Xylazine and Medetomidine: What Tranq Does, Wounds, and Withdrawal

What are xylazine and medetomidine?

They are animal sedatives, not opioids, and both are now mixed into the fentanyl sold in New Jersey. Xylazine is the one people call “tranq” or “tranq dope.” Medetomidine is newer and stronger; street names include “rhino tranq,” “mede,” and “dex.” Neither is approved for use in people.

Sedation is what both drugs are for, so it is the part everyone expects. What should change your decisions is the harm that comes after, and it differs by drug: xylazine leaves wounds, and medetomidine leaves a withdrawal that can land someone in intensive care.

Sources for the table: the CDC on xylazine, the CDC’s April 2026 medetomidine advisory, the New Jersey State Commission of Investigation, and an April 2026 Department of Health alert. The Commission puts medetomidine at 100 to 300 times as potent as xylazine; the Department of Health alert says 100 to 200.

How common is tranq in New Jersey?

Common enough that anyone using fentanyl in New Jersey should assume it may be there. A New Jersey Department of Health alert found xylazine in one-third of suspected heroin and fentanyl seizures in 2022 and 45 percent in the first quarter of 2023, and 99 percent of seizures with xylazine also contained fentanyl. The state’s Commission of Investigation reported in December 2025 that xylazine showed up in 3 percent of lab submissions in 2019 and 57 percent in 2024, and that deaths in New Jersey with xylazine on the toxicology report rose from 19 in 2019 to 210 in 2022.

Medetomidine moved faster. The same report says it was not seen in New Jersey seizures before 2024; from January 2024 to May 2025, state forensic labs found it in 910 cases of suspected heroin, every one of them a mix with heroin, fentanyl, or xylazine. In April 2026 the Department of Health confirmed an increasing presence of medetomidine in the state’s illicit opioid supply, and in July 2026 the New Jersey Poison Information and Education System warned hospitals across the state about patients in severe medetomidine withdrawal.

Nobody can see either drug in a bag. A powder sold as heroin or fentanyl may carry one, both, or neither.

Xylazine wounds

Xylazine wounds are the reason most people have heard of tranq. A 2025 multidisciplinary guidance in Open Forum Infectious Diseases describes how they usually run: small blisters or bruises that merge, harden into a dry, dark crust (eschar), and open into wounds that can grow large. Tendon or bone can end up exposed and infected, and severe cases have led to amputation.

The location catches people off guard. The wounds are mostly on the arms and legs, but they are not always tied to injecting, and the same guidance reports them on the chest and scalp. The Department of Health alert makes the same point: they are not always near the injection site. A wound on someone who smokes or snorts can still be a xylazine wound.

When a wound needs a clinician

The CDC says these wounds can become infected and worsen quickly, and that untreated they can lead to amputation or become life threatening. Get it seen promptly if it:

• Is getting bigger, or the redness around it is spreading fast
• Has pus, feels hot or hard, or hurts more each day
• Is turning black, or shows tendon or bone
• Comes with a fever or chills; that is a same-day visit, and an emergency room or 911 if the person is also confused, breathing fast, has a racing heart, or is in extreme pain

The CDC lists those as possible signs of sepsis, a life-threatening emergency.

Most of those signs come from the 2025 guidance, which counts pus, warmth, hardness, worsening pain, a wound that is breaking down or growing, and fast-spreading redness as signs of infection.

Basic wound care until then

The 2025 guidance lists simple steps that also fit home care:

• Wash the wound with clean water, saline, or mild soap.
• Skip hydrogen peroxide and rubbing alcohol.
• Cover it with a non-stick dressing and keep the wound bed moist; a barrier ointment such as petroleum jelly on the gauze helps.
• Secure the dressing without wrapping it tight.
• Do not cut or scrape at the dead tissue. The guidance tells even clinicians to avoid aggressive debridement, because it can make the wound bigger.

New Jersey’s harm reduction centers list wound care among their services, along with naloxone and sterile supplies, at fixed and mobile sites. These wounds are often slow to heal. The guidance notes that injecting in or near a wound can keep it from healing.

Does naloxone work on tranq?

No, and give it anyway. Naloxone reverses opioids only, so it does nothing for xylazine or medetomidine. Both usually arrive with fentanyl, though, and the CDC says naloxone should be given in any suspected overdose to reverse whatever opioid is there. Its medetomidine advisory adds that fentanyl is involved in most medetomidine overdoses, and tells responders to give naloxone to restore breathing rather than trying to restore alertness.

That last instruction changes what a bystander should expect. Someone may start breathing again and still be deeply sedated, because the sedative is still working. That is not a failed dose. If they are still not breathing well, the CDC says rescue breaths should be given in overdoses involving xylazine; the 911 dispatcher can talk you through them. Keep them on their side, keep watching their breathing, and let 911 take it from there.

Xylazine withdrawal

Whether xylazine has its own withdrawal is not settled. The CDC lists severe withdrawal symptoms among the effects of xylazine use. The 2025 wound guidance, written by clinicians who treat these patients, says an objective and distinct xylazine withdrawal syndrome has not been identified, with anxiety hard to separate from fentanyl, benzodiazepine, or alcohol withdrawal happening at the same time.

The best direct comparison is small. In a 2025 study of 71 people in a Tennessee inpatient withdrawal unit, those who also tested positive for xylazine showed no detectable difference in withdrawal scores from fentanyl-only patients but somewhat higher systolic blood pressure in the first two days, and were more likely to leave early, though that difference was not statistically significant.

Medetomidine withdrawal

Medetomidine withdrawal is the more dangerous of the two. The CDC lists its signs as a heart rate over 100, severe high blood pressure, alertness that comes and goes, tremor, chest pain, and nausea and vomiting that will not stop. It tells the public to go to the hospital or call 911 for vomiting that will not stop, chest pain, going in and out of awareness, or severe withdrawal.

In Philadelphia, 165 patients were hospitalized with suspected medetomidine withdrawal between September 2024 and January 2025; 91 percent needed intensive care, and the syndrome did not respond to the medications that had worked for fentanyl and xylazine withdrawal. The CDC reports similar cases in Pittsburgh, where many patients needed intensive care and IV infusions of dexmedetomidine. In New Jersey, the poison center described patients treated for opioid withdrawal who kept getting worse despite standard opioid medication.

Opioid withdrawal is rarely fatal by itself, though tolerance falls within days, so a return to a former dose can be fatal. A medetomidine withdrawal hiding inside it is a different problem. Our fentanyl withdrawal guide covers the opioid side, and the timeline.

What tranq means for detox

It moves the line between “could ride it out at home” and “needs a supervised setting.” Early on, a racing heart can look like ordinary opioid withdrawal. The New Jersey poison center’s July 2026 warning was about exactly that: patients treated for opioid withdrawal who kept getting worse.

• Say it on the first call. Tell the program, or the emergency room, if xylazine or medetomidine may be involved, even if you are not sure.
• Show the wounds. A detox that sees a wound on day one can treat it, or send you where someone can.
• Leave on medication. Pooled cohort studies in the BMJ (Sordo, 2017) and JAMA Psychiatry (Santo, 2021) found all-cause death rates about half as high or lower during time on methadone or buprenorphine than during time off them. The Sordo review also found sharply higher death rates in the weeks right after people leave opioid agonist treatment.

The opioid detox guide lists New Jersey’s licensed opioid-capable programs.

Test strips and other harm reduction in New Jersey

Test strips are legal to carry. New Jersey’s P.L.2023, c.224, approved January 8, 2024, defines harm reduction supplies to include test strips designed to identify what is in a drug, including substances added to strengthen it, and says drug paraphernalia never includes harm reduction supplies.

The CDC says strips exist for fentanyl, xylazine, and medetomidine, and warns that they can give false negatives. A negative strip lowers the odds. It does not make a bag safe.

• Carry naloxone. Under the state’s Naloxone365 program, anyone 14 or older can get it free and anonymously at participating pharmacies.
• Do not use alone. Naloxone only helps if someone else is there to give it.
• Use a harm reduction center. They hand out naloxone and do wound care. The Department of Health keeps the list of authorized centers.

Is xylazine illegal in New Jersey?

Not as of the latest sources. The Commission of Investigation reported in December 2025 that xylazine and medetomidine were unregulated in New Jersey and not federally controlled, and recommended that the state classify both as controlled dangerous substances. A bill introduced for the 2026 session, S2036, would place xylazine in Schedule III under certain circumstances. As of October 2026 it had not moved past committee.

For someone using, the legal status changes little. The drug is already in the bag.

In New Jersey

Under New Jersey law P.L.2017, c.28, fully insured New Jersey plans and the State Health Benefits and School Employees’ plans cannot require prior authorization for the first 180 days per plan year of in-network treatment your own physician, psychologist or psychiatrist finds medically necessary, or, during those same 180 days, for outpatient prescription drugs that treat substance use disorder, such as buprenorphine and naltrexone, when that clinician finds them medically necessary. Self-funded employer plans, Medicare and Medicaid are not covered by that rule, so verify with the plan.

NJ FamilyCare covers buprenorphine, methadone, and naltrexone. Residential detox is authorized through the IME for most members, and residential care and opioid treatment programs are scheduled to move into the NJ FamilyCare health plans in January 2027.

For help independent of us, the state’s IME Addictions Access Center at 1-844-276-2777 screens NJ FamilyCare and uninsured residents and refers them to treatment, and ReachNJ, the state treatment line, is at 1-844-732-2465. Periscope Behavioral Health, which publishes this site, is opening a medical detox in Hammonton, Atlantic County, expected Summer 2027. Until it opens, Periscope Behavioral Health at (888) 313-3583, our publisher’s admissions line, can talk through options in New Jersey and Florida, including facilities Periscope operates. What a plan covers depends on the plan and the facility’s network status.

Three questions to ask a detox program about tranq

1. How do you recognize medetomidine withdrawal, and at what point do you send someone to a hospital?
2. Who looks at wounds, and can you treat them on site or refer the same day?
3. Will I leave with naloxone, a medication plan, and an appointment already booked?

Listen hardest to the answer to the first question. A program that has treated medetomidine withdrawal should be able to tell you what it monitors and when it calls an ambulance. A general promise that staff handle every kind of withdrawal does not answer it.