‘Tranq dope’ — fentanyl mixed with xylazine animal sedative — present in deaths in 39 states

The sedative does not show up on routine toxicology reports

The FDA is investigating reports that animal tranquilizers — colloquially called “tranq” — are being mixed with heroin and fentanyl with potentially fatal results.

Xylazine is an FDA-approved animal sedative and pain reliever, but when combined with heroin and fentanyl the mixture is reportedly extremely dangerous and potentially resistant to naloxone, a drug used to prevent overdose deaths.

According to the FDA, the symptoms of suffering Xylazine exposure are similar to those one would experience during an opioid overdose. This makes it difficult in cases where the drugs have been mixed for health professionals to immediately determine if patients are suffering from the effects of the tranquilizer or the opioid. The mixture of the opioid and the sedative is commonly called “tranq dope.”

In addition to the extreme sedative effects, the drug — when injected — can reportedly cause severe skin ulcers. One woman who used the mixture told Fox29 that her bone was visible through the ulcers. Other individuals who claim they’ve used the sedative have shared graphic images of their deteriorating skin in digital discussion spaces like Reddit’s r/opiates subforum, often as a way to deter others from using the drug.

The FDA issued the report to health care providers after it became “aware of increasing reports of serious side effects from individuals exposed to fentanyl, heroin, and other illicit drugs contaminated with xylazine.”

It’s currently unclear if the side effects of the drug can be reversed with naloxone, and the drug does not show up on routine toxicology screens, according to the FDA.

The agency said it was not clear if illicit producers were creating their own xylazine or if legally produced doses were being redirected into the drug trade.

According to the journal Injury Prevention, reports of the drug are especially prevalent around Philadelphia, Pennsylvania. The city’s Medical Examiner’s Office studied heroin and fentanyl overdoses between 2010 and 2019 and found that the presence of xylazine in fatal heroin and/or fentanyl overdoses increased, spiking between 2015 and 2019.

The researchers reported that the sedative was present in fewer than 2 per cent of fatal overdose cases between 2010 and 2015. By 2019, xylazine was detected in 31 per cent of the fatal heroin/fentanyl overdoses in the city. The most significant jump occurred between 2018 and 2019, when the drug was detected in 18 per cent of fatal heroin overdoses to 31 per cent a year later.

The study determined that “whenever possible, jurisdictions should consistently test for xylazine.”

According to the study, in 2019 overdose fatalities found with xylazine in their systems were 76 per cent male. About half — 47 per cent — were between the ages of 35 and 54, and about 65 per cent were white.

The rise of xylazine is likely tied to fentanyl largely replacing the heroin supply in Philadelphia. According to researchers, “some evidence suggests that the combination of xylazine and fentanyl in humans may potentiate the desired effect of sedation and the adverse effects of respiratory depression … caused by fentanyl alone, comparable to the synergistic effects of combining benzodiazepines with heroine.”

In other words, the sedative provided by the xylazine helps reduce the unpleasant respiratory side effects caused by the fentanyl.

On the other hand, some individuals who used the combination expressed to researchers that using tranq dope versus just fentanyl alone provides an experience that feels more like pre-fentanyl heroin use.

They said during a focus group that tranq dope “makes you feel like you’re doing dope in the hold days [before it was replaced by fentanyl].”

It’s unclear exactly how prevalent xylazine has become in the US drug market, but available research suggests the sedative is seeing significant use across the country. VICE News reports that xylazine has been found in suspected impaired driving cases and autopsies in at least 39 states as well as Puerto Rico, Washington DC and in Canada.