The White House Office of National Drug Control Policy earlier this week unveiled a plan to combat the growing threat of overdose deaths from fentanyl combined with xylazine, a powerful animal sedative.
According to the Centers for Disease Control and Prevention, the monthly percentage of fatal opioid overdose deaths involving xylazine – also known as “tranq” – rose by 276% between Jan. 2019 (2.9%) and June 2022 (10.9%).
And a report from the Drug Enforcement Administration shows that overdose deaths involving xylazine increased more than 1,100% in the South, more than 500% in the Midwest and more than 750% in the West between 2020 and 2021.
DEA administrator Anne Milgram said that the inclusion of xylazine makes “the deadliest drug threat our country has ever faced, fentanyl, even deadlier.”
“DEA has seized xylazine and fentanyl mixtures in 48 of 50 States,” Milgram said in an alert issued by the agency. “The DEA Laboratory System is reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.”
At the drug analysis lab at the University of North Carolina at Chapel Hill, which tracks drugs from across the state, about 25% of the fentanyl they’ve tested has been laced with xylazine.
“We’re not really sure why it’s growing,” said Colin Miller, a drug researcher at UNC-Chapel Hill. “Most people who are using drugs really don’t want the xylazine in their product.”
The White House in April officially designated the combination an “emerging threat” to the United States. The whole-of-government response announced earlier this week builds on that declaration in an effort to combat the scourge.
“As a doctor, I have seen the devastating consequences of xylazine combined with fentanyl firsthand,” Dr. Rahul Gupta, Director of National Drug Control Policy, said in a statement on Tuesday. “And as President [Joe] Biden’s drug policy advisor, I am laser-focused on finding every tool we have and following the best evidence-based practices to take on this new challenge. This will be an all-hands-on-deck effort – but I am confident we can take action together and eradicate this emerging threat.”
Dr. Gupta told reporters on a call on Monday that xylazine “slows breathing and heart rate and lowers the blood pressure to unsafe levels” and does not respond to medications like Narcan that reverse opioid overdoses.
“If you thought fentanyl was deadly or dangerous, xylazine mixed with fentanyl makes it much more destructive and dangerous,” Dr. Gupta said. “What worries me is this drug is not only lowering your blood pressure, your heart rate and causing sedation, it also has some of the worst flesh wounds I’ve seen in my career.”
The Biden administration’s strategy involves six pillars: testing, data collection, evidence-based prevention, harm reduction and treatment, reduction of supply, scheduling and research.
The administration wants to move toward possibly scheduling xylazine under the Controlled Substances Act “while simultaneously maintaining the legitimate supply of xylazine in veterinary medicine, and prioritizing facilitation of access to xylazine for research purposes.” Some states have already taken action to schedule the drug, but farmers, veterinarians and others who regularly use it for legitimate purposes have cried foul.
Officials also want to conduct research immediately to try and identify potential antidotes to xylazine in humans.
It also includes steps that states and individuals can take to address the issue. For instance, the plan suggests that law enforcement and elected officials consult with public health experts on efforts to reduce and disrupt supply chains and go after traffickers, and encourages emergency responders and those involved with addiction treatment to consult with experts on xylazine detoxification methods.
Officials hope that the strategy will reduce xylazine-related overdose deaths 15% by 2025.
“We put forward a plan that is proactive in nature, as opposed to what’s happened in the past, we’ve always been reactive,” Dr. Gupta said. “We want to make sure we’re working with state, local officials and individuals to take an approach that heads this off as quickly as possible.”