Xylazine, often referred to as ‘tranq’ or ‘zombie drug’ has reached all corners of the United States, but it is still concentrated in the Mid-Atlantic and Great Lakes regions, according to a new report.

The drug, a sedative for large animals that is legal in the U.S. for veterinary use, has become a persistent adulterant in heroin. It can slow breathing, heart rate and blood pressure to dangerously low levels and is almost always mixed with fentanyl and injected. Lesions can form at the injection site that, if not treated, can lead to amputation and death.

Among nationwide drug samples, researchers found 16% contained fentanyl and xylazine, but as many as 40% of samples contained xylazine in the Mid-Atlantic region, according to a new study conducted by Millenium Health.

The DEA reported last year that the xylazine is taking the same path through the country that fentanyl did, “beginning with white powder heroin markets in the Northeast before spreading to the South, and then working its way into drug markets westward,” the DEA report said.

Currently, North Carolina, Ohio and Pennsylvania have the highest xylazine positivity rates nationally, with a very high concentration in Philadelphia, where past testing has shown that 90% of opioid samples contain ‘tranq.’  

“Xylazine has devastated our local community. The challenges it has brought are many, because at present there are no treatments specifically approved for xylazine use nor any xylazine-specific overdose reversal agents approved for xylazine-involved overdoses,” Leonard Kamen, D.O., a clinical associate professor of physical medicine and rehabilitation at Sidney Kimmel Medical College, Thomas Jefferson University Hospital in Philadelphia said in a press release. 

People on a street in the Kensington neighborhood of Philadelphia in January 2018.
People on a street in the Kensington neighborhood of Philadelphia in January 2018.Spencer Platt/Getty Images

Although xylazine is not an opioid and so does not respond to naloxone, experts still recommend it to treat an overdose. Naloxone, also known as Narcan, is now available over-the-counter nationwide for about $45. 

“This is a substance no human being was meant to ingest and often people may be exposed to it without their knowledge, which increases the risk. Though the effects of xylazine cannot be reversed using naloxone, xylazine often is used alongside opioids, which naloxone can reverse, so it should be administered in a suspected overdose,” Chief Clinical Officer Dr. Angela G. Huskey at Millennium Health said in a press release.

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