Opioids + Xylazine ('Tranq')
Opioids (fentanyl) + Xylazine: the short answerXylazine — a veterinary sedative now mixed into much of the fentanyl supply — deepens sedation and breathing suppression, and naloxone does not reverse it. Always still give naloxone (the opioid part responds), call emergency services, and be ready to give rescue breaths.
Why it’s dangerous
Xylazine is an alpha-2 adrenergic agonist that causes profound sedation, slowed heart rate, low blood pressure, and respiratory depression; naloxone cannot touch it because it is not an opioid. Stacked on fentanyl it lengthens and deepens the unresponsive period and can cause severe skin wounds even with injection-free use. A related veterinary sedative, medetomidine, has begun appearing in the same supply — it is even more potent, causes the same unresponsive sedation with dangerously slow heart rate and breathing, and likewise is not reversed by naloxone.
What happens
- Very prolonged, heavy sedation — hours of unresponsiveness
- Slow breathing, slow heart rate, and low blood pressure
- Painful skin ulcers and wounds, sometimes far from any injection site
- Overdoses that partially respond to naloxone but leave the person still sedated
Warning signs
- Person wakes only partly, or not at all, after naloxone
- Very slow pulse and shallow breathing
- Open sores, blackened skin, or spreading skin infections
- Breathing stops again after naloxone wears off
What to do
- Give naloxone anyway — fentanyl is usually present and responds
- Call emergency services and say the person may have taken 'tranq' (xylazine)
- Provide rescue breathing if trained: sedation can outlast naloxone by hours
- Recovery position; keep them warm; do not leave them alone
- Get skin wounds treated early — they worsen fast and can become life-threatening
- Never use alone; consider fentanyl/xylazine test strips where available