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Xylazine is becoming more common in the illegal drug supply, and is being mixed with opioids like heroin and fentanyl. Xylazine can cause drowsiness, slow breathing, decrease blood pressure, and lower heart rate. When mixed with other opioid drugs, like heroin, fentanyl, and benzodiazepines (like Xanax®, Valium®, Klonopin®, Ativan® and others), the risk of opioid overdose is higher. Xylazine can also make it more difficult to tell is naloxone (NARCAN®) is working, because a person may start breathing again, but remain unconsciousness. If you suspect that someone is experiencing an opioid overdose, always use naloxone (NARCAN®), call 911, and stay with them until help arrives. Remember, naloxone (NARCAN®) cannot hurt someone if they have not used an opioid, so always use it if an opioid overdose is a possibility.

Xylazine can also cause severe wounds to appear on the skin. These wounds have been seen with people who smoke, snort, or inject drugs that have xylazine in it. These wounds can away from injection or use sites, and can get worse quickly. These wounds can be very difficult to heal, so it is important to get medical attention if you see them. Medical providers can help prevent infections and stop the wounds from getting worse.

Following these harm reduction practices may reduce the risk of fatal opioid overdose:

• CARRY NALOXONE (NARCAN®): Show others where it is and how to use it. More than one dose may be needed.
• USE WITH SOMEONE ELSE: If you overdose, it's important to have someone around to help.
• TAKE TURNS USING: Be prepared with naloxone (NARCAN®) and have a phone on hand in case you need to call 911.
• TEST YOUR DRUGS: A small amount of fentanyl can cause an overdose. Use fentanyl test strips to see if fentanyl is in your drugs. This can help you make safer use decisions.
• USE SLOW AND USE LESS: Use a small amount first to see how strong your drugs are.
• AVOID MIXING DRUGS: Mixing drugs - including alcohol - increases your risk of overdose.

If you suspect that someone is experiencing an opioid overdose, always use naloxone (NARCAN®), call 911, and stay with them until help arrives.

Naloxone (NARCAN®) will have a direct effect on the opioid, like fentanyl or heroin. The most important reason to use naloxone (NARCAN®) is to restore normal breathing. When someone is experiencing an overdose, their breathing is very slow or shallow. Giving naloxone (NARCAN®) to a person experiencing an overdose will work to restore normal breathing.

Xylazine is not an opioid, so naloxone (NARCAN®) will not have a direct effect on the symptoms that xylazine causes. Xylazine can cause drowsiness, slow breathing, decrease blood pressure, and lower heart rate.

When you give naloxone (NARCAN®) to a person that has used an opioid mixed with xylazine, the most important thing to look for is normal breathing. Because the xylazine can cause heavy sedation, the person may remain unconscious, even though the naloxone (NARCAN®) is working on the opioid, and the person is breathing more normally. Because some opioids, like fentanyl, are stronger than others, it may take more than 1 dose of naloxone (NARCAN®) to restore breathing. After you give 1 dose of naloxone, monitor the person for changes in breathing. If breathing has not improved after 3-5 minutes, give a second dose of naloxone (NARCAN®) into the other nostril. Always call 911 so you have backup on the way to help save the person’s life!

The U.S. Drug Enforcement Administration (DEA) has issued a public safety alert about xylazine, and the risk it poses to health and safety. Visit their website now to read more: https://www.dea.gov/alert/dea-reports-widespread-threat-fentanyl-mixed-xylazine

The New York State Department of Health has issued a summary document on xylazine for healthcare providers, titled Xylazine: What Clinicians Need to Know. This document provides information to providers about what xylazine is, current trends, diagnostic testing, presentation and management of xylazine-involved overdoses, and wound care. The document also includes information on how to message basic harm reduction methods with their patients, and relevant resources. Use the following link to access Xylazine: What Clinicians Need to Know:

https://www.health.ny.gov/publications/12044.pdf