Xylazine has primarily been found as a contaminant in combination with illicit fentanyl and heroin sold on the streets. It is typically used by injection. It may be used unknowingly when injected with other street drugs, like heroin or fentanyl.

However, some people may knowingly abuse xylazine to help lengthen the euphoric effect (“high”) from fentanyl injections. People who inject drugs are at a high risk for exposure to xylazine due to its increasing prevalence on the streets.

Stimulants, such as methamphetamine and cocaine have also been combined with xylazine. There are reports of users combining it with “speedballs” (a mixture of an opioid and stimulant) to offset the unintended effects of the mixture.