Donate Image

Your Donations Count Donate Graphicat the Westside Observer!

Xylazine response team
Graphic Courtesy of

Tranq – the Next Drug Scourge

Fentanyl has a new rival

Help Save 120 Beds at Laguna Honda Hospital

Laguna Honda Puzzle

Please Sign My Petition

Given our severe shortage of Skilled Nursing beds, DPH claimed it would do “everything it can” to save LHH’s 120 beds. But it hasn’t submitted a written waiver request yet!

Please share this petition widely with your contacts, I’d really appreciate your help.

••••••• April 6, 2023 •••••••

Major East Coast cities are ravaged by “Tranq” or “Zombie Dope.” Tranq refers to a combo of fentanyl plus xylazine - an animal sedative and pain reliever commonly used to calm horses and cattle before veterinary procedures. Although not approved for humans, xylazine is being mixed into fentanyl, heroin and other street drugs, resulting in a zombie-like daze, intractable overdoses, and rotting ulcerations of the skin and soft tissues. Xylazine was detected in 34% of all overdose deaths in Philadelphia in 2021. And it’s spreading. According to the Drug Enforcement Administration (DEA), “Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier.".

Data compiled by the DEA shows a galloping step up in xylazine’s infiltration of street drugs;

Xylazine By Region




% Increase

















Source: DEA

While Western states are relatively spared, identification of xylazine in confiscated drug samples doubled from 2020 to 2021. That’s an undercount because testing for xylazine is not a routine procedure in most jurisdictions. Just as fentanyl adulteration of the East Coast drug supply took a few years to migrate out West, it’s likely that xylazine will eventually assail San Francisco. Xylazine has recently been detected in overdose cases and drug seizures in Los Angeles, San Diego, and San Francisco.

Zylazine by the Barrell
Some states restrict the use of Zylazine

Xylazine is just one of dozens of synthetic drugs infiltrating North American fentanyl and heroin supplies. For example, in British Columbia, Canada, 52% of overdose deaths showed traces of etizolam, a benzodiazepine similar to Valium. Like “Tranq," this “Benzo-dope” is causing more fatal overdoses, zombie-like intoxication, and complex addictions that are harder to treat than simple fentanyl dependency.

Government Warnings

Tranq contamination of the drug supply has surged so strikingly that the Food and Drug Administration issued a warning to Health Departments and physicians in November, 2022. Notably, Xylazine’s “toxidrome may appear similar to that of opioids, making it difficult to distinguish between toxicity from opioids versus xylazine. Of note, naloxone is not known to be effective in reversing overdoses involving xylazine, as xylazine is not an opioid.” In other words, Narcan - the agent that is used to treat heroin and fentanyl overdoses - doesn’t reverse the effects of xylazine.

Moreover, “Repeated exposure may also result in dependence and withdrawal. Withdrawal symptoms such as agitation or severe anxiety may occur when usual doses of the drug are decreased or discontinued.” Since xylazine is not an opioid, drugs like methadone and Suboxone aren’t helpful in treating withdrawal symptoms or managing detoxification.

Alarmingly, “Repeated exposure to xylazine, by injection, has been associated with severe, necrotic skin ulcerations that are distinctly different from other soft-tissue infections (e.g., cellulitis, abscesses) often associated with injection drug use. These ulcerations may develop in areas of the body away from the site of injection.” Some of these ulcers worsen quickly, become life-threatening and require amputations.

Xylazine in San Francisco

The City’s Department of Public Health (DPH) and the Office of the Chief Medical Examiner (OCME) launched an investigation, outlined in a 2/16/23 “Xylazine Media Statement.” Of note, “Testing overdose decedents who died between mid-December 2022 and mid-January 2023, the OCME found, so far, that four individuals who had died of drug overdoses had low levels of xylazine in their systems.”

Unfortunately, the DPH Media Statement failed to disclose the denominator, i.e., how many overdose cases were sampled before reaching four positive xylazine cases. The Westside Observer contacted David Serrano Sewell, Executive Director of the OCME. Turns out, 4 of 145 cases (2.8%) were initially positive for xylazine. The OCME obtained a State grant to retest overdose deaths from 2022 and implement a xylazine surveillance program for 2023 and beyond. So far, 410 fatal overdose cases have been tested, and 7 or 1.7% showed xylazine.

Meanwhile, overdoses appear to be rising. For January and February of this year, the City saw 131 fatal overdoses. At that rate, we’re heading for 700-plus drug-related deaths. For the record, there were 725 overdose deaths in 2020, declining to 640 in 2021, and 647 in 2022. Around 72% of these deaths were attributed to fentanyl. If xylazine gains a foothold in the City, fatalities and injuries will climb.

Interestingly, the Medical Examiner's reports on overdose deaths do not include testing for benzodiazepines like etizolam - the "Benzo-dope" that infests Vancouver's drug scene. The Westside Observer asked the OCME about this apparent omission but received no reply.

So, xylazine is here, albeit not widespread. This February, DPH officials told the SF Chronicle that SF is relatively xylazine-free. The characteristically grotesque soft-tissue ulcerations haven’t yet been reported here. However, the SF AIDS Foundation has proactively published an informative handout for those who may use xylazine, or encounter xylazine users.

Why Xylazine?

Necrosis in Zylazene users
Necrosis in zylazine user

What makes a horse tranquilizer desirable as a cutting agent for fentanyl? Drug users say that xylazine extends the intoxicating effects of fentanyl. Some like the “knock-out” effect that induces amnesia and a nap. Eventually, they keep using just to avoid getting sick.

But drug dealers usually “cut” their products to increase profits. According to a 2022 DEA report, “A kilogram of xylazine powder can be purchased online from Chinese suppliers with common prices ranging from $6-$20 US dollars per kilogram.” Compare that to $36,000 for a kilo of fentanyl. Ergo, diluting fentanyl with xylazine saves big bucks. What’s more, xylazine is not a controlled substance, so there’s less risk of law enforcement entanglements.

Police interdictions can create difficulties in acquiring fentanyl supplies. Under US pressure, China banned the unauthorized manufacture of fentanyl products in 2019. Whatever shortages followed were transient. Resilient traffickers simply find alternate sources - or cheaper substitutes with similar effects. Unfortunately for drug users, Tranq is worse than fentanyl, just as fentanyl is worse than heroin, and heroin is worse than Oxycontin.

As the Westside Observer previously reported, drug prohibitions tend to generate more potent and toxic substitutes. This dynamic spawns demand for “safe consumption sites," aka "overdose prevention sites" and now, “Wellness Hubs.” Such harm-reduction measures trigger concerns that San Francisco is enabling drug use - unless tied to robust recovery services. The City’s 2022 Overdose Prevention Plan seeks to enhance drug treatment services.


For now, the US Department of Justice is working to tightly regulate the importation and distribution of xylazine. The FDA recently issued an Import Alert authorizing the seizure of xylazine products until their legitimate purpose can be verified. Several states have declared xylazine a dangerous drug and have restricted its use. Congress is working on the Combating Illicit Xylazine Act to declare xylazine an emerging drug threat, restrict it at the federal level, and enable the DEA to track its manufacture and distribution.

Reflecting the ever-worsening scope of the drug crisis, xylazine test strips are now available for drug users, health departments and harm-reduction organizations.

Unfortunately, plenty of analogous adulterants are waiting in the wings. Also looming are thousands of distressed persons who will self-medicate with whatever the drug market provides.

Dr. Derek Kerr is a San Francisco investigative reporter for the Westside Observer and a member of SPJ-NorCal. Contact:

April 6, 2023

Have Your Say

More Trending Articles

Wolf in sheep's clothing

Sowing Discord

by Julie Pitta

Big money ‘neighborhood’ groups step up their campaign of take-over tactics in 2024 elections.

Check it out

Popular bay view

Say NO to expanding yacht harbors for the wealthy

by Evelyn Graham

Rec and Park’s plan expands access for the privileged few bupkis for the rest of us.

Check it out

New proposed site

New proposed location for Ocean View Library is ideal

by Glenn Rogers

Few were surprised when Supervisor Safai learned the library was not to be built in the Greenbelt — he feared the worst. No library at all.Since 2023, the Library Commission has been considering 466 Randolph Street, where the I.T. Bookman Community Center and the Pilgrim Community Church are located.

Check it out

SF from Alameda Point

San Francisco. In Alameda? Wait, what?

by David Osgood

When the runways for the Alameda Naval Air Station were extended out into the bay—using dredged bay fill, the same way Treasure Island was created — they crossed over the city line. The federal government apparently didn't know or care.

Read More ...

Man in Wheelchair

San Franciscans need nursing home care

Will Laguna Honda Admissions Start Soon?

by Dr. Teresa Palmer

The survey attests to a quality of care that is higher than in for-profit private nursing homes. But there are ongoing problems.

Read More


parking tickets for RVs on Winston

RV residents on Winston Drive face uncertain future

by Thomas K. Pendergast

A four-hour parking limit is going to make things even more difficult for RV residents.

Check it out

© 2023 Westside San Francisco Media. No portion of the articles or artwork may be republished without expressed consent. Legal disclaimer.