Notification from the Los Angeles County Department of Public Health
Notification from the Los Angeles County Department of Public Health
LAC DPH Health Advisory
Xylazine in Illicit Drugs Increasing Overdose Risks
February 24, 2023
This message is intended for healthcare professionals including emergency departments, primary care physicians, and first responders.
Please distribute as appropriate.
Key Messages
  • Xylazine, a veterinary anesthetic, is increasingly present in the illicit drug supply. It is not FDA approved for humans and lowers blood pressure, heart rate, and breathing rate.
  • Xylazine may be included in street drugs, illicit drugs, and counterfeit pills—often without the knowledge of people who use these drugs. There is no test readily available to the public to detect xylazine in drugs.
  • Xylazine is often combined with opioids and increases the risk of overdose and death. It is also associated with complex skin infections when injected.
  • Xylazine is not an opioid, so its effects are not reversed by naloxone. However, naloxone should still be administered during a suspected or known xylazine overdose because of the high likelihood that opioids are also present.
  • Clinicians should consider collecting serum toxicology tests specifically for xylazine through an available laboratory to confirm xylazine overdose.
Situation
The illicit drug supply in Los Angeles County increasingly includes substances with a high potential for overdose. Xylazine, also known as “tranq,” “tranq dope,” or “zombie drug,” is now being mixed into the illicit drug supply, in addition to fentanyl. Xylazine is a cheap additive that increases the effect of opioids as well as the risks for overdose and death.
Xylazine has been found in drug supplies on the East Coast of the United States for years but has not been reported on the West Coast until more recently. The LA County Medical Examiner-Coroner identified a single case of a fatal overdose involving xylazine in 2021, but both San Francisco and San Diego have detected xylazine in drug samples obtained in 2023, indicating that xylazine is now also likely increasingly present within the drug supply in Los Angeles. San Francisco reported 4 recent overdose deaths involved both xylazine and fentanyl in 2023.
This communication is to alert LA County healthcare providers about the increasing prevalence of xylazine in the illicit drug supply on the West Coast, including in Los Angeles County.
The Los Angeles County Department of Public Health (LAC DPH) continues to work closely with other partners to understand the extent of the possible xylazine contamination in the illicit drug supply to increase awareness and education to the public.
Xylazine
Xylazine is an alpha-2 adrenergic agonist and non-opioid sedative medication and muscle relaxant that comes in a clear liquid and is used as a veterinary anesthetic. It is not approved by the U.S. Food and Drug Administration (FDA) for human use.
Xylazine is cooked down from a liquid into a powder and added to illicit opioids such as heroin or fentanyl to heighten and prolong their effects. It can also be mixed into counterfeit pills including opioids (e.g., Norco, Percocet, Vicodin, etc.), sedatives (Xanax), or stimulants (Adderall) as a cheap additive.
People who are obtaining these drugs may not be aware that xylazine may be present in what they’re using, which can increase the risk of a fatal overdose.
Xylazine can be swallowed, inhaled, smoked, snorted, or injected into muscles or veins. When mixed with opioids and other central nervous system depressants, like alcohol or sedatives, xylazine intensifies the effects, including sedation (drowsiness leading to unresponsiveness) and respiratory depression, and can lead to a fatal overdose. Xylazine overdoses have been observed to last from 8 - 72 hours.
Because it is not an opioid, naloxone is not effective against xylazine. However, because xylazine is frequently mixed with opioids, naloxone is still recommended to reverse the opioid contribution to overdose.
Chronic xylazine exposure can lead to physiologic dependence and withdrawal symptoms, which include irritability and anxiety. Repeated xylazine injection has also been associated with severe, necrotic skin lesions often requiring advanced wound care. These wounds may occur in areas of the body away from the injection site.
Xylazine is colorless, odorless, and there are no rapid drug tests that screen for it. Xylazine can be detected in a comprehensive toxicology screen, such as a gas chromatography-mass spectrometry test, ordered by a provider in an emergency room, hospital, or clinic when the sample is sent to a lab that conducts spectrometry test for xylazine.
Actions Requested of Providers
  • Administer naloxone:
    • To patients with symptoms of a xylazine or an opioid overdose. Naloxone will successfully reverse the opioid effects and restore breathing.
    • If xylazine is present, the patient may remain somnolent or minimally responsive.
    • The goal of an overdose reversal is to restore breathing, not to necessarily restore full consciousness.
  • Order and collect serum toxicology tests specifically for xylazine:
    • In suspected overdose cases where patients do not fully respond to naloxone treatment.
    • In cases where people who use drugs present with atypical skin infections.
  • Inform Poison Control of suspected or confirmed Xylazine overdoses or other associated symptoms of xylazine use including atypical or severe skin wounds or atypical clinical syndromes among people who use drugs.
    • Report suspected or confirmed cases to Poison Control at 1-800-222-1222.
  • Prescribe naloxone to patients at risk for overdose:
    • Educate patients that naloxone should be given for any suspected drug overdose, even if there is uncertainty about what drug(s) were used.
    • Explain that the goal of administering naloxone is to save the overdosing person’s life by restoring their breathing.
    • Naloxone can be administered through the nose or as an intramuscular injection to save their life. Both methods are equally effective.
    • Educate patients on how to use naloxone: https://www.narcan.com.
  • Identify patients at risk for overdose and provide anticipatory harm reduction guidance:
    • Screen all patients, including adolescents, for recreational drug use.
    • Educate patients who use drugs to:
      • Never use alone
      • Use small “tester” doses
      • Stagger drug use with others
      • Avoid mixing drugs
      • Carry naloxone
      • Consider bringing their drugs to test for xylazine using Fourier-transform infrared spectroscopy (FTIR), which analyzes a drug sample in about 15-20 minutes and is available for free. See the Information Sheet: Xylazine in LA County for more information about how to access xylazine drug testing.
      • Use fentanyl test strips to test drugs for fentanyl. Information about fentanyl test strips is available on the LAC DPH Overdose Prevention webpage.
    • Advise patients that medications and other forms of treatment for substance use are available through treatment programs, primary care services, and other health providers.
Resources
  • Information Sheet: Xylazine in LA County
    This information sheet is intended for the general public. It contains frequently asked questions, describes harm reduction steps to reduce the risk of xylazine overdose, and includes information about how LA County residents can obtain spectroscopy testing of drugs for xylazine.

  • LAC DPH Overdose Prevention Webpage
    This Substance Abuse Prevention and Control (SAPC) website features information sheets and toolkits for the community relevant to overdose prevention. publichealth.lacounty.gov/sapc/public/overdose-prevention.htm

  • Poison Control 1-800-222-1222

  • Finding Substance Use Disorder Treatment
    In Los Angeles County, the general public, health care providers, and patients can find substance use treatment services and bed availability using an online, filterable service locator known as the Services and Bed Availability Tool (SBAT), in the resource section of www.RecoverLA.org, or by calling the Substance Abuse Service Helpline (SASH). Services include outpatient and intensive outpatient treatment, residential treatment, withdrawal management, and Opioid Treatment Programs.
This communication was sent by Dr. Siddarth Puri, Associate Medical Director for Prevention, Division of Substance Abuse Prevention and Control, Los Angeles County Department of Public Health
To view a printable PDF of this communication and other LAHAN communications, please visit ph.lacounty.gov/lahan.
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