Deadly Connections: Xylazine and Fentanyl in a Dangerous Combination

Opioid-related overdoses continue to affect communities across the United States. As drug cartels seek to increase the potency and profitability of their product, they have been turning to new combinations of illicit drugs.1 In particular, there is a dangerous combination of drugs that is posing a significant threat to public health: fentanyl and xylazine.1

The Dangers of Fentanyl

Fentanyl is a powerful synthetic opioid commonly prescribed for severe pain management and as an anesthetic.2 It is approximately 100 times more potent than morphine and 50 times more powerful than heroin.2

The dangers of fentanyl lie in not just its high potency, where even small doses can lead to significant respiratory depression and overdose, but also that people using opioids or counterfeit prescription pills often do not realize that they’re also ingesting fentanyl. 

Fentanyl is a major contributor to nonfatal overdoses and overdose-related deaths in the United States. In 2022 fentanyl-related overdose deaths continued to rise; more than 107,000 people died from drug overdoses in the U.S., and 66% of those involved synthetic opioids like fentanyl.1

Xylazine Risks and Dangers

Xylazine, also known as “tranq,” is a non-opioid veterinary sedative and muscle relaxant. It has not been approved for use by humans.4 However, it has entered into the illicit drug market with a startling frequency. According to the Drug Enforcement Administration (DEA), 23% of the seized fentanyl powder in 48 out of 50 states contained xylazine.1

People may unknowingly consume xylazine in counterfeit pills, heroin, or other illicit substances. It has been reported that some people may take xylazine to intensify the effects of opioids like heroin.4,5

On its own, xylazine can cause a range of health issues, such as hypotension, respiratory depression, and slowed heart rate.4 According to the Centers for Disease Control and Prevention (CDC) the number of estimated deaths in the U.S. involving xylazine was 3,480 — a 1,238% increase from 2018.6

Furthermore, xylazine use is associated with severe skin wounds that can result in severe wounds that result in necrosis.1,4 These wounds appear regardless of the method of ingestion5 — smoking, snorting, or injection — and may require amputation of the affected body part to treat.1

A Deadly Combo: Fentanyl and Xylazine

When fentanyl and xylazine are combined, the risks of experiencing a potentially deadly outcome from use escalate exponentially. Both xylazine and fentanyl cause significant sedation, respiratory depression, and a slower heart rate, but the effects are enhanced when the two drugs are combined.1 This can lead to individuals losing consciousness or entering respiratory arrest, depriving the brain of oxygen and leading to irreversible damage or death.1,4

Moreover, this dangerous combination’s unpredictable nature poses challenges for emergency responders. Xylazine is not an opioid, though its effects often mimic one, and is not responsive to naloxone4 — the opioid overdose-reversal agent typically used as a first-line treatment for a suspected overdose. While naloxone will still effectively reverse fentanyl-induced respiratory depression, it won’t reverse the effects of xylazine.4 Additional life-saving supportive care may be required, such as rescue breathing, maintaining an open airway, and remaining with the person until medical help arrives.

Getting Help if You’re Struggling with Opioid Use

The recent surge in the use of fentanyl and xylazine, both separately and in combination, is a serious public health threat. These drugs are extremely dangerous and can lead to overdose and death.

If you or someone you love is struggling with opioid use, effective compassionate help is available. Contact us today at to learn more about our levels of care that can get you on the road to recovery and back to living the life you deserve.

Was this page helpful?
Thank you for your feedback.

American Addiction Centers (AAC) is committed to delivering original, truthful, accurate, unbiased, and medically current information. We strive to create content that is clear, concise, and easy to understand.

Read our full editorial policy

While we are unable to respond to your feedback directly, we'll use this information to improve our online help.

The Best Place to Recover in Orange County
We are here to help you get sober and learn how to stay that way. Laguna Treatment Center is located in Orange County within easy reach of the entire Los Angeles metro. We are the premier chemical dependency recovery hospital in the OC. We offer safe medical detox, mental health support, and wellness programs.