SAMHSA is issuing an alert about the risks associated with xylazine, a non-opioid agent increasingly found in combination with opioids like fentanyl, which can cause severe circulatory changes and tissue damage. Xylazine is known as “tranq” or “tranq dope” in the illicit drug market and poses dangers including drowsiness, respiratory depression, and potentially life-threatening skin wounds. SAMHSA emphasizes the need for practitioners to be aware of xylazine risks, manage patients accordingly, and provide counseling and harm reduction advice.