May 15, 2023

Kirksville, MO 5/15/23 – The Missouri Department of Health and Senior Services (MODHSS) has issued a call for vigilance relating to a steep rise in fatal drug overdoses among Missourians using xylazine-laced opioids. Confirmed deaths involving xylazine rose 180% between 2021 and 2022.

Xylazine Graph

Xylazine is a sedative and muscle relaxant used by veterinarians on animals. It is not approved for use in humans by the Food and Drug Administration (FDA) and is not controlled under the federal Controlled Substances Act (CSA). This non-opioid is being added to opioids such as fentanyl. In all xylazine deaths in Missouri from 2019 to 2022, synthetic opioids were also detected in 99.4% of them.

Xylazine is commonly referred to as “tranq” or “tranq dope” among illegal drug users, due to its sedating effect which may lengthen the feeling of euphoria. The drug is most often injected but may also be smoked, snorted, or ingested orally. Decreased blood pressure, heart rate, and sensitivity to pain, depressed breathing, and hypothermia, leading to drowsiness, coma, lack of airflow, and death are caused by the drug.

Because xylazine is not an opioid, it does not respond to naloxone during overdose and currently has no antidote. MODHSS recommends that healthcare providers consider xylazine as an issue, especially when overdose victims do not respond fully to naloxone. The only treatment airway maintenance, breathing and circulation support, and administration of intravenous fluids. Atropine may be administered if the heart rate slows.

The drug causes dependency and withdrawal symptoms that are not managed by those used in opioid withdrawal, such as methadone. However, MODHSS recommends use of intervention designed for opioids since xylazine is most often used in conjunction with them. Use of xylazine causes severe circulatory changes that lead to poor conditions in skin tissues, open and unhealed sores, and dead and rotting skin that becomes easily infected. This can lead to loss of fingers and toes and require amputation of limbs, even far away from injection sites.

For providers with questions regarding management of patients who have taken xylazine, contact the Missouri Poison Center at 1-800-222-1222.