White House rolls out strategy to battle deadly drug mixture of fentanyl and xylazine

The White House is unveiling a plan to combat the growing threat of drug overdose deaths involving the combination of illicitly manufactured fentanyl and the powerful sedative xylazine, approved only for veterinary use.

The plan comes ahead of Vice President Kamala Harris’s meeting with state attorneys general next week to discuss the staggering increase in deaths from the mixture. Details for the meeting have not yet been released.

Overdose deaths involving the presence of the non-opioid sedative and illicit synthetic opioid fentanyl increased 276% from January 2019 to June 2022 in 20 states and the District of Columbia, according to an analysis of available data by the U.S. Centers for Disease Control and Prevention.

The Biden administration’s Office of National Drug Control Policy on Tuesday released a six-point plan to increase testing and coordinate standardized data collection to gain a clearer picture of xylazine-related overdoses across the country and guide policy decisions, according to the 15-page document.

The administration’s goal is to reduce xylazine-positive drug poisoning deaths by 15% (compared to 2022 as the baseline year) in at least three of four U.S. census regions by 2025.

In April the administration officially designated illicit fentanyl adulterated with xylazine as an “emerging drug threat,” triggering federal actions authorized by Congress in 2018. Under the law, several federal agencies must develop response plans within 180 days of the designation.

“What I want everyone to understand is this: If we thought fentanyl was dangerous, fentanyl combined with xylazine is even deadlier,” Dr. Rahul Gupta, ONDCP director, said in a call with reporters Monday.

“We’re going to move ahead as quickly as possible because the fact is that lives are on the line,” he later continued.

Alone, xylazine slows breathing and the heart rate, lowers blood pressure to unsafe levels, and causes deep flesh wounds. Mixed with fentanyl, the xylazine — approved by the Food and Drug Administration in 1972 as a sedative and analgesic for veterinary use — complicates efforts to reverse opioid overdoses with the administration of naloxone, commonly known by the brand name Narcan.

There is no known antidote for xylazine poisoning, according to current scientific research.

“As a physician, I’ve never seen wounds this bad at this scale,” Gupta said. “So I’ve seen this crisis up close myself, including when I visited the Wound Care Clinic in the Kensington neighborhood of Philadelphia, one of the hardest-hit communities in the nation.”

The Wound Care Clinic is run by Prevention Point Philadelphia, a nonprofit public health organization specializing in harm reduction for those who inject drugs.

Percentages of illicitly manufactured fentanyl deaths where xylazine was also detected were highest in Maryland, Pennsylvania, Massachusetts and Vermont from January 2021 to June 2022, according to the CDC’s State Unintentional Drug Overdose Reporting System data from 31 states and the District of Columbia.

Data from 2020 to 2021 show both positive xylazine tests of the illicit drug supply and overall numbers of xylazine-related overdoses and deaths were most prevalent in the Northeast and South, according to Drug Enforcement Agency figures.

The DEA issued a public safety alert in March, noting that it had found xylazine and fentanyl mixtures in 48 of the 50 states.

Often called “tranq” or “tranq dope,” xylazine was found in 23% of illicit fentanyl powder and 7% of counterfeit fentanyl pills seized by the agency in 2022.

An already challenging illicit fentanyl crisis

Officials have already been struggling to contain the crisis of illicit fentanyl mixed into other substances, including heroin and cocaine.

Drug overdose rates in the U.S. have risen fivefold in the past two decades, according to a CDC study published in December.

The study shows that deaths attributed to synthetic opioids, including fentanyl and its many analogues, have been steadily on the rise, with a staggering jump in recent years.

The CDC tracked a record 107,622 overdose deaths in 2021 — 71,238 of them due to manmade, illegal fentanyl substances.

The DEA attributes more deaths to illegal fentanyl among Americans under 50 than any cause of death, including heart disease, cancer, homicide, suicide and other accidents.

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