Xylazine and Drug Mixtures

Since 1999, the United States has experienced an overdose crisis that has claimed the lives of more than 1 million people and caused 107,543 deaths in 2023 alone. Of these, 69.5 percent involved synthetic opioids (not including methadone)— most often illicitly manufactured fentanyl. The first reports of illicit xylazine use, a sedative also known as tranq, occurred in Puerto Rico in the early 2000s and then Philadelphia in 2016. Since then, mixtures of fentanyl and xylazine have become especially common, spreading first through the northeast and mid-Atlantic regions, then across the country. Nationally, the number of drug overdose deaths involving xylazine rose from 102 deaths in 2018 to 3,468 in 2021, a 34-fold increase in just 4 years.

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