Xylazine ('Tranq') Treatment in New York City
Xylazine — a veterinary sedative commonly called 'tranq' — was present in 21% of New York City's 2,192 overdose deaths in 2024. It is increasingly mixed into fentanyl, heroin, and cocaine supplies. Because xylazine is not an opioid, naloxone (Narcan) does not reverse xylazine-related sedation — fundamentally changing the approach to overdose response and medical detox. Source: NYC Special Narcotics Prosecutor.
What is xylazine?
Xylazine is a central nervous system depressant used in veterinary medicine as a sedative and analgesic. It was never approved for human use. Drug traffickers began mixing it into illicit opioid supplies to extend the duration and intensity of the high, reduce production costs, and increase addictiveness. It has spread from Philadelphia — where it was first widely reported — to New York City, where it is now present in a significant portion of the street drug supply.
Why doesn't Narcan work on xylazine?
Naloxone (Narcan) is an opioid receptor antagonist — it works by binding to opioid receptors and displacing opioids. Xylazine acts on alpha-2 adrenergic receptors, not opioid receptors, so naloxone has no effect on the xylazine component of an overdose. When someone overdoses on a fentanyl-xylazine mixture, naloxone can reverse the opioid-related respiratory depression but cannot reverse the xylazine sedation. The person may briefly regain responsiveness and then lose consciousness again. This is not a naloxone failure — xylazine simply requires a different intervention: calling 911.
What are xylazine skin wounds?
Xylazine causes severe, recurring skin wounds at and near injection sites — even at sites not directly injected. The wounds appear as darkened, necrotic ulcers that are slow to heal, prone to secondary infection, and can progress to deep tissue damage requiring amputation if untreated. They appear to be caused by xylazine's vasoconstrictive properties (reducing blood flow to tissue) and local tissue toxicity. Wound care must be part of any treatment plan for patients with xylazine exposure.
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How is xylazine dependence treated?
There is no FDA-approved medication specifically for xylazine withdrawal or dependence. Treatment focuses on the opioid component of dependence (buprenorphine or methadone for the fentanyl) while managing xylazine withdrawal symptoms supportively. Xylazine withdrawal symptoms include agitation, tremor, anxiety, and elevated blood pressure — typically managed with comfort medications in a supervised inpatient setting. Wound care is integrated into the inpatient program when skin ulcers are present.
Where can I get xylazine wound care in NYC?
NYC's overdose prevention centers (OnPoint NYC at 360 W. 125th St in Harlem and 126 E. 174th St in the Bronx) provide harm reduction services including wound care. NYC Health + Hospitals emergency departments are equipped to treat xylazine wounds. Inpatient treatment programs with xylazine-aware clinical protocols provide integrated wound care alongside addiction treatment — call us to identify programs with this specific capability.