Key takeaway
Xylazine is a veterinary tranquilizer often mixed into illegal fentanyl, and people often do not know it is there. It can slow breathing, heart rate, and blood pressure. Naloxone does not reverse xylazine. Give it anyway if an opioid may be involved, call 911, and stay until help arrives.
Last updated: Mon Oct 05 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
Someone is down, and the naloxone did not fully bring them back. The bag may have had xylazine in the fentanyl. That sedative is a veterinary tranquilizer, not an opioid, and people often take it without knowing.
If someone will not wake, is breathing slowly, or has stopped breathing, call 911. Give naloxone if you have it, and stay until help arrives. For a mental health crisis, call or text 988.
Give naloxone, then stay
Naloxone does not reverse xylazine. Give it anyway when an opioid overdose is possible. It can reverse the fentanyl, and it does not harm someone who has no opioids involved. Xylazine's own effects may continue afterward. More than one dose may be needed before breathing looks normal. Follow the dispatcher on rescue breaths. Place an unconscious person on their side, with the head supported, while you wait.
Xylazine can slow the brain, breathing, heart rate, and blood pressure. It is especially dangerous with opioids, alcohol, and benzodiazepines. If the picture is mixed and you are unsure, make that call. A fast heart is a different emergency, covered in stimulant overdose signs. Nalmefene is another opioid reversal medicine. It does not cancel xylazine either.
Most states have some form of Good Samaritan protection for the person who calls. Those laws vary. Make the call.
After the person is breathing
Repeated use is linked with painful skin sores. They can show up away from an injection site, including in people who smoke or snort. Keep a wound clean, and get severe ones to a hospital. A clinician has to plan any change in dose. Tell them if fentanyl and xylazine may both have been in the supply.
In 2022, about 23 percent of seized fentanyl powder and 7 percent of seized fentanyl pills contained xylazine. A test strip on one sample is information about that sample. Search FindTreatment.gov when the emergency is over, and say what you suspect was in the bag. Call or text (800) 653-9376 if you want help finding care after an overdose, or for wounds that are not an emergency tonight.
Additional Resources
Sources cited on this page:
- NIDA: Xylazine
- CDC: What you should know about xylazine (reviewed May 16, 2024)
- SAMHSA FindTreatment.gov
- 988 Suicide & Crisis Lifeline
Common Questions
Is xylazine an opioid?
No. It is a tranquilizer approved for veterinary medicine and not for people. On its own it may be called tranq. Mixed with fentanyl or another opioid it may be called tranq dope. Because it is not an opioid, an opioid reversal medicine does not cancel it.
Should I still give naloxone?
Yes, if an opioid overdose is possible. Give naloxone for any suspected drug overdose. It does not reverse xylazine, and it does not harm someone who has no opioids on board. Fentanyl is often in the same bag, so the opioid part can still be reversed. More than one dose may be needed to restore breathing. Xylazine's own effects may continue after that. Follow the product you have and the dispatcher.
Are the skin wounds only at the injection site?
No. Repeated use can cause painful sores and abscesses at the injection site and often somewhere else. Some clinicians report wounds even when people smoke or snort and do not inject. Keep wounds clean. Severe ones may need a hospital. Healing can happen even if use continues, and it is slower if xylazine exposure continues.
Does xylazine make a fentanyl overdose more likely to be fatal?
The combination is especially dangerous because both drugs can slow breathing. It is not clear that adding xylazine raises the chance of a fatal overdose. Early studies did not find higher odds of death when xylazine was also present. Call 911 either way. On death records from 20 states and the District of Columbia, the monthly share of illegally made fentanyl deaths with xylazine rose from 3 percent in January 2019 to 11 percent in June 2022.
Is xylazine a controlled substance?
Not under the federal Controlled Substances Act. It is still not approved for any human use. Some states have scheduled it themselves. A state health department can tell you the local rule. Mixtures had been seized in 48 of 50 states.