‘Emerging Explanation’ Xylazine Use Continues to Widespread in US

The illicit use of the veterinary tranquilizer xylazine («tranq» or «Tranq dope») continues to spread rapidly across the United States, severely escalating the existing opioid crisis. Xylazine, which is increasingly mixed with fentanyl, often renders the opioid overdose reversal medication naloxone ineffective and causes severe necrotic ulcers that can necessitate amputations.

A new report from Millennium Health, a specialized laboratory, has revealed an alarming rise in urine samples testing positive for xylazine collected at medical centers nationwide over the past six months.

The Emerging Threat: Official Recognition and Escalation

Since late 2022, the U.S. Food and Drug Administration (FDA) has issued warnings to doctors regarding the specialized management required for opioid overdoses contaminated with xylazine.

The issue escalated in early 2023, when the White House Office of National Drug Control Policy designated the xylazine-fentanyl mix as an emerging threat to the United States. Despite efforts by both the FDA and the Drug Enforcement Administration (DEA) to halt its illicit sale, xylazine use has continued its expansion.

US West Sees Fastest Growth in «Tranq» Use

The Millennium Health Signals report, which analyzed over 50,000 fentanyl-positive urine drug tests (UDTs) collected between April 2023 and April 2024, showed that the sharpest increase in xylazine consumption is concentrated in the Western United States.

Nationwide, 16% of all urine samples tested positive for xylazine between late 2023 and April 2024, up slightly from 14% recorded in the preceding six months.

Regional Trends: Hotspots and Shifts

While growth is fastest in the West, xylazine use remains highest in the Eastern and Mid-Atlantic United States.

• Persistent High Rates: South Atlantic states (including Florida, Georgia, Maryland, and Virginia) experienced a 17% increase in positivity, climbing from 22% to 26%. Maryland and South Carolina showed about a third of their samples contaminated with xylazine.
• Local Hotspots: The highest state-level UDT rates were observed in Pennsylvania (40%), New York (37%), and Ohio (35%). In specific local areas, such as the Clermont and Hamilton sites in the Cincinnati, Ohio area, nearly 70% of samples tested positive.
• Mid-Atlantic Drop: Contrary to the national trend, Mid-Atlantic states (New York, Pennsylvania, Delaware, and New Jersey) saw their positive rates drop from 44% to 33%. The East North Central states (Ohio, Michigan, Wisconsin, Indiana, and Illinois) also experienced a slight decrease from 32% to 30%.

Critical Warning from Health Experts

Angela Huskey, PharmD, Chief Medical Officer at Millennium Health, stressed the need for widespread medical preparedness.

«Because xylazine exposure remains a major challenge in the East and a growing concern in the West, clinicians across the US need to be prepared to recognize and address the side effects of xylazine use—such as the decreased response to naloxone and severe skin lesions that can lead to amputations—among people who use fentanyl,» stated Dr. Huskey.

This analysis underscores the urgent necessity for adapting overdose treatment protocols and public health strategies to combat the compounding threat posed by this drug, which introduces a devastating array of medical complications.