White House designates animal sedatives as an ’emerging drug threat’

On Wednesday, the White House designated a common animal tranquilizer that is increasingly being mixed with street fentanyl as an “emerging drug threat,” an official decision that requires administration create strategies to strengthen law enforcement efforts, health interventions and data collection to combat it.

This is the first time that the White House Office of National Drug Control Policy has never identified a substance with this name, a sign of the seriousness of the danger which it considers to be posed by the drug, xylazine.

Xylazine was approved for veterinary procedures, primarily in cattle and horses, 50 years ago, but has never been sanctioned for medical use in humans. Popularly known as tranq or tranq dope, it is a powerful and addictive sedative that slows breathing and heart rate, increases the risk of fatal overdose, and often produces severe skin ulcers and abscesses that have led to amputations .

“Many communities are not even aware of the threat in their backyards,” Dr Rahul Gupta, head of the drug control bureau, often called the national drug czar, said during a briefing with officials. journalists.

According to a 2018 Congressional Directive which established the emerging threat designation, the administration must now establish plans within 90 days to coordinate a national response to xylazine. This could include creating protocols for treatment, withdrawal and wound care therapies, expanding testing for the drug’s presence and scheduling it as a controlled substance, which would give federal agents tasked with law enforcement authority to prosecute its unlawful use.

Dr Gupta said xylazine withdrawal can lead to such intense symptoms – such as migraine headaches, double vision and body-shattering anxiety – “that people may drop out of medical treatment, including drug treatment, against the advice of a physician.

But it is sought after by drug dealers and addicts because it is relatively cheap, with its own addictive properties, whether taken alone or mixed with opioids or even amphetamines. Like fentanyl, xylazine first appeared as an adulterant in the northeast illicit drug supply, mainly in Philadelphia, then quickly spread west and south. Citing data compiled by the Drug Enforcement Administration and Department of Justice, Dr. Gupta noted that over the two-year period from 2020 to 2021, detection of xylazine in forensic labs increased by 112% in the West and 193% in the South.

Currently, supplies of xylazine are thought to come from China and possibly Mexico, India and Russia, but could also come from some domestic manufacturers who sell to veterinarians.

Wednesday’s announcement follows a crescendo of recent alerts from local health officials and warnings from other federal agencies. In a xylazine alert in March, the DEA said it detected the drug in 23% of fentanyl samples confiscated from 48 states in 2022. Last November, the Food and Drug Administration, which approved xylazine decades ago for veterinary procedures, issued a national warning to health care providers, and in February announced it would monitor imported xylazine for illegal diversion.

Xylazine differs from fentanyl in major ways, which contributed to the administration’s decision to declare it an emerging threat. Unlike fentanyl, heroin, or oxycodone, a prescription pain reliever, xylazine is not an opioid. This means that conventional methods for reversing an opioid overdose, such as naloxone injections or nasal sprays, may fail to fully revive someone who has used it.

Withdrawal symptoms from xylazine must be managed differently than from an opioid, and rehabilitation protocols are not yet established. And unlike opioids or, for that matter, amphetamines, xylazine is not listed as a controlled substance, which would subject it to greater scrutiny by law enforcement.

Wednesday’s White House announcement was long overdue by many community and clinical advocacy groups concerned about how to combat xylazine. Dr. Joseph D’Orazio, chief of medical toxicology and addiction medicine at Temple University Hospital in Philadelphia, which has seen perhaps the largest influx of xylazine patients in the nation, said research on how the drug works in humans would be essential.

“We still don’t know what’s causing the injuries, just a lot of guesswork,” he said. “Once this is understood, we may be able to develop strategies to avoid injuries or better treat them. And we need to understand withdrawal so we can better deal with it.

Dr. Gupta noted that managing the legal and illegal uses of xylazine would be difficult. It is frequently used as a sedative and analgesic in large animal medicine as veterinarians suture wounds, grind down sharp molars, and treat infected hooves. Preserving the drug’s status and access for veterinarians while closing supply to resellers is a topic already under extensive discussion.

And Dr. Gupta was candid that better control of xylazine, while urgent, would be just one step in a long and painful journey. His office is also pushing the effort, he said, in part to anticipate “what potentially comes after xylazine, as an additive to fentanyl, in order to overtake the next additive in the drug supply.” .