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Pennsylvania and The Stark U.S. Divide in Xylazine Use

Back in April, Gov. Josh Shapiro announced that his administration would be taking action to limit access to xylazine, also known as “tranq.”

He noted that, “Xylazine is a powerful animal sedative that should never be ingested by humans and is compounding our fight against the opioid crisis – and today, my Administration is taking action to keep it out of our communities and protect Pennsylvanians.”

Acting Secretary of Health Dr. Debra Bogen submitted notice to temporarily add xylazine to the list of schedule III drugs under Pennsylvania’s Controlled Substance, Drug, Device, and Cosmetic Act, effective June 3.

“District attorneys across Pennsylvania are grateful that this illicit dangerous drug, xylazine, is being scheduled as a controlled substance,” said Greg Rowe with the Pennsylvania District Attorneys’ Association. “There is no legitimate human purpose for its use. Scheduling xylazine will allow law enforcement and prosecutors to investigate and hold drug traffickers seeking to sell it in our communities, often to unsuspecting users, accountable.”

According to the drug testing lab Millenium Health, there are stark regional differences in the use of the drug that is increasingly mixed with illicit fentanyl that may result in skin ulcers and abscesses that drain pus, have decaying tissue and bacterial infections, and which can lead to amputation.

While virtually all positive urine tests for xylazine also contained fentanyl, 16% of fentanyl-positive tests contained xylazine between April and July, according to Millennium’s data.

  • The rates are much higher in some states — 42.8% in Pennsylvania, 40% in North Carolina, and 36.1% in Ohio.
  • It’s still largely a regional phenomenon, though Millennium testing detected xylazine in 34 states since the Biden administration in April declared the fentanyl-xylazine combination a threat to the U.S.
  • In Mid-Atlantic states, 40% of fentanyl-positive tests contained xylazine, and it was 33% in East North Central states.
  • Here’s how the remaining states broke down, by U.S. Census Division: South Atlantic (22%), East South Central (19%), New England (16%), West NorthCentral (13%), West South Central (5%), Pacific (4%) and Mountain (2%)


Eric Dawson, vice president of clinical affairs at Millennium Health, said his company’s data shows there hasn’t yet been a significant geographical shift, but it’s something to watch very closely.

“You still have this incredibly sharp divide within the country,” he said. “It looks like our fentanyl map around 2017, and we know what happened with fentanyl — it moved sharply west.”

The findings also showed that the use of multiple drugs was significantly higher among those using fentanyl with xylazine, compared to those using just fentanyl.

They were about twice as likely to also use prescription opioids and three times as likely to use fentanyl analogues.

“That really speaks to the danger of xylazine. It’s being taken with fentanyl and all of these other things, some of which like xylazine won’t respond to Narcan,” Dawson said, referring to the overdose reversal drug that works just on opioids like fentanyl.


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