Skin-Rotting 'Zombie Drug' Xylazine Tied to Increase in US Drug Overdoses

by Liz Neporent
February 23, 2023 at 8:05 AM UTC

A new street drug is causing skin to rot.

Clinical Relevance: Be on the lookout for use of xylazine, a new animal sedative often used in conjunction with opioids

  • Xylazine is a fast-spreading, deadly new street drug often cut into other drugs or used used to extend the effects of fentanyl and mimic the high of heroin.
  • The drug can cause sedative-like symptoms and severe skin rot.
  • Although approved for use in veterinary medicine, the drug is unsafe for humans and overdoses cannot be reversed by the opioid antidote, naloxone.

There is a deadly new street drug to worry about. It acts as a sedative, analgesic, and muscle relaxant. Oh, and it also causes severe skin rot.

Xylazine–which goes by the street names “tranq,” “tranq dope,” and “zombie drug”–is approved for use in horses, cattle, and other non-human mammals. In the past couple of years, opioid users have started taking it to extend the effects of fentanyl and mimic the high of heroin. 

However, some users may not intentionally seek out xylazine. In many cases, people are not aware that it has been cut into the other drugs they are buying and using, according to an urgent warning from Philadelphia’s Department of Public Health. 

The tranq trend appears to have begun in Puerto Rico in the early 2000s, a study published in the journal Injury Prevention suggested. Philly was the first US city to document its use around 2006. Since then, it has quickly spread across the country to at least 36 states, with xylazine-related overdose deaths recorded in Ohio, Maryland, Massachusetts, and Texas. Other public health warnings about the drug have been issued by New York City, Los Angeles, and San Francisco.

Prevalence Prescription Stimulant Misuse Among US College Students

Fentanyl Vaccine Could Help Fight Opioid Epidemic

Treating PTSD and Alcohol Use Disorder

FDA-approved for use in veterinary medicine, xylazine is considered unsafe for humans. It’s not an opioid, so users who overdose on the drug can’t be saved by naloxone (Narcan), the opioid OD reversal injection recently recommended by a government panel for over the counter sales. But because xylazine is now almost always found in combination with opioids, including fentanyl, the Philadelphia warning recommended administering Narcan anyway for any suspected opioid overdose.

The drug causes excessive sleepiness and respiratory depression. But its most distressing symptom is raw, crusty skin ulcers that spread out from the injection site. The skin wounds decompensate quickly and can be so severe that the infected body part may require amputation if left untreated. 

Research has yet to definitively prove a connection between xylazine and the open sores, but the Philadelphia report noted that there does appear to be an association between the two. Since xylazine came onto the city’s drug scene, local hospital systems have reported a rise in skin and soft tissue infections among drug users. 

Xylazine is not on the list of controlled substances under the federal Controlled Substances Act. Currently, there is no way to test for the drug in the system. A person who has overdosed on the drug will likely be unresponsive, the Philadelphia report noted. When a person overdoses on xylazine in combination with fentanyl, symptoms can include blue-to-grayish skin, as well as slowed breathing and heart rate.

Commentary

Learning by Doing: Can Our Collective Experiences as Clinicians Improve Mental Health Care?

Drs Rush and Tramontin discuss how simple outcomes, often patient reported, could facilitate evidence-based decision making by clinicians, administrators, and payors and provide the foundation for a learning health care system.

A. John Rush and others

Letter to the Editor

Psychiatric History of Presenting Illness Mnemonic

In this letter to the editor, the author presents a mnemonic created to help clinicians obtain a psychiatric history.

Abdulsamad A. Aljeshi