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April 12, 2023

White House gives xylazine unprecedented 'emerging threat' designation

The animal sedative, now commonly mixed with fentanyl to make tranq dope, has fueled deadly new concerns in the nation's opioid epidemic

The White House took urgent action Wednesday to declare the veterinary tranquilizer xylazine an "emerging threat," marking the first time the federal government has used that designation to mount a response to a life-threatening drug. 

The animal sedative has increasingly been diverted from veterinary sources to be mixed with fentanyl, the synthetic opioid blamed for exacerbating the opioid epidemic and causing a sharp rise in fatal overdoses in the U.S. The street name for the drug cocktail is tranq dope. 

"I am deeply troubled about the devastating impact of the fentanyl-xylazine combination, and as President Biden’s drug policy advisor, I am immensely concerned about what this threat means for the Nation,” said Rahul Gupta, director of the White House Office of National Drug Control Policy.

Xylazine is only FDA-approved for veterinary use in large animals such as horses and cattle. In people, the sedative slows breathing and heart rate and also causes severe outbreaks of skin ulcers that require medical attention to prevent infections. 

Drug interactions between fentanyl and xylazine can lead to more serious and potentially deadly overdoses. Xylazine can mask the effects of the overdose reversal drug Narcan, complicating the efforts of first responders who may not be able to clearly distinguish between the effects of the opioid and the sedative. Xylazine can also be addictive on its own and requires separate protocols to manage withdrawal symptoms. 

In recent years, as fentanyl has replaced heroin as the dominant opioid in the U.S., drug dealers have turned to xylazine as a way to prolong the high that users experience. Fentanyl is not as long-lasting as heroin, but tranq dope compensates for this by extending the effects of intoxication.  

Cutting fentanyl with xylazine also increases profit margins for dealers. Fentanyl can be produced synthetically in a lab and it is at least 50 times more powerful than heroin, by volume, making it cheaper and easier for drug dealers to acquire.

The "emerging threat" designation was created by a congressional directive in 2018, but hasn't been used until now. The federal action triggers a 90-day period for the White House to develop an accelerated national response plan. For xylazine, that may include rapid research to establish new treatment protocols for overdoses and wound care. The plan could also spur new regulatory and enforcement actions, like increasing criminal penalties and scheduling the drug as a controlled substance in order to allow the DEA to crack down on illicit suppliers. 

The move by the Biden administration follows a string of recent government efforts to contain the spread of xylazine, including the FDA's decision to restrict its importation and the DEA's safety alert issued last month on the dangers of the drug. A bipartisan bill introduced in the Senate in March aims to make xylazine a Schedule III drug under the Controlled Substances Act, one level below fentanyl on the five-tiered scale.

Although xylazine first surfaced in the early 2000s as a recreational drug in Puerto Rico, it began to appear more widely in Philadelphia's street drugs as early as 2006, the city's health department said last year. Alongside the rise of fentanyl, Philly became "ground zero" for tranq dope in the U.S. 

The drug has since spread rapidly west and south. 

Between 2020 and 2021, the DEA reported that forensic lab identifications of xylazine rose in all four U.S. Census regions. The sharpest increases were observed in the southern and western U.S., where lab reports of xylazine rose 193% and 122%, respectively, during that period.

Xylazine-positive overdose deaths increased by 1,127% in the South, 750% in the West, more than 500% in the Midwest and more than 100% in the Northeast during that timeframe, the DEA said. 

Federal officials believe much of the nation's diverted supply of xylazine is coming from nations including China, Russia, India and Mexico, the New York Times reported. Domestic manufacturers may also be playing a role in the drug's availability to dealers. 

The Biden administration said national overdose deaths have flattened or declined for seven months straight, but the complications presented by xylazine are regarded as growing threats to that progress. 

"By declaring xylazine combined with fentanyl as an emerging threat, we are being proactive in our approach to save lives and creating new tools for public health and public safety officials and communities across the nation," Gupta said. 

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