As clinicians it’s critical that we understand the drugs our patients are using and can identify their side effects, but it can be tough to keep up.
An emerging threat across the country is the use of xylazine, or “tranq.” Xylazine is an animal sedative, muscle relaxant and analgesic with a potent central nervous system depressant effect in humans. This tranquilizer is frequently added to various drug mixtures sold on the street. Tranq can be found across the U.S. – the Drug Enforcement Administration reports finding it in 48/50 states — and last year almost one quarter of the fentanyl the DEA seized contained xylazine.
Tranq Side Effects
The most notorious physical health problem from tranq is skin ulcers. These start with a black eschar, often involve malodorous pus, and may not always be at the site of injection. Other side effects include some that overlap with opioids (stupor, bradypnea, apnea) but also some symptoms that are not seen with opioids, including hypotension, bradycardia, hyperglycemia, and necrotic skin lesions.
It’s easy for people to develop addiction to and dependence on tranq, and withdrawal symptoms include hypertension, anxiety, depressed mood, cravings, and head and body aches.
Treatment for Tranq Effects
Treatment of the effects of tranq can be challenging. Xyalazine does not have a predictable range of toxicity in humans, and is NOT reversible with naloxone (although naloxone should still be given, as opioids are commonly mixed with tranq). Hypotension should be treated with IV fluids, and atropine can be considered for bradycardia.
Tranq ulcers range in severity from ulcers that don’t appear to be infected to severe, deep, necrotizing infections that need hospitalization, IV fluids and potentially surgery.
Providing the best possible care for our patients means we have to keep current with evaluation and management of substance use disorder. We do this by making sure we learn about the substances our patients are using, harm reduction methods, and management of the disorder.
To learn more about OUD and SUD (substance use disorder) and to meet the recent DEA requirement, you can access our new course, OUD Decoded: A DEA-Compliant Audio Course.