“Tranq-dope,” a combination of fentanyl and the veterinary tranquilizer xylazine, is the newest challenge in the opioid epidemic in Ohio. The state ranks third in the country with the highest xylazine positivity rates in lab tests, according to a national report.
“Xylazine has been in the Akron area for at least three or four years,” said Lt. David Garro of the Akron Police Department. “We haven’t really kept track of it because until recently, it wasn’t a controlled substance” and regulated by the government in the same way as other drugs, like heroin and cocaine.
The drug, which is not an opioid, was classified in March as what’s known as a Schedule III controlled substance in an executive order signed by Gov. Mike DeWine. Ohio is one of the first states to designate it a controlled substance. The executive order will allow toxicology and crime labs to conduct more robust testing and make the sale and trafficking of xylazine for illicit use a criminal offense.
“As far as xylazine goes, it’s used as a cutting agent,” Garro said. “I’ve never seen or heard of anyone walking around with five or ten pounds, or even an ounce of pure xylazine” the way other illicit drugs are frequently transported.
Between July 1 and Sept. 30, xylazine was confirmed in 750 suspected drug samples submitted by Ohio law enforcement to the Bureau of Criminal Investigation (BCI), about 8.5% of the total samples tested. The BCI stated in an email that xylazine was the fourth-most reported controlled substance during the period. It is generally found mixed with fentanyl.
At the state level, the Ohio Department of Health recorded 119 xylazine-involved unintentional overdose deaths in 2022, compared to 15 deaths in 2019.
Treatment facility sees increase in positive tests for xylazine
Staff at IBH Addiction Recovery, an addiction treatment center in Coventry Township, said they have not seen any residential treatment admissions with obvious signs of xylazine use so far, such as wounds that do not heal.
“We know that xylazine is present in Akron and being cut into the drug supply that is in our community,” Elizabeth Langford, health services director at IBH, said in an email. “We have had several urine drug screens test positive for xylazine, usually with fentanyl, on admission to residential treatment. The numbers keep going up.”
Some clients said they specifically sought fentanyl cut with xylazine because xylazine can prolong the euphoric high, Langford said. Others have said they were unaware they had taken xylazine.
Xylazine is only approved for use in veterinary medicine to sedate large animals like horses and cattle. The danger it presents comes when it is used as a cutting agent in fentanyl.
The drug was first noted as an adulterant, or a drug mixed with other illicit substances, in the early 2000s by the Drug Enforcement Agency. Now, nearly 100% of xylazine-associated deaths involve illicitly manufactured fentanyl or fentanyl-like drugs.
Xylazine not present so far in Summit County overdose deaths
In August, Summit County Public Health officials issued a health advisory because of a spike in overdose deaths. The county recorded 306 overdoses in 2023 and 21 so far in 2024.
Lisa Kohler, chief medical examiner at the Summit County Medical Examiner’s Office, said the majority of overdose cases that cause a death are related to fentanyl, cocaine or methamphetamine.
“We have an increasing number of cases that are being sent to the reference lab, where they test for xylazine,” she said. “They’re not reporting finding xylazine.”
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Still, Kohler noted there is a reporting limit for xylazine. If xylazine is present in someone’s body below the reporting limit, the test will come back negative.
“But if it’s not reaching that level, then it’s unlikely to be causing any problems” in those particular cases, she said.
Typically a cutting agent, but dangerous alone
Xylazine is a dangerous drug on its own, with potential side effects including respiratory depression and reduced heart rate. Repeated use leads to skin lesions and ulcers. In extreme cases, amputations may be necessary because of necrosis, or the death of tissue believed to be caused by a loss of circulation.
“The nature of [xylazine] is sedation,” said John M. Ellis, professor of Instruction and the addictions curriculum coordinator at the University of Akron. “When you have too much sedation, you might see things like difficulty breathing, low blood pressure, low heart rate, and there’s also some risk if the person using drugs has open wounds – the wounds can become infected.”
In Philadelphia, an “epidemic” of xylazine is making the opioid crisis there worse. According to the Drexel College of Medicine’s website, xylazine was detected in only 2% of heroin and/or fentanyl overdoses in the city between 2010 and 2015. In 2019, the number rose to 31% and in 2021, xylazine was found in more than 90% of the city’s lab-tested opioid samples.
“It’s a very frightening thing,” said Dr. Barbara Schindler, vice dean emerita and professor of psychiatry and pediatrics, in an article on the school’s website. “We thought things were bad with fentanyl, but this is even worse. It’s grown so much in the past few years, especially here on the East Coast. It’s widespread in Philadelphia street drugs and it’s frightening in a number of ways.”
Typically, people who use drugs are not seeking out xylazine as a standalone substance. But Ellis said xylazine is becoming a nationwide phenomenon because it is being blended into heroin and other illicit substances.
No approved antidotes for xylazine-related overdoses
Xylazine is cheap, so dealers can charge more for their drugs since it extends the high, said Langford at IBH. When people consume xylazine, knowingly or unknowingly, it causes a pronounced withdrawal, leading them to buy and consume more to avoid withdrawal.
“It’s really important that physicians or treatment programs know what drugs someone has taken or are in the area because withdrawal [of certain drugs] can be pretty severe,” Ellis said. Quitting a depressant cold turkey can even be fatal, he said, or cause seizures.
There are currently no approved antidotes for xylazine overdoses, and first responders may have to provide additional life-saving measures in xylazine-related drug overdoses.
Still, it can be difficult to know if someone has overdosed on xylazine or an opioid mixed with xylazine because the symptoms of overdose are similar.
In overdose cases, always administer naloxone
Although xylazine is not an opioid, it causes opioid-like effects. Fentanyl, other opioids, and xylazine all depress the central nervous system, causing slower breathing, lower heart rate and potentially dangerously low blood pressure. The drugs work together and increase the potential for a fatal overdose.
Narcan and other naloxone products do not prevent an overdose related to xylazine. Naloxone reverses opioid overdoses by blocking the effects of opiates on opioid receptors in the brain, but it cannot reverse the effects of other drugs that interact with different receptors in the brain.
Nevertheless, experts urge people to administer naloxone if they suspect someone has overdosed even if xylazine may be involved. Naloxone could still reverse the effects of any opioids mixed with the tranquilizer.