TThe White House on Tuesday unveiled a new plan to address the growing presence of xylazine, a veterinary sedative, in the country’s illicit drug supply.
In recent years, xylazine, commonly known as “tranq,” has helped accelerate the already deadly drug crisis in the US. The drug is increasingly being mixed with illicit opioids like fentanyl, contributing to overdose spikes across the country, especially in northeastern cities like Philadelphia and New York.
Since xylazine is not an opioid, it does not interact with naloxone, the drug used to reverse opioid overdoses. While significant amounts of xylazine are known to depress respiration and cause unconsciousness, it has no antidote.
“[W]We are launching coordinated government-wide efforts to ensure we use every lever we have to protect public health and safety and save lives,” said Rahul Gupta, the director of the White House Office of National Drug Control. Policy, in a statement. “As a physician, I have seen firsthand the devastating effects of xylazine in combination with fentanyl. And as drug policy adviser to President Biden, I am focused on finding every resource we have and following best evidence-based practices to meet this new challenge.”
The plan rests on six pillars, including testing, research, data collection, disrupting the supply of xylazine, and developing evidence-based treatment and harm reduction practices. In addition, Gupta said, the federal government will “explore” adding xylazine to the list of drugs scheduled under the Controlled Substances Act, allowing law enforcement to more aggressively prosecute the importation and distribution of xylazine for non-veterinary purposes.
Overall, he added, the White House is aiming to reduce the percentage of drug poisoning deaths involving xylazine by 15% over the next two years. Xylazine was implicated in nearly 11% of all fentanyl-related deaths as of mid-2022, according to the White House, nearly triple the rate from early 2019.
The new plan marks the latest in a series of federal government actions to address the xylazine crisis. By the end of 2022, the Drug Enforcement Administration will have a public safety warning with respect to xylazine. In February, the Food and Drug Administration issued a import warning for xylazine and warned it could intercept some suspicious-looking shipments, and in April the White House designated the substance an “emerging threat”.
Local groups have been sounding the alarm for years about the threat posed by xylazine. In Philadelphia and New York, harm reduction organizations have included xylazine in their training and outreach materials. In particular, they have emphasized the importance of ensuring a continuous oxygen supply to the brain, warning that reversing a xylazine overdose can require much more time and effort than administering naloxone alone.
The response has become particularly challenging for overdoses involving a combination of xylazine and the potent synthetic opioid fentanyl. Increasingly, people who overdose do not respond to even large doses of naloxone – not because of the potency of fentanyl, but because naloxone has no effect on xylazine.
There are currently no treatments in development that can reverse the impact of xylazine. Instead, in recent years, much of the pharmaceutical industry’s efforts have focused on developing increasingly higher-dose and mechanically more complex naloxone products. However, experts have questioned the medical usefulness of those products, instead proposing them as a way to command much higher prices for a drug that has been around for nearly 50 years.
While xylazine is now very common in some cities, it remains rare in others — meaning that even people who knowingly use fentanyl may not know that their meds also contain xylazine. And while fentanyl test strips are now common, until recently there was no tool available to quickly and reliably test for the presence of xylazine.
However, in March, Canadian distributor BTNX began offering xylazine test strips for sale to harm reduction groups for $200 per box of 100, or $2 per strip. However, given the limited supply and the high price, the test strips remain difficult to obtain.
“We are also working hard to make xylazine test strips available to people who need them, just like fentanyl test strips,” Gupta told reporters Monday.
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