LISTEN: Test strips for xylazine are now available alongside fentanyl test strips to help prevent overdose deaths. GPB’s Ellen Eldridge has more on the growing need as overdose deaths from xylazine go up.

Nina Downs and Bethany Crippen

Nina Downs and Bethany Crippen at the AHRC Lyla Center in Woodstock, Georgia.

Credit: Ellen Eldridge / GPB News

Xylazine, an animal tranquilizer, is increasingly mixed with fentanyl in street drugs. Both are used to increase profit by dealers of heroin, cocaine and other illicit substances.

Fentanyl is also increasingly found in counterfeit prescription medications like Xanax and Percocet.

Between August 2021 and August 2022, drug poisoning killed 107,735 Americans, with 66% of those deaths involving synthetic opioids like fentanyl, according to the Centers for Disease Control and Prevention.

Knowing what's in your drug supply allows for dosing decisions.

When people who use drugs have access to harm reduction programs, they can learn more about the dangers of drug misuse. Condoms, vaccinations, and clean syringes reduce infectious disease in the community.

Free test strips for fentanyl and xylazine are also available throughout Georgia thanks to the Harm Reduction Coalition.

Test strips are legal in some, but not all states. In some states, test strips are legal only if they are acquired from harm reduction programs or syringe exchange programs, but Gov. Brian Kemp signed a bill in 2022 to no longer consider fentanyl test strips drug paraphernalia.

That means anyone can sell or distribute the test strips.

But findings from a recent survey of Georgia community pharmacies indicate as many as 82% of pharmacists don't stock fentanyl test strips and may be unaware of their legalization.

Fewer still are aware of the existence of xylazine test strips.


In 2023, harm reduction advocates opened an office north of Atlanta to reach more people. The Georgia Harm Reduction Coalition also offers mail services and a mobile unit.

Bethany Crippen, an administrative assistant with the Lyla Center in Cherokee County, said harm reduction is, literally and metaphorically about meeting people where they are as a community.

Being invited into a caring space where non judgemental people offer real help makes all the difference in reaching people who are already plagued by guilt and shame, Crippen said.

"Harm reduction is something that I would have found super beneficial to me back when I was using substances," Crippen said. "Because it's ultimately life-saving. It's health care for people of all backgrounds, and provides them safe resources and ways to prevent further harm to their bodies."

Xylazine addiction will further worsen the opioid epidemic, she said.

While many opioid addicts' lives have been saved from fatal overdose with naloxone, a victim of xylazine overdose will not respond to that overdose reversal medication, because xylazine is not an opioid,

Xylazine is dangerously addictive and its withdrawal is unlike withdrawal from opioids, with serious concerns about blood pressure and wound care.

Repeated use of xylazine causes ulcers, sepsis and intensely painful sores that can lead to limb-threatening infections, pharmacist Bill Lynch said during an annual drug summit in Atlanta.

Those telltale injection sites give away the existence of xylazine, and the best way to treat the skin-rotting infection is to amputate, he said.

But that doesn't kill the addiction.

The Georgia Department of Health mapped Xylazine-related overdose deaths in 2022. One to five deaths each were reported in Middle Georgia counties including Bibb, Crawford, Monroe and Peach counties.

The Georgia Department of Health mapped Xylazine-related overdose deaths in 2022. One to five deaths each were reported in Middle Georgia counties including Bibb, Crawford, Monroe and Peach counties.

Credit: Georgia Department of Health

"We know patients who actually sign out against medical advice to continue treatment because the withdrawal syndrome is not controlled well enough," Lynch said. "And when that happens, they leave [the hospital]."

The latest drug data from 2020-2021 shows a stunning increase of fatal overdoses linked to xylazine, with deaths in the South surging more than 1,000%.

The state Department of Public Health reported 15 people died by drug overdose involving xylazine in 2020. Two years later, that number was 222.

"People need to seek medical care ultimately," Crippen said. "And that's going to flood our hospitals, our psych hospitals, the behavioral hospitals. That's all stuff we can prevent. If people are testing their drugs with xylazine test strips."

FDA recently communicated to health care providers about the risks among patients exposed to xylazine in illicit drugs.

The U.S. Drug Enforcement Administration issued an alert about a "sharp increase in the trafficking of fentanyl mixed with xylazine," which is also known as "tranq" or "Philly dope."

DEA Special Agent in Charge Robert J. Murphy said most of the drugs seized up and down the coast have come through Atlanta at one point because multiple factors make Atlanta a good distribution hub for fentanyl, including its location on an extensive interstate system and the Hartsfield-Jackson International Airport.

“The interstate system is the No. 1 way [drugs are] being transported up and down the coast,” Murphy said, adding that once drugs reach Atlanta, they’re moved to the Northeast, Midwest and down to south Florida.

The Sinaloa Cartel and Jalisco Cartel in Mexico, using chemicals largely sourced from China, are primarily responsible for the vast majority of the fentanyl that is being trafficked in communities across the United States.

“We’re seeing it everywhere," Murphy said. "Unfortunately, we’re seeing it in colleges, seeing it in high schools.”