Deadly Rise of Xylazine (Tranq): Wounds, Necrosis, Help

Xylazine is a sedative approved only for animals, and it is now part of the fentanyl supply in Philadelphia and Maryland. Between April 2024 and June 2025, Maryland’s drug-checking program found xylazine in 35.9% of tested samples from Howard County and 34.1% from Cecil County.

Many people who buy fentanyl have no way to know xylazine is in it. They find out through sedation that naloxone can’t fully reverse, wounds that won’t heal, or withdrawal harder than they expected.

What Is Tranq?

Tranq is the street name for xylazine, a sedative, pain reliever, and central nervous system depressant. The Food and Drug Administration (FDA) approved it for veterinary use only, and it has never been approved for people. Xylazine is not an opioid. Sellers often mix it into fentanyl, so people usually encounter the tranq drug inside an opioid they bought.

In the body, xylazine slows breathing, heart rate, and blood pressure, sometimes to dangerously low levels. Heavy sedation can stop a person’s breathing altogether.

Xylazine Is Still in the Mid-Atlantic Drug Supply

Xylazine has turned up less often in Maryland drug samples since 2024, but it has not disappeared. In spring 2025, the state found it in 8.47% of samples statewide, with far higher rates in some counties. A newer animal sedative, medetomidine, now appears about as often as xylazine statewide and has overtaken it in several counties.

Drug-checking programs only test samples that people choose to share, so these figures show direction more than precise totals. The direction tells families what to watch for. Medetomidine does not cause xylazine-type wounds, but it carries a severe withdrawal of its own.

Tranq Wounds and Xylazine Necrosis

Repeated xylazine use can cause painful skin and muscle wounds that resist healing. These tranq wounds can appear even when a person smokes or snorts the drug instead of injecting it, so they are not limited to injection sites.

Early wounds tend to look like small purple or red bruises, blisters, or birthmark-like patches. Left untreated, they can open into dark wounds filled with dead tissue. That tissue death is xylazine necrosis, and in severe cases it can lead to amputation.

No medical association has issued treatment guidelines for these wounds yet. Until that changes, people with tranq wounds need a provider who can watch the wound over time and treat infection early.

When a Wound Needs Medical Care

Keep any wound clean, and get medical care promptly if it:

• Grows larger or deeper over several days
• Turns dark, black, or crusted
• Spreads redness or warmth into the surrounding skin
• Smells bad or drains pus
• Comes with fever, chills, or a racing heart

If you see wounds like these on someone you love, start with the wound. An offer to drive them to urgent care keeps the conversation on their health. It can open a door that an argument about drug use would close.

Xylazine Complicates Overdose and Withdrawal

Researchers have not settled whether xylazine raises the chance of a fatal overdose when it is mixed with fentanyl. It does change how an overdose looks and how to respond. Naloxone reverses fentanyl but not xylazine, so a person may stay sedated or breathe poorly after a dose. Give naloxone anyway, because opioids are usually present.

Philadelphia health officials advise focusing on breathing rather than on waking the person up. Check whether the person is breathing, give naloxone, and call 911. If breathing is slow or uneven, give rescue breaths, about one every five seconds. Once breathing steadies, roll the person into the recovery position and stay with them until help arrives.

What Does Withdrawal From Tranq Feel Like?

Early research suggests withdrawal may hit harder for people who use xylazine with fentanyl, though the science is still young.

Medetomidine raises the stakes. Its withdrawal can begin sooner than fentanyl withdrawal and bring dangerously high blood pressure, a racing heart, tremors, vomiting, and confusion. A CDC review of 165 Philadelphia patients, cited in a Maryland health advisory, found that 91% were admitted to intensive care.

People rarely know which sedative is in their supply, so stopping at home carries real risk. Medically supervised opioid detox lets staff track vital signs and treat symptoms as they appear.

How Treatment for Xylazine Addiction Works

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has no diagnosis specific to xylazine addiction. Treatment focuses on the fentanyl use that brings xylazine into a person’s life, plus the withdrawal and wound care that come with it.

After detox, medication for opioid use disorder, such as buprenorphine or methadone, reduces cravings and helps prevent relapse. Therapy gives the person tools to rebuild daily routines without substances. Xylazine rarely arrives alone, so polysubstance use treatment fits this situation better than a program built around a single drug. Ashley’s fentanyl addiction treatment brings these pieces together.

Relatives can find support of their own through Ashley’s family services. If someone is in emotional crisis or thinking about suicide, call or text 988, the Suicide & Crisis Lifeline. If someone has overdosed, call 911.

If you or someone you love uses fentanyl that may contain xylazine, Ashley can help you plan the next step. Our main campus in Havre de Grace provides medically supervised detox and inpatient care, and our Bel Air location continues care through outpatient treatment. Call 1-800-799-HOPE (4673) seven days a week, or verify your insurance before you call.