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Biden administration offers plan to counter deadly xylazine use

Plan, which includes public health and criminal justice provisions, will need funding from Congress to fully implement

Rahul Gupta, director of the White House Office of National Drug Control Policy, designated xylazine mixed with fentanyl as an emerging threat in April — the first time a substance has received that designation.
Rahul Gupta, director of the White House Office of National Drug Control Policy, designated xylazine mixed with fentanyl as an emerging threat in April — the first time a substance has received that designation. (Juan Pablo Pino/ AFP via Getty Images)

The Biden administration on Tuesday released its plan to tackle the proliferation of xylazine, a deadly drug that is increasingly contributing to drug overdose deaths in the United States.

The plan’s public health component calls for increased testing and treatment and better data collection to track the spread of the drug and how it is contributing to overdose deaths. It also calls for using law enforcement to identify the sources of xylazine and disrupt the supply. And it calls for exploring whether to schedule the drug, which would give the government more authority to regulate it.

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Xylazine — a sedative used in veterinary medicine — has made its way into the illicit drug supply chain in recent years, becoming mixed with fentanyl, a powerful opioid that is the primary driver of overdose deaths in the United States.

“If we thought fentanyl was dangerous, fentanyl combined with xylazine is even deadlier,” Rahul Gupta, director of the White House Office of National Drug Control Policy, said in a call previewing the plan Monday. 

The plan released Tuesday will need funding from Congress to fully implement, Gupta said, noting that President Joe Biden’s fiscal 2024 budget request includes funding for emerging threats.

“We will do what we can with what we have until we get the resources from Congress,” Gupta said. “It’s a matter of utilizing what we have right now in order to save lives while we’re encouraging Congress to pass the president’s budget and provide those resources as quickly as possible.”

In April, Gupta designated xylazine mixed with fentanyl as an emerging threat — the first time a substance has received that designation. He also set a 90-day deadline for a government plan to address the problem.

The death rate from xylazine overdoses increased 35-fold from 2018 to 2021, according to Centers for Disease Control and Prevention data. Xylazine does not respond to naloxone, a drug used to reverse opioid overdoses, and can cause other serious health issues including breathing difficulty and wounds that may require limb amputation.

Federal officials worry that there may be more deaths than the government knows about.

The plan calls for scaling up forensic and postmortem toxicology testing to better estimate the usage of xylazine, developing new rapid tests to be used in clinical settings and developing tests that can be used to detect the drug in drug supplies.

Currently, tests exist that help people who use drugs detect fentanyl in their supply, part of a public health response focused on preventing overdose deaths. The administration would like similar tests that allow those using drugs to test for xylazine.

The plan also calls for improving data systems to track xylazine deaths, the spread and impact of fentanyl laced with xylazine across the country and wastewater testing for the drug when necessary.

The federal government also plans to develop and disseminate best practices for treating patients exposed to xylazine, evaluate overdose reversal strategies and educate health care providers and first responders about treating flesh wounds.

The government plans to find ways to disrupt the illicit xylazine supply, potentially by scheduling it and prosecuting those who manufacture, import, export, sell or distribute the drug.

And the plan calls for researching how xylazine impacts human behavior and the reasons people use it. Because xylazine is not approved for human consumption, and its use in illicit drugs is fairly new, there is little research about how to treat it.

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

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