The misuse of animal tranquilizers by drug users can exacerbate the ongoing drug epidemic.
Governor Mike DeWine signed an executive order on March 29 classifying xylazine, also known by its street name Trunk, as a Schedule III controlled substance. Ohio is one of the first states in the country to do so. Currently, no federal classification exists.
Xylazine is a central nervous system depressant used in veterinary medicine as an analgesic, anesthetic, and muscle relaxant. The substance, which is not approved for human consumption, is increasingly being found in Ohio’s illegal drug supply, often mixed with heroin, fentanyl, or newer synthetic opioids.
DeWine signed the order directing the State Board of Pharmacy to classify xylazine as Schedule III. The new classification means it is an illegal substance, although vets will be able to obtain it for their practice.
“This potentially deadly drug has serious side effects that cannot be reversed by naloxone, so there is no way to reverse it in people,” DeWine said. “The rate of overdose deaths involving combinations of xylazine and other drugs is increasing at an alarming rate, which is exactly why we need to take action now.”
According to the Ohio Department of Health, overdose deaths involving xylazine have increased every year in Ohio since 2019, with 15 deaths in 2019, 45 in 2020, and 75 in 2024. Percentage of doses Fatal overdose included xylazine in 2024. The drug did not appear in any toxicology reports in Trumbull County after fatal overdoses last year.
to the valley
The first documented cases of xylazine abuse were in Puerto Rico just after 2000, said Dr. John Surborough, chief physician for addiction medicine services at Mercy Health Youngstown/Warren. And in the past six months, he said, he’s learned more about the drug because it has become more apparent that it’s making its way into the Mahoning Valley.
Now, Surborough said xylazine has been found in about 35 states and Washington, D.C. He said studies show it is present in about 10 to 20 percent of street drugs, while one study in Philadelphia showed it is present in about 90 percent of the drug supply.
The fatal overdoses in which xylazine has been found all occurred in the second half of last year, said Brenda Heidinger, associate director of the Mahoning County Mental Health and Recovery Board.
New drugs usually start in large coastal cities, Heidinger and Sorboro said, and then work their way to smaller areas inland.
“Right now, we’re learning from our peers on the coasts and preparing for what might come our way,” Heidinger said.
Capt. Michael Iannucci, commander of the TAG Drug Task Force, said he is not aware of any cases in which TAG has handled xylazine.
“So far, we don’t think we’ve come across xylazine yet, but the state labs (Ohio Bureau of Criminal Investigation) take about six months to return the results to us,” Iannucci said.
He said he does not ask his officers to test any substance, because the risk is too high. Very few labs have the ability to test for xylazine because it is so new on the street. There are no test strips, as there are for fentanyl – another drug that is often mixed with other drugs.
The danger with any street drugs, including xylazine, Iannucci said, is that dealers mix the drugs, so people often get something different from what they think. He also noted that even if a person knows the combination of drugs, they cannot know how much of each is in their supply.
Surborough said dealers will mix in things they think will create a better level, but he hasn’t encountered any patients in his work looking for xylazine. He said this was likely due to the dangerous effects of drug use.
Xylazine has been found to cause skin lesions at the injection site, or around the nose and mouth if inhaled. These wounds can grow large with pus, decaying tissue, and bacterial infections. DeWine’s executive order states that this can lead to amputations at higher rates than those who inject other drugs.
Naloxone, commonly referred to by the brand name Narcan, helps reverse the effects of an overdose by binding to opiate receptors. Xylazine is not an opioid, so naloxone does not have the same effect.
Naloxone seems to help with breathing, but xylazine is a tranquilizer, Heidinger said, so it relaxes a person so much that they don’t really wake up. Surborough said those who overdosed when xylazine was involved experienced prolonged sedation and slow heart rates.
“It’s critical for people to call 911 after an overdose if xylazine is involved, even after using Narcan,” Heidinger said.
Last year, Trumbull County experienced 125 fatal overdoses and 633 non-fatal overdoses, while Mahoning County had 152 fatal overdoses and 747 non-fatal overdoses. The number of non-fatal overdoses is likely much higher, Heidinger said, because although people are supposed to go to the hospital after giving Narcan at home, they don’t always do so.
The number of non-fatal overdoses reported includes only those who overdosed, received Narcan and were then hospitalized. It does not include those who do not go to hospital or those who refuse to be transported by ambulance if one has already arrived.
Heidinger said that while in the Mahoning Valley drug users may not be looking for xylazine, in other parts of the country they are. She said she has done training with her peers in New Jersey and that they see people seeking xylazine for regular use.
Heidinger and Sorboro said it’s too early to know exactly how the drug is making its way to the Mahoning Valley, though its use for the animal community means it’s not difficult to get online or through vets. Heidinger said the new designation means vets are likely to be subject to more regulations.
It is comparable, she said, to when prescription opioid misuse and overdoses began to rise. Doctors had to go through more regulations to be able to prescribe it.
Surborough said that while it’s good that the new classification brings attention to xylazine, he’s not confident it will prevent the sedative from making its way into a street drug. It’s often mixed with other illegal drugs, such as fentanyl, he noted, so this new designation won’t deter people — just as it doesn’t stop them from using other street drugs.
“Because the drug is not intended for use in humans and makes its way into the drug supply via veterinary sources, it makes it difficult to trace,” Surborough said. “The professionals didn’t look for it.”
He said drug suppliers are always one step ahead of testing, so one drawback is that few labs have the capacity to test xylazine. Surborough said new technologies and testing methods will have to be created to catch up.
“I think it’s important for people to have the information and understand the risks of this drug,” Surborough said.
Surborough said those administering naloxone should know its effect on xylazine. Nothing seems to have the same effect on xylazine as naloxone on opioids. This, he said, makes it even more important that it not be used alone or without the presence of naloxone combinations.