Tranq (Xylazine): Withdrawal, Overdose, and Recovery Support

Tranq is the street name for xylazine, a veterinary sedative that has spread through the illicit fentanyl supply. The rate of overdose deaths involving xylazine in 2021 was 35 times higher than in 2018, and between 97 and 99 percent of those death certificates also mentioned fentanyl (CDC National Center for Health Statistics, 2023). Almost nobody sets out to use it. It arrives inside the fentanyl someone was already using and brings its own problems: deeper sedation, wounds that do not heal, a withdrawal opioids do not fix, and an overdose naloxone only partly reverses. Here is what it is, how withdrawal unfolds, and how support at home fits in.

What xylazine is and how it works

Xylazine is a sedative, pain reliever, and muscle relaxant approved by the FDA for animals, mostly large ones like horses and cattle. It has never been approved for people. The FDA's alert to clinicians is direct: "Xylazine is not safe for use in humans and may result in serious and life-threatening side effects" (FDA, November 2022). It is an alpha-2 adrenergic agonist; the DEA describes it as a drug that "acts as an agonist at alpha-2 adrenergic receptors and decreases the release of norepinephrine and dopamine in the central nervous system" (DEA Diversion Control Division). In plain terms it turns down the body's alarm system, which produces the heavy sleep and also drops blood pressure, heart rate, and breathing.

Street names for xylazine and the fentanyl it is mixed into include tranq, tranq dope, sleep-cut, Philly dope, zombie drug, and anestesia de caballo (DEA). It is not a federally controlled substance, although the DEA has pushed for scheduling (DEA). In March 2023 the DEA issued a public safety alert reporting that in 2022 "approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine," with the mixture seized in 48 of 50 states (DEA, March 2023). On April 12, the White House Office of National Drug Control Policy designated fentanyl combined with xylazine an emerging threat to the United States, the first use of that authority since Congress created it in 2018 (ONDCP, April 2023).

How tranq gets into the supply and why people rarely choose it

Xylazine is not a drug people seek out the way they seek out heroin or pills. NIDA puts it plainly: "Illicit xylazine is often mixed in with illicit opioids, most frequently fentanyl" (NIDA). It is cheap, and the DEA reports it is added to fentanyl "to extend the high" (DEA). Fentanyl's effect is short; xylazine's sedation lasts longer, so a bag with both feels like it "holds" better. That is a selling point for whoever cuts the product, and most people who use tranq did not know it was there the first time. Some people, once dependent, come to prefer bags with tranq because its withdrawal is its own misery. But nearly all tranq use is fentanyl use with an unwanted passenger. When we talk with a member about tranq, we are really talking about opioid use disorder plus the harms xylazine adds on top.

Signs tranq is in the picture

Some signs point to xylazine specifically, over and above what fentanyl use looks like. Long stretches of deep, heavy sleep, often slumped upright in public. Wounds on the arms, legs, or hands, including places the person never injected. Overdoses where naloxone brings breathing back but the person stays out cold for hours. A withdrawal that arrives fast and that more fentanyl does not fix. If someone you love uses fentanyl, assume xylazine is in the mix until testing says otherwise. About half of fentanyl-involved deaths with xylazine detected in CDC surveillance were in the Northeast (CDC MMWR, June 2023), but it has been found nearly everywhere.

Why naloxone does not reverse tranq, and why you give it anyway

Naloxone (Narcan) knocks opioids off their receptors. Xylazine is not an opioid, so naloxone does not touch it. The CDC says it in one sentence: "naloxone will not reverse the effects of xylazine" (CDC). It is just as clear that "Naloxone should be given in response to any suspected drug overdose," because fentanyl is almost always there too. After naloxone, a person may breathe again and still be deeply sedated for a long time; the CDC notes that "effects of xylazine may continue after naloxone is given" (CDC). So call 911, give naloxone, then turn the person on their side and give rescue breaths if breathing is slow. Once breathing is back, the job is to keep it going until help arrives, not to wake them with more doses.

Tranq wounds

The FDA describes "severe, necrotic skin ulcerations" with repeated exposure (FDA), and the DEA warns of "severe wounds, including necrosis, the rotting of human tissue, that may lead to amputation" (DEA). They show up in people who smoke or snort, too. NIDA's advice is that wounds should be "kept clean but open (without stitches or skin grafts)" during active use (NIDA), and the CDC's is to seek care because they "may become infected and worsen quickly" (CDC). Shame keeps people from showing these wounds; the most useful thing a family member can say is that you would rather see it than not.

Is stopping tranq dangerous?

Xylazine withdrawal and fentanyl withdrawal are both awful and, by themselves, rarely fatal, unlike alcohol and benzodiazepine withdrawal, which can cause seizures and death. The danger with stopping tranq is more common: the person gets a few days in, cannot stand it, and goes back to a dose their body no longer tolerates. Lost tolerance plus an unpredictable supply is how relapse becomes overdose. NIDA reports early findings that "substance use disorder symptoms and withdrawal symptoms may be more intense for those taking xylazine with fentanyl versus fentanyl alone" (NIDA). Someone with a heavy tranq habit should be in front of a clinician who knows what xylazine withdrawal is, ideally where buprenorphine or methadone can be started at the same time.

Tranq withdrawal timeline

There is no large study of xylazine withdrawal in people yet; this comes from clinical guidance and what our members describe.

First 8 to 24 hours

Penn Medicine's addiction guidance describes early irritability, anxiety, restlessness, and dysphoria, with raised blood pressure, fast heart rate, and sweating arriving within 8 to 24 hours of the last use (Penn CAMP). Opioid withdrawal starts in the same window. The tell that xylazine is involved is that "additional doses of full agonist opioids do not improve symptoms" (Penn CAMP).

Days 2 to 4

This is the peak. Anxiety can be severe, sleep is nearly impossible, and blood pressure and heart rate run high. It is when people walk out of detox, and it is the window we plan for most carefully.

Days 5 to 10

The physical symptoms settle and sleep returns in fragments. If buprenorphine or methadone has been started, the opioid piece is usually under control. Cravings shift from "make it stop" to the ordinary triggers: a text from a contact, money on a Friday.

Weeks 2 and beyond

Mood, energy, and sleep keep improving over weeks; wounds take longer. This is where structure matters more than medicine, because the discomfort is gone and the reasons the person used are still there.

What withdrawal management looks like

Penn Medicine's protocol uses scheduled clonidine as first-line treatment, titrated to effect, with intravenous dexmedetomidine reserved for intensive care, plus gabapentin for pain and phenobarbital only for severe agitation in an emergency setting (Penn CAMP). Protocols vary, so ask the hospital or detox whether they have one, and if you get a blank look, ask for clonidine by name and an addiction medicine consult.

The bigger decision is the opioid use disorder underneath, because that is what is still there when the xylazine withdrawal ends. The same Penn guidance calls for starting buprenorphine or methadone alongside the xylazine treatment (Penn CAMP). NIDA reports that patients on methadone had 33 percent fewer opioid-positive drug tests and were 4.44 times more likely to stay in treatment than controls, and that patients on 16 mg or more of buprenorphine per day were 1.82 times more likely to stay in treatment than those on placebo (NIDA). Leaving detox without a buprenorphine or methadone plan means being treated for the smaller problem and sent home with the larger one.

Tranq with alcohol, benzodiazepines, and other sedatives

Everything xylazine does, alcohol and benzodiazepines also do: slow breathing, lower blood pressure, and the fentanyl underneath does the same. Stacking them is how a survivable dose becomes a fatal one; many tranq overdoses involve someone who "just had a few drinks" or "took a Xanax to come down." Counterfeit pills add to the risk: DEA testing finds that 5 out of every 10 fentanyl-laced fake pills contain a potentially lethal dose (DEA, One Pill Can Kill). Some now contain xylazine too (DEA). If a member drinks or uses benzodiazepines on top of fentanyl, that is the first thing we address.

Drug testing for xylazine

Standard drug panels do not look for xylazine; the FDA notes that specialized testing is required (FDA), and SAMHSA's letter to clinicians says the same: "Routine toxicology tests do not test for xylazine. It may therefore be under-detected" (SAMHSA). In a study of emergency patients positive for both fentanyl and xylazine, the median half-life of xylazine in blood was about 12 hours, with a range of roughly 6 to 21 hours in most patients (Lin et al., Clinical Chemistry, 2025), so it clears within a few days of the last use. Fentanyl is what standard panels and our own screening pick up, and since xylazine rarely travels alone, that is the more useful signal. Xylazine test strips check the drug rather than the person; the CDC notes that "There are commercially available test strips to test for the presence of xylazine in a sample of drugs" (CDC). For someone not yet ready to stop, knowing what is in the bag is a real safety step.

Our members use saliva-based screening that is assigned at random through the week. You do not choose whether you test; you choose who sees the results. For a member coming off tranq, that usually means the prescriber managing buprenorphine or methadone and, if you want, a parent or partner. Those medications show up on a screen as expected; what matters is whether the result matches the plan. We explain the details in our guide to how sobriety monitoring works.

How recovery from tranq works with Accountable

We are not a detox, a wound clinic, or a prescriber. What we provide is ongoing support after or alongside that care, at home and for as long as you need it. It usually runs in three stages.

1. Get the full picture

In the first sessions your coach maps what is actually going on: whether you are on buprenorphine or methadone and whether the dose is holding, who is treating the wounds, and whether alcohol or benzodiazepines are part of the day. If there is no prescriber yet, we help you find one, and with your permission we coordinate with the program and your family so everyone works from the same plan. Naloxone in the house is not optional, and we make sure the people around you know how to use it.

2. Build a plan that fits your life

Your coach helps you plan around the real calendar: the wound care appointments that are easy to skip, the pharmacy trip for buprenorphine, the block you have to walk past, what you will do at 3 a.m. when your skin is crawling and the old number is still in your phone. Daily peer group meetings and a weekly family Zoom group give you and your family your own places to get support. Our guide on how to help someone with addiction is a good place for them to start.

3. Weekly check-ins through the long stretch

Recovery from fentanyl and tranq is measured in months and years, not the two weeks it takes withdrawal to fade. Your coach shows up every week, and the saliva screening turns "I think he's doing okay" into a shared record that you control. When a slip happens, we treat it as information. The plan changes and the support goes up. Every coach at Accountable has their own recovery behind them, and many came through opioids themselves.

Accountable is covered by a growing list of commercial health plans, with more added each month, and private-pay plans start at $375 per month. You can check your coverage in a few minutes or call the care team at (646) 450-7641. Families are welcome to make the first call; see our page for families.

Common questions

What is the difference between xylazine and fentanyl?

Fentanyl is a synthetic opioid; xylazine is a non-opioid veterinary sedative. Both slow breathing, but through different receptors. Naloxone reverses fentanyl and does nothing for xylazine (CDC). In the illicit supply they almost always come together, with xylazine added to make fentanyl's short effect last longer.

Is xylazine physically addictive?

People who use it regularly develop dependence and go through a distinct withdrawal that opioids do not relieve, with agitation, anxiety, and high blood pressure in the first day (Penn CAMP). Whether xylazine alone produces addiction in the clinical sense is still being studied, but in practice it is nearly always tied to fentanyl use disorder, which certainly does.

Why doesn't Narcan work on xylazine?

Narcan blocks opioid receptors. Xylazine acts on alpha-2 adrenergic receptors, so there is nothing for Narcan to block. Give it anyway, because fentanyl is almost always in the mix, then call 911 and support breathing until help arrives (CDC).

What do xylazine wounds look like, and what should I do?

They usually start as small dark or blistered patches, often on the arms or legs, and open into deep ulcers with dead tissue, sometimes far from any injection site. Keep them clean and covered, do not try to cut anything away at home, and get to a wound care clinic or emergency department. The CDC warns they "may become infected and worsen quickly" (CDC).

How long does xylazine stay in your system?

In emergency patients, the median half-life in blood was about 12 hours (Lin et al., 2025), so it clears within a few days. Standard drug tests do not look for it; a lab has to run a specific xylazine test (SAMHSA).

Sources

• Centers for Disease Control and Prevention, National Center for Health Statistics. New Analysis Looks at Drug Overdose Deaths Involving Xylazine. NCHS Blog, June 2023.

• Centers for Disease Control and Prevention. What You Should Know About Xylazine. Overdose Prevention.

• Kariisa M, et al. Illicitly Manufactured Fentanyl-Involved Overdose Deaths with Detected Xylazine, United States, January 2019-June 2022. MMWR. 2023;72(26).

• U.S. Food and Drug Administration. FDA alerts health care professionals of risks to patients exposed to xylazine in illicit drugs. November 8, 2022.

• Drug Enforcement Administration. DEA Reports Widespread Threat of Fentanyl Mixed with Xylazine. Public safety alert, March 20, 2023.

• Drug Enforcement Administration. Xylazine Information.

• Drug Enforcement Administration, Diversion Control Division. Xylazine drug and chemical evaluation fact sheet.

• Drug Enforcement Administration. One Pill Can Kill, Get Smart About Drugs.

• White House Office of National Drug Control Policy. Biden-Harris Administration Designates Fentanyl Combined with Xylazine as an Emerging Threat to the United States. April 12, 2023.

• National Institute on Drug Abuse. Xylazine. Research topic.

• National Institute on Drug Abuse. Medications to Treat Opioid Use Disorder: Efficacy of Medications for Opioid Use Disorder. Research report.

• Substance Abuse and Mental Health Services Administration. Dear Colleague letter on xylazine. 2023.

• Penn Medicine Center for Addiction Medicine and Policy. Best Practices for Management of Xylazine Withdrawal and Overdose. 2023.

• Lin Y, Farnsworth CW, Azimi V, Liss DB, Mullins ME, Crews BO. Xylazine Pharmacokinetics in Patients Testing Positive for Fentanyl and Xylazine. Clinical Chemistry. 2025;71(2):266-273.