Xylazine overdose rates increasing in Philadelphia

Xylazine was found in 90 percent of heroin and fentanyl tested by the City of Philadelphia.

In a recent study horse tranquilizer were found in 90 percent of heroin and fentanyl tested. | FILE / THE TEMPLE NEWS

Ninety percent of heroin tested by the City of Philadelphia in 2021 included xylazine, a horse tranquilizer, said Dr. Joseph D’Orazio, professor of clinical emergency medicine at Temple. 

Xylazine is a veterinary sedative used for surgical procedures and is often found in illicit opioids, the most common being fentanyl and heroin. Recreational use of xylazine was originally reported in Puerto Rico in the 2000s, reaching Philadelphia in 2006, D’Orazio said. 

More than 100,000 fatal drug overdoses were reported between April 2020 and April 2021, roughly 75,000 of which were due to opioids, according to the Centers for Disease Control and Prevention’s National Center for Health Statistics. 

Philadelphia reported 1,250 fatal drug overdoses in 2021, four in five of which involved fentanyl, the opioid most commonly found with xylazine. Fentanyl was also found in 98.4 percent of xylazine-present overdoses and cocaine was found in 45.4 percent. 

“It’s really opioids are killing people, specifically fentanyl,” D’Orazio said. “But we are seeing more and more opioid deaths that on post-mortem had xylazine on board.” 

Fatal xylazine overdoses increased from 0.36 percent of opioid deaths in 2015 to 6.7 percent in 2020. Philadelphia had the highest number of xylazine deaths in 2020 in the U.S., accounting for 28.5 percent of deaths. The rate of xylazine found in post-mortem toxicology increased by 8 percent from 2020 to 2021, according to Philadelphia’s 2021 Overdose Fatality Review. 

Narcan, an overdose treatment, is proven to be ineffective in reversing the sedative effects of xylazine, but people should administer Narcan in the event of a xylazine overdose, D’Orazio said. 

Xylazine is not considered a controlled substance, meaning it can be bought as a prescription medication from a veterinarian. The drug causes high blood pressure, slows breathing and heart rates and produces severe skin ulcerations. 

Xylazine causes severe soft tissue infections due to the substance’s ability to restrict oxygen flow to the infection, which occasionally leads to amputation, said Shannon Ashe, co-founder of the Everywhere Project. 

Here are university, city and community resources to help combat the presence of xylazine in Philadelphia.  


Temple’s Wellness Resource Center refers students to harm reduction organizations outside of the university or the Philadelphia Department of Health and hosts monthly meetings for students in recovery. 

Tuttleman Counseling Services has a Campus Alcohol & Substance Awareness unit which offers specialized counselors trained in substance abuse and addictive behaviors. CASA also has individual and group therapy and psychiatric services for students. To join, a student must undergo a consultation to be placed with the right counselor for their needs. 

The College of Public Health also offers a free, non-credit course for overdose reversal, “College of Public Health Narcan/Overdose Reversal Training.” The training teaches students how to recognize signs of an overdose and steps to administering Narcan.  


The Everywhere Project, a nonprofit organization based in Philadelphia, provides harm reduction resources and educational tools to areas of the city impacted by substance use.  

Shannon Ashe, a 2021 master of social work alumna, and Jen Shinefeld, a 2017 master of public health in epidemiology alumna, debuted the program in March 2021 and hold weekly outreach sites in Center City and Kensington,  where they supply Narcan, fentanyl testing strips and safer use kits.


The City of Philadelphia has an online map to find Narcan sold at pharmacies. The overdose treatment can be found at Rite Aid on Diamond Street and Broad Street, as well as Rite Aid on 15th Street and Broad Street. 

If a pharmacy isn’t nearby, NEXT Distro, a harm reduction supplier, ships products like Narcan, clean needles and syringes nationwide.  

The city also offers programs for individuals in recovery, like Prevention Point Philadelphia, which promotes health and empowerment in areas affected by drug use and Project SAFE, which supports drug users with outreach sites on Kensington Ave to distribute food and harm reduction supplies.

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