Xylazine is a veterinary sedative — not approved for human use, and not an opioid — that has become widespread in the illicit fentanyl supply in many parts of the U.S.
What xylazine does
It’s a powerful sedative that causes deep, prolonged sedation. Because it’s not an opioid, naloxone does not reverse its effects — someone who has used xylazine along with fentanyl may remain sedated even after naloxone successfully reverses the opioid component of an overdose.
The wound problem
Xylazine use is strongly associated with severe skin wounds — sores that can appear even in places with no injection, spread quickly, and, if untreated, can lead to serious infection or amputation. This appears related to xylazine’s effect on blood flow to the skin, not solely to how it’s used.
Withdrawal is different too
Xylazine withdrawal has features that don’t match typical opioid withdrawal — including anxiety and physical symptoms that can be severe, and that opioid withdrawal medications alone don’t fully address. This is an active area of clinical research, and protocols are still evolving.
What actually helps
- Give naloxone anyway during a suspected overdose — fentanyl is almost always present too, and naloxone can still reverse that part
- Call 911 regardless — continued sedation after naloxone is itself a reason to seek emergency care, not a sign naloxone “isn’t working” this time
- Xylazine test strips exist and are distinct from fentanyl test strips — [link to test strip limitations tool]
- Wound care matters urgently — untreated xylazine-associated wounds progress faster than many people expect; don’t wait to seek care out of shame or fear of judgment
Medically reviewed by [pending]. Sources: CDC, DEA, state public health department drug-checking data.