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U.S. Department of Health and Human Services
National Pharmacy & Therapeutics Committee

DEA Reports Widespread Threat of Fentanyl Mixed with Xylazine

The Drug Enforcement Agency (DEA) issued a Public Safety Alert to warn the American public of a sharp increase in the trafficking of fentanyl mixed with xylazine. Xylazine, also known as “Tranq,” is a powerful sedative that the U.S. Food and Drug Administration has approved for veterinary use. The DEA has seized xylazine and fentanyl mixtures in 48 of 50 States. The DEA Laboratory System is reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.

Xylazine is a non-opioid tranquilizer that can cause drowsiness and amnesia and slow a person's breathing, heart rate and blood pressure to dangerously low levels. Xylazine is only authorized by the U.S. Food and Drug Administration for veterinary use. It is not currently a controlled substance under the U.S. Controlled Substances Act. Xylazine is being mixed with fentanyl and other opioids as an adulterant and may lengthen the euphoric effects compared to fentanyl alone. As a non-opioid medication, its effects are not reversed by the use of naloxone and it increases the risk of suffering a fatal poisoning. Additional adverse effects of xylazine include physical dependence, withdrawal symptoms, skin ulceration, severe wounds, and necrotic tissue that can lead to amputation.

Recommendations for Healthcare Providers

  • Health care professionals should continue to administer naloxone for opioid overdoses and consider xylazine exposure if patients are not responding to naloxone or when there are signs or symptoms of xylazine exposure (e.g., severe, necrotic skin ulcerations).
  • Health care professionals should provide appropriate supportive measures to patients who do not respond to naloxone.
  • Routine toxicology screens do not detect xylazine, and additional analytical techniques are required to detect xylazine when it might be involved in illicit drug overdoses, particularly when there are other signs or symptoms of xylazine exposure.

FDA encourages health care professionals and patients to report adverse events in humans associated with possible illicit xylazine exposure to FDA’s adverse events to the MedWatch program as recommended in the Indian Health Manual. Instructions for reporting can be found online at the NPTC Pharmacovigilance website

For more information, please consult the complete DEA Public Safety Alert Exit Disclaimer: You Are Leaving www.ihs.gov , the DEA Joint Intelligence Report Exit Disclaimer: You Are Leaving www.ihs.gov , and the FDA Drug Safety message Exit Disclaimer: You Are Leaving www.ihs.gov