Xylazine and Medetomidine in Philadelphia's Drug Supply
Xylazine was involved in 38% of Philadelphia's overdose deaths in 2023, and medetomidine — a newer veterinary sedative 200 times more potent than xylazine — appeared in 87% of Philadelphia drug samples by January 2025 (Philadelphia Department of Public Health and DEA Operation Engage Philadelphia).
What Xylazine Is
Xylazine is a non-opioid veterinary sedative used in livestock medicine and in wildlife immobilization. It is not approved for human use. It first appeared in the Philadelphia drug supply around 2019; by 2021, 100% of tested heroin and fentanyl samples in Philadelphia contained xylazine (Philadelphia Department of Public Health research cited in The Conversation). Its street name is 'tranq.'
Why Dealers Add Xylazine to Fentanyl
Fentanyl's effects last roughly one-third as long as heroin. Xylazine extends the sedative effect, mitigates early withdrawal symptoms, and reduces the amount of fentanyl needed per dose — all of which benefit the economics of the drug supply. The unintended consequence: xylazine causes severe, slow-healing skin wounds that can require surgical debridement or amputation, and xylazine withdrawal adds a non-opioid sedative withdrawal syndrome on top of opioid withdrawal.
What Medetomidine Is
Medetomidine is another veterinary sedative — used primarily in animal surgery as a pre-anesthetic — approximately 200 times more potent than xylazine. It began appearing in the Philadelphia drug supply in 2024. By early 2025, DEA testing found medetomidine in 87% of fentanyl samples seized in Philadelphia. Philadelphia DPH preliminary data found medetomidine in about 15% of fatal overdoses between May 2024 and May 2025. Withdrawal from medetomidine adds intractable vomiting, tremors, sweating, and severe tachycardia to the clinical picture.
Why Standard Detox Protocols Fall Short
Buprenorphine and methadone — the standard opioid detox medications — reverse and treat the opioid component of withdrawal. They do not address non-opioid sedative withdrawal. Callers detoxing in programs not prepared for xylazine and medetomidine report that opioid symptoms resolve on schedule but are followed by days of vomiting, tremors, and autonomic dysregulation. The licensed programs we refer to that understand Philadelphia's supply use gabapentin, clonidine, tizanidine, and other non-opioid agents to manage this second phase.
When you are ready, placement advisors are available 24/7.
Free insurance verification, no obligation. Call (215) 302-0133 to start.
Wound Care During Inpatient Treatment
Xylazine-associated wounds are distinct from typical injection-site infections. They appear as chronic, necrotic ulcers that can occur at injection sites or elsewhere on the body (xylazine wounds have been documented in people who only snort, not inject). Proper wound care during inpatient rehab — debridement, dressing changes, antibiotic coverage when infected — is important both clinically and to help the caller stay in treatment rather than leaving AMA due to untreated discomfort. Philadelphia-area programs have been developing these protocols since 2021.
If Someone Overdoses on a Xylazine-Contaminated Supply
Naloxone (Narcan) reverses the fentanyl component but does not reverse xylazine or medetomidine sedation. If the person breathes again after naloxone but remains unresponsive, the sedative component is still active. Call 911, perform rescue breathing if needed, and keep them on their side to prevent aspiration. Naloxone is free and available 24/7 at 61 Philadelphia fire stations through the city's Naloxone in Black initiative, and by mail from NEXT Distro.
Frequently Asked Questions
Does naloxone work on xylazine?
Can I get rehab if I have xylazine wounds?
Is medetomidine worse than xylazine?
When you are ready, placement advisors are available 24/7.
Free insurance verification, no obligation. Call (215) 302-0133 to start.