Expanding fentanyl crackdown, Biden administration designates xylazine combos emerging threat

Xylazine, a non-opioid tranquilizer approved for veterinary use, was recently declared an emerging threat to the United States by Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy (ONDCP), when combined with fentanyl.

While never approved for human use, xylazine has begun to crop up in recent days as a factor in the opioid crisis, with a growing role in overdose deaths, according to the White House. Its role as a threat was based on geographic presence, and impact metrics such as overdoses over the course of a year. Between 2020 and 2021 alone, forensic lab identifications of xylazine rose in all four U.S. census regions, according to the Drug Enforcement Agency (DEA), but particularly in the South and West, by 193 percent and 112 percent, respectively.

“As a physician, 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,” Gupta said. “That’s why the Biden-Harris Administration is using this designation authority for the first time since it passed Congress in 2018. 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. To parents, loved ones, community leaders, and those affected by xylazine use: I want you to know that help is on the way.”

ONDCP monitors novel and evolving patterns of substance use and creates the criteria for determining when substances or combinations of substances can be designated and declared as emerging threats. The White House deemed the criteria met in this case due to the sheer rapid increase in negative health outcomes and levels of geographic distribution.

Alarmingly, the government added that overdose death numbers had been flattening or decreasing for seven months straight, but that xylazine is complicating efforts to reverse opioid overdoses with Naloxone and threatening gains made in the opioid crackdown. In fact, xylazine-positive overdose deaths increased 1,127 percent in the South, 750 percent in the West, more than 500 percent in the Midwest and more than 100 percent in the Northeast, according to the DEA last year.

Going forward, the White House plans to publish a whole-of-government response with evidence-based prevention, treatment and more. This will be aimed at halting the illicit combination and sale of xylazine and fentanyl. ONDCP will convene an interagency working group to develop a national response plan accordingly, including xylazine testing, treatment and supportive care, comprehensive data systems, supply reduction and rapid research on the drugs and their interactions.