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From Philadelphia to California, officials on alert over xylazine threat

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A veterinary sedative embedded in the nation’s illicit drug supply has public health officials, state lawmakers and federal leaders on alert as it helps fuel the nation’s overdose epidemic.

Xylazine, a cheap tranquilizer approved by the Food and Drug Administration for veterinary use, has emerged as a growing threat in the unregulated illicit drug trade. It is often mixed with other drugs, including potent fentanyl and other opioids.

In July, the White House Office of National Drug Control Policy outlined a plan to reduce xylazine-positive drug deaths by 15% in most of the country. The plan focuses on testing; data collection; evidence-based prevention, harm reduction and treatment; supply reduction; and scheduling and research. The goal is a 15% reduction – compared to 2022 as the baseline year – of xylazine-positive drug poisoning deaths in at least three of four U.S. census regions by 2025.

Some U.S. states and local communities have also taken steps to address the problem.

In March, Ohio became one of the first states to make xylazine a Schedule III controlled substance. Gov. Mike DeWine signed an executive order reclassifying xylazine as a controlled substance drug amid growing overdoses throughout the state. Gov. Josh Shapiro did the same thing in Pennsylvania in April. In May, a bipartisan group of 39 attorneys general asked Congress to classify xylazine as a controlled substance.

Officials in Arizona, California, Florida, and other states have issued warnings about the drug, which can pose its own health problems. The sedative can leave users with skin ulcers that can become infected and, in some cases, require amputation if untreated. Xylazine also slows breathing, making opioids that cause respiratory depression even more dangerous by increasing the risk of overdose deaths.

Philadelphia has emerged as an epicenter of xylazine use. The Philadelphia Department of Health has collaborated with local hospital systems and updated overdose response training “to incorporate the risk of fatal overdose,” according to the agency.

The U.S. Centers for Disease Control and Prevention reported the monthly percentage of illegally manufactured fentanyl-involved deaths with xylazine detected increased 276% – from 2.9% to 10.9% – between January 2019 and June 2022.

Katharine Neill Harris, a fellow in drug policy at Rice University’s Baker Institute for Public Policy, said addressing the issue will require cooperation at the local, state and federal level. She said testing will be key.

“Testing is very critical right now,” she said. “We need testing at multiple levels. A few of the ones that were emphasized in the report, for example, include community-level testing right at the point of care so that people who use drugs, have more knowledge about what they’re getting and are maybe able to avoid xylazine if it’s in the drugs that they purchase. We also need more testing in terms of monitoring of the drug supply.”

Community-level testing could prove especially important.

“The White House needs the help of state and local communities as well,” Harris said. “We need communities that are willing to distribute xylazine test strips so that people who use drugs can get information about this and avoid this drug.”

She said drug users who don’t want xylazine added to the product they are buying could do more to reduce the supply of the drug than government and law enforcement efforts.

The White House plan also calls for reducing the supply of xylazine. That could be difficult, Harris said. In part because it’s not yet clear when and where xylazine is entering the illicit drug supply.

“I’m always somewhat skeptical of supply-side interventions for the simple fact that we’ve done that many, many times and it doesn’t seem to work ever,” Harris said. “[Xylazine] does seem fairly easy to buy right now off the internet. You might be like a veterinary license, but it doesn’t seem that hard.”

Harris said while xylazine is likely combined with other illicit drugs at the street level or above, it’s not likely being done at the cartel level. Still, she said more research is needed to determine how xylazine has become entrenched in the nation’s drug supply.

“We still need more information about where exactly in the unregulated supply chain xylazine is entering the drug supply,” she said. “The speculation is that this is happening at a lower level and that this isn’t necessarily happening at the cartel level, but it’s happening more at like a mid-level dealer. And so that information I think, is important in terms of deciding how it should be regulated.”

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