extreme anxiety that can last for months. Opioid withdrawal symptoms can be treated with medications like methadone and buprenorphine, but xylazine withdrawal symptoms cannot be treated with these medications.

Biden-Harris Administration Designates Fentanyl Combined with Xylazine as an Emerging Threat to the United States

Fact Sheet: In Continued Fight Against Overdose Epidemic, the White House Releases National Response Plan to Address the Emerging Threat of Fentanyl Combined with Xylazine

Xylazine poisoning: a systematic review (PubMed)