Xylazine, a veterinary sedative, has become a growing concern as an adulterant in illicit drugs, particularly in combination with fentanyl. It is injected intravenously and is often used with other drugs, leading to severe adverse effects such as bradycardia, hypotension, respiratory depression, and skin ulcers. Xylazine has no known antidote, unlike naloxone for opioid overdoses, making it particularly dangerous. Recent data show a significant increase in xylazine-related overdose deaths, with xylazine found in a growing number of illicit drug markets. The DEA has reported xylazine in 48 out of 50 U.S. states, with 23% of fentanyl powder and 7% of fentanyl pills containing xylazine. Xylazine is associated with severe skin damage, including abscesses and ulcers, and can lead to amputation. It is also addictive and can cause severe withdrawal symptoms. Xylazine use has increased in areas like Puerto Rico, Philadelphia, and Toronto. Xylazine's effects on the body include vasoconstriction, which can lead to prolonged wounds and complications. There is a lack of effective treatment for xylazine overdose, and naloxone is ineffective in reversing its effects. Research is needed to better understand xylazine's pharmacological effects and to develop public health interventions and harm reduction strategies. The use of xylazine in illicit drugs is a growing public health concern, with increasing prevalence and associated risks.Xylazine, a veterinary sedative, has become a growing concern as an adulterant in illicit drugs, particularly in combination with fentanyl. It is injected intravenously and is often used with other drugs, leading to severe adverse effects such as bradycardia, hypotension, respiratory depression, and skin ulcers. Xylazine has no known antidote, unlike naloxone for opioid overdoses, making it particularly dangerous. Recent data show a significant increase in xylazine-related overdose deaths, with xylazine found in a growing number of illicit drug markets. The DEA has reported xylazine in 48 out of 50 U.S. states, with 23% of fentanyl powder and 7% of fentanyl pills containing xylazine. Xylazine is associated with severe skin damage, including abscesses and ulcers, and can lead to amputation. It is also addictive and can cause severe withdrawal symptoms. Xylazine use has increased in areas like Puerto Rico, Philadelphia, and Toronto. Xylazine's effects on the body include vasoconstriction, which can lead to prolonged wounds and complications. There is a lack of effective treatment for xylazine overdose, and naloxone is ineffective in reversing its effects. Research is needed to better understand xylazine's pharmacological effects and to develop public health interventions and harm reduction strategies. The use of xylazine in illicit drugs is a growing public health concern, with increasing prevalence and associated risks.