Tranq, Philly dope, the zombie drug, sleep cut–all different names for the drug causing mass concern throughout the United States: Xylazine, an animal sedative not approved for human use. 

Suppliers are increasingly turning to the drug, which is relatively easy to access because of its use in veterinary clinics, to dilute the purity of their opioids and increase their profit margins.

After first appearing in Pittsburgh’s illegal drug supply in 2022, Xylazine has become infamous for the necrotic-like wounds it leaves on people that sometimes lead to amputation. 

Despite these graphic circumstances, experts, such as Otis Pitts, deputy director for the Bureau of Food Safety, Housing and Policy for the Allegheny County Health Department [ACHD], explained that although Xylazine is appearing in more overdose toxicology reports and in the drug stream overall, it’s “not necessarily causing the death[s].”

“It’s very important for folks to remember that, for all intents and purposes, it’s really fentanyl that’s driving our deaths here in the county and nationwide,” Pitts said. 

According to Earl Hord, epidemiology research associate supervisor for overdose epidemiology at ACHD, Xylazine has been seen in around 30% of overdoses in Allegheny County. Despite that statistic, every death that included Xylazine in the county also included another opioid, usually fentanyl.

“There has not been a death that has included Xylazine that has not also included fentanyl,” Hord said. 

Pennsylvania issued an emergency order in June 2023 that made Xylazine a Schedule III drug in the state, which means the drug is more highly regulated and must be documented when used. After this, the county began testing for the substance in toxicology reports.

Pitts noted that most people who use Xylazine aren’t doing it intentionally–they’re usually looking for opioids and don’t know that they might contain significant amounts of Xylazine. Because of the wounds it often causes and its strong sedative qualities, most people who have taken the drug highly dislike it.

“We don’t think folks are necessarily electing to use Xylazine,” Pitts said. “It just happens to be found in their substance of choice here locally. Folks are looking for street opioids like heroin [or] largely fentanyl these days, and fentanyl has been cut increasingly with Xylazine as an adulterant.” 

Alice Bell, Overdose Prevention Project director at Prevention Point, said she doesn’t know anyone who actively seeks out the drug.

“People really hate [Xylazine],” Bell said. “People do not like it. They just hate it. We’ve talked to people who’ve said that they’ve even talked to their dealers and said ‘I don’t like this. I don’t want it. I’m going to look for somebody that doesn’t have it in their supply.’ But as it becomes more and more common, then people don’t have a choice.” 

Organizations like Prevention Point Pittsburgh, a harm reduction group that has been working in Allegheny County for over 20 years, have been at the forefront of data collection and reporting on Xylazine’s presence in opioids. 

Prevention Point’s self-reported bag testing program most recently reported 18 bags of street drugs in February and March, 12 of which contained a mix of Xylazine and fentanyl. The posts include bag names, stamp colors, and neighborhoods they’re found in, which help people identify where the heavily cut drugs are coming from. 

The primary source of concern for people like Bell is that Xylazine’s sedative qualities often mean people who overdose on a combination of opioids and Xylazine have a harder time waking up after overdose reversals. 

“Fentanyl overdose typically takes one or two doses of four milligram nasal Naloxone – doesn’t take more than that,” Bell said. “And we’ve seen people who have reversed many overdoses over the years coming in and saying ‘I had to give them more doses; I gave them three doses or four doses.’ And when we hear that, anytime we hear somebody reporting that they had to use more than two doses, we want to know why. [One of the reasons] is that there’s some kind of other sedative substance that they’re also taking.” 

Despite the added complications Xylazine presents when someone overdoses, Naloxone (an opioid reversal also known colloquially as Narcan) still works when Xylazine is present, and it remains the best way to ensure someone’s safety after they’ve overdosed. 

“It complicates things because people are used to one or two doses [of Naloxone] in a person,” Bell said. “We’ve always taught that a person should be doing rescue breathing while they’re waiting for Naloxone to work, but now it’s really even more important with Xylazine. Even if they’re not conscious, as long as they’re breathing, they’ll be OK.” 

The Allegheny County Health Department provides a host of resources for people impacted by Xylazine and the wider opioid epidemic, including partnerships with organizations like Prevention Point. The county distributed over 15,000 Xylazine test kits for public use and has implemented wound care clinics, and its website provides information for safe syringe services as well as general harm reduction information.

Still, many overdose prevention advocates believe there’s only one way to eliminate the sedative from drug streams and prevent people from using it. 

“What we really need, if we’re serious about addressing these problems, people need to have access to a safe, legal drug supply,” Bell said. “If people could get medical-grade heroin, then we wouldn’t have the problems with fentanyl overdose or Xylazine wounds or things like that. There’s a great quote from Jacob Solomon that starts out saying ‘Did you hear about the guy who thought he was drinking 80-proof vodka and it turned out to be 150-proof everclear and he died of alcohol poisoning? Probably not, because that doesn’t happen with a legal drug supply.’”