The White House has declared that the powerful synthetic opioid fentanyl combined with xylazine -- an animal tranquilizer that's increasingly being used in illicit drugs -- is an "emerging threat" facing the United States due to its role in the ongoing opioid crisis.
Administration officials call the threat FAAX, for fentanyl-adulterated or -associated xylazine.
The move, announced Wednesday, marks the first time in history that any administration has declared a substance to be an emerging threat to the country, said Dr. Rahul Gupta, director of the Office of National Drug Control Policy. The SUPPORT Act of 2018 established that the office has authority to declare such "emerging threats," and no administration has used it until now. Last year, Congress declared methamphetamine an emerging drug threat but none have been declared by an administration previously. Under other agencies or in separate circumstances, concerns such as bioterrorism, infectious diseases or climate change may be identified as "emerging threats."
"This drug, which is an animal sedative, is being mixed with fentanyl and is being found in almost all 50 states now," Gupta said Tuesday. "It's become an important part for us to make sure that we're declaring it an emerging threat."
Now that the administration has declared fentanyl combined with xylazine an emerging threat, it has 90 days to coordinate a national response. "We are working quickly to develop and implement a whole of government nationwide plan, with real deliverable action, that will save lives and will be published within 90 days of this designation," Gupta said.
Xylazine, also known as tranq or tranq dope, has been linked to an increasing number of overdose deaths in the United States due to its rising illicit use. Between 2020 and 2021, overdose deaths involving xylazine increased more than 1,000% in the South, 750% in the West and about 500% in the Midwest, according to an intelligence report released last year by the US Drug Enforcement Administration.
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And in some cases, people might not even know that xylazine was in the drug they used.
Just last month, authorities at the DEA issued a public safety alert about the "widespread threat" of fentanyl mixed with xylazine, reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.
Fentanyl, which has been driving the opioid crisis, is a fast-acting opioid, and people who use it illicitly say that adding xylazine can extend the duration of the high the drug provides.
Xylazine is not an opioid. It is approved by the US Food and Drug Administration for use as a tranquilizer in veterinary medicine, typically in horses, but it is not approved for use in humans. And xylazine can do major damage to the human body, including leaving drug users with severe skin ulcers, soft-tissue wounds and necrosis -- sometimes described as rotting skin -- that can lead to amputation.
"Xylazine is one of the contaminants in fentanyl, but there could be others," Gupta said. "So, I think with the declaration of an emerging threat, we're sending a clear message to producers and traffickers of illicit xylazine and illicit fentanyl that we're going to respond quicker, we're going to match the challenge of evolution of these drugs supply, and that we're going to protect lives first and foremost."
'There is a shift that is occurring'
Now that xylazine has been declared an emerging threat, some of President Biden's $46 billion drug budget request to Congress can be used to respond.
This year, the Biden administration announced that the President has called on Congress to invest $46.1 billion for agencies overseen by the Office of National Drug Control Policy to tackle the nation's illicit drug crisis.
If the budget request is not approved, there could be the option to reallocate money within the Office of National Drug Control Policy, but "we don't want to be in a position where moneys that are being utilized for some other important aspect of saving lives has to be moved away for this purpose," Gupta said Tuesday. "That is the reason we are asking Congress to act."
Such funds could be used to test drugs on the street for xylazine, collect data on FAAX, invest in care for people exposed to FAAX and develop potential treatments for a xylazine-related overdose.
The medication naloxone, also known as Narcan, is an antidote for an opioid overdose, but people who have overdosed on a combination of opioids and xylazine may not immediately wake up after taking naloxone, as it may not reverse the effects of xylazine in the same way it does opioids.
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"We need to recognize, first of all, that there is a shift that is occurring from organic compounds and substances like heroin and cocaine to more synthetics," Gupta said of the state of the nation's illicit drug crisis.
"Both the types of drugs have changed -- from predominantly organic to predominantly synthetics -- but the way drugs are bought and sold have also changed," he said. "Now, all you need is a phone in the palm of your hand and a social media app to order and buy some of the most dangerous substances on planet Earth."
Rise of synthetic drugs
Xylazine is just one of the many adulterants -- or substances that are typically added to others -- found in the nation's illicit drug supply.
"All of a sudden, you can synthesize hundreds of compounds and kind of mix them together and see what does the best in the market," Joseph Friedman, a researcher at the University of California, Los Angeles, told CNN in March. "People are synthesizing new benzodiazepines, new stimulants, new cannabinoids constantly and adding them into the drug supply. So people have no idea what they're buying and what they're consuming."
Some of these adulterants may be as simple as sugar or artificial sweeteners added for taste or additives or fillers that bulk up the drug. Sometimes, they may be contaminants left over from the manufacturing process.
But all of these things can carry real-life health harms, says Naburan Dasgupta, an epidemiologist and senior scientist at the Gillings School of Global Public Health at the University of North Carolina, Chapel Hill.
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Like an opioid, xylazine can depress the respiratory system, so the risk of overdose multiplies when it's combined with heroin or fentanyl.
Also, "in the veterinary literature, we know that it causes a really bad severe form of anemia. And so when people are injecting heroin that's contaminated with xylazine, they can end up with a near-fatal form of blood iron deficiency," Dasgupta said in March. "We had one person here who ended up going to the hospital needing multiple blood transfusions. And it was all because of the xylazine."
Move to make xylazine a controlled substance
US lawmakers are moving to classify xylazine as a controlled substance.
In March, bipartisan legislation -- the Combating Illicit Xylazine Act -- was introduced in the House and Senate. It describes illicit xylazine as an "urgent threat to public health and safety" and calls for it to be a Schedule III drug under the Controlled Substances Act, a category on the five-level system for substances with moderate to low potential for physical or psychological dependence. Xylazine would be one level below opioids like fentanyl.
"Our bipartisan bill would take important steps to combat the abuse of xylazine by giving law enforcement more authority to crack down on the illicit distribution of this drug, including by putting stiffer penalties on criminals who are spreading this drug to our communities," Sen. Maggie Hassan, D-N.H., said in a statement in March.
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The bill would also require manufacturers to send reports on production and distribution to the DEA so the agency can ensure that the product is not being diverted to the black market.
"This bill recognizes the dangers posed by the increasing abuse of animal tranquilizers by drug traffickers, and provides new tools to combat this deadly trend," Sen. Chuck Grassley, R-Iowa, said in the statement.
"It also ensures that folks like veterinarians, ranchers and cattlemen can continue to access these drugs for bona fide animal treatment."
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