A team led by Olivia Sugarman PhD MPH is studying how people who use drugs, and healthcare providers interpret and share information, about a rapidly changing drug supply. The research includes the veterinary sedative xylazine.
The Johns Hopkins Bloomberg School of Public Health’s Center for Mental Health and Addiction Policy highlighted the work this month. The research sounds academic until you apply it to a treatment setting. A patient may arrive and report that the drug supply has changed. The clinic may still use protocols that were designed for the previous supply.
How Xylazine Changed the Crisis
Xylazine is a sedative approved only for veterinary use which began appearing in the US illicit opioid supply in the late 2010s. It first appeared in Puerto Rican networks, and later spread through the Philadelphia fentanyl market.
By March 2023 researchers had detected xylazine in drug seizures across 48 states and drug poisoning deaths involving xylazine also rose more than twelvefold between 2018 and 2021.
Its effects changed the clinical picture in several important ways:
- Xylazine can cause deep sedation and slowed breathing. These effects can mimic or worsen an opioid overdose.
- It can cause severe skin wounds and ulcers that are not limited to injection sites. These wounds helped give the adulterated supply the name “tranq dope.”
- Naloxone does not reverse xylazine because xylazine is not an opioid. Naloxone remains essential, because fentanyl often appears alongside xylazine.
- Heavy and prolonged xylazine use can cause its own difficult withdrawal syndrome. People may experience this withdrawal alongside opioid withdrawal.
Why Treatment Systems Struggle to Keep Up
Sugarman’s research focuses on the connection between what people who use drugs know and what healthcare systems do. People who use drugs often notice changes in the supply first.
They learn about those changes through personal experience and community networks. Providers may see the same changes later. They may notice them through overdose cases or lab results.
The way these two sources of information connect can affect how quickly treatment systems respond.
The pandemic era showed the cost of slow information sharing. Xylazine spread for years before surveillance systems caught up. Wound care protocols and withdrawal management also took time to adapt.
The drug supply has already changed again. Medetomidine and other sedatives have started appearing in the supply.
What This Means for People Seeking Treatment
The research offers a practical point for people comparing rehab centers and treatment options. In 2026 a thorough admission assessment should address issues that received less attention five years ago.
Ask what substances may be present in the local drug supply. Ask whether the program knows how to manage xylazine related wounds. Ask whether the medical team can manage withdrawal from other sedatives alongside opioid withdrawal.
You can also ask whether you can speak honestly about your drug use without risking discharge, because those answers can tell you how a program handles the current drug supply.
Finding Treatment for Fentanyl and Adulterated Drugs
If you or someone you love uses fentanyl or adulterated street drugs you can take several steps:
Ask treatment programs how they manage xylazine and other sedatives found in the drug supply.
Verify insurance coverage. Check whether the plan covers wound care and treatment for co occurring mental health conditions.
Keep naloxone available. Call 911 if you suspect an overdose.
Rehab.com’s directory includes verified treatment centers nationwide. Call
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to speak with a treatment advisor about programs that understand today’s changing drug supply.
