When Mayor Greg Ballard appointed me as Director of Public Safety in Indianapolis (2012), my executive team began assessing the likelihood that heroin (opioids) would emerge as a serious problem for IMPD, IFD, and IEMS. My experience in South Texas working with Federal Authorities on the influx of heroin across America’s Southern border during my time as Chief of the Corpus Christi Police Department (2009) helped me understand the drug’s impact, society’s voracious appetite for such a drug, and that it would only be a matter of time before its deadly spread made it to the mid-west. In those initial meetings, neither police narcotics nor the fire department had yet seen evidence of a meaningful increase in heroin-related incidents.
Fortunately for the citizens of Indianapolis and me, IEMS Chief Miramonti showed the kind of leadership that saves lives: he reviewed data on overdoses and saw a significant early uptick in the drug being the cause of death. As any great leader does, he reviewed the data and came to our team with a solution. That solution was to equip emergency personnel with Narcan and launching a public information campaign. This was national leading response that gave our city a head start on an evolving crisis.
That same pattern is now playing out with xylazine, sometimes called “tranq” or “tranq dope.” It is a veterinary tranquilizer, not approved for human use, and when it is mixed with fentanyl or heroin, it can intensify overdose risk while also making rescue more complicated. I first wrote about this in a previous article about three years ago, and now it appears to be gaining popularity.
Xylazine can cause profound sedation, slowed breathing, dangerously low blood pressure, slowed heart rate, and severe skin wounds that can become infected or spread quickly. The FDA notes that repeated exposure can produce necrotic skin ulcerations, sometimes away from the injection site. The DEA says xylazine has been found in increasing numbers of drug seizures and overdose deaths, especially in the South and West.
The key operational point for responders is this: Narcan does not reverse xylazine itself because xylazine is not an opioid. However, naloxone should still be given whenever opioid overdose is suspected, because xylazine is often mixed with fentanyl or heroin.
What should first responders do?
The priority is breathing support and rapid medical care. The Substance Abuse and Mental Health Service Administration’s (SAMHSA) guidance is straightforward: call 911, assess responsiveness, give rescue breaths if needed, and administer naloxone when opioid overdose is suspected.
Practical steps for the scene:
- Use gloves and standard PPE if available.
- Move the person only if necessary for safety.
- Call 911 immediately and report an unresponsive or not-breathing person.
- Give naloxone if opioid overdose is possible, then repeat per protocol if there is no response in 2 to 3 minutes.
- Provide rescue breathing and oxygen support if trained and equipped to do so.
- Monitor closely, because symptoms can return after naloxone wears off.
If naloxone is ineffective, do not assume the event is “not an overdose.” FDA guidance says to consider xylazine exposure when a patient is not responding as expected and when wounds or other xylazine signs are present. In that case, airway support and EMS transport remain critical.
What families should know
For family members, the most important message is that xylazine changes the overdose picture but not the need to act fast. If someone is unresponsive, breathing slowly, or hard to wake, call 911 immediately and give naloxone if opioids may be involved. Stay with the person, keep them on their side if they are breathing, and continue rescue breathing if trained to do so.
Families should also watch for warning signs of xylazine-related injury: open sores, worsening skin ulcers, infections, and wounds that do not heal. These wounds can appear even away from injection sites, so they should not be dismissed as minor skin problems. Encourage prompt medical evaluation, especially if redness spreads, drainage develops, or the person has fever or increasing pain.
The Alice, Texas lesson
On July 10, 2026, two police officers and seven EMTs or firefighters were hospitalized after being exposed to an unknown substance, later determined to be xylazine while treating an unresponsive woman in Alice, Texas.
The Alice incident is a reminder that xylazine is no longer just an urban headline or a distant public health trend; it is now a real operational hazard for police, fire, EMS, and hospitals throughout the United States. The fact that nine first responders needed hospital care underscores how important scene safety, PPE, decontamination awareness, and rapid recognition are.
Police Chief Eden Garcia provided outstanding leadership during this event. As a result of what the Alice PD dealt with, other first responders across the nation need to stay ahead of the drug supply, not behind it. As Benjamin Franklin once said, Failure to Prepare is Preparing to Fail!
The larger lesson is the same one I learned years ago in Indianapolis: when leaders identify a trend early, act decisively, educate the public, and lives are saved. Xylazine demands that same posture now.
