White House announces new plan to address the growing threat of xylazine in overdose crisis

The White House on Tuesday unveiled a new plan to address the growing presence of xylazine, a veterinary tranquilizer, in the country’s illicit drug supply.

In recent years, xylazine, which is commonly known as “tranq,” has helped to accelerate the already-deadly U.S. drug crisis. The drug is increasingly being mixed into illicit opioids like fentanyl, contributing to overdose spikes across the country, particularly in northeastern cities like Philadelphia and New York. 

Since xylazine is not an opioid, it does not respond to naloxone, the medication used to reverse opioid overdoses. While a significant amount of xylazine is known to suppress breathing and cause unconsciousness, it has no antidote. 

“[W]e are launching coordinated efforts across all of government to ensure we are using every lever we have to protect public health and public safety, and save lives,” Rahul Gupta, the director of the White House Office of National Drug Control Policy, said in a statement. “As a doctor, I have seen the devastating consequences of xylazine combined with fentanyl firsthand. And as President Biden’s drug policy advisor, I am laser-focused on finding every tool we have and following the best evidence-based practices to take on this new challenge.” 

The plan relies on six pillars, including testing, research, data collection, disrupting the xylazine supply, and developing evidence-based treatment and harm reduction practices. Additionally, Gupta said, the federal government will “explore” adding xylazine to the list of medications scheduled under the Controlled Substances Act, which would allow law enforcement to more aggressively prosecute xylazine importation and distribution for non-veterinary purposes. 

Overall, he added, the White House aims to reduce the percentage of drug poisoning deaths involving xylazine by 15% in the next two years. Xylazine was involved in nearly 11% of all fentanyl-related deaths as of mid-2022, according to the White House, nearly triple the percentage from early 2019. 

The new plan marks the latest in a string of federal government actions aimed at addressing the xylazine crisis. In late 2022, the Drug Enforcement Administration issued a public safety alert regarding xylazine. In February, the Food and Drug Administration issued an import alert for xylazine and warned it may intercept some suspicious-seeming shipments, and in April, the White House designated the substance an “emerging threat.” 

Local groups, meanwhile, have raised alarms about the threat posed by xylazine for years. In Philadelphia and New York, harm-reduction organizations have incorporated xylazine into their training and outreach materials. In particular, they have stressed the importance of ensuring continued oxygen flow to the brain, and warned that reversing a xylazine-involved overdose may require far more time and effort than simply administering naloxone. 

The response has grown particularly challenging for overdoses involving a combination of xylazine and the powerful synthetic opioid fentanyl. Increasingly, people experiencing an overdose remain unresponsive to even large doses of naloxone — not because of fentanyl’s potency, but because naloxone has no effect on xylazine. 

There are currently no treatments in development that could reverse xylazine’s impact. Instead, for the past several years, much of the pharmaceutical industry’s efforts have focused on developing increasingly high-dose and mechanically complex naloxone products. Experts have questioned those products’ medical utility, however, instead casting them as a way to charge vastly higher prices for a medication that has existed for nearly 50 years.

While xylazine is now highly common in some cities, it remains rare in others — meaning that even people who knowingly consume fentanyl may be unaware their drugs contain xylazine, too. And while fentanyl test strips are now common, until recently, there was no tool available to quickly and reliably test for the presence of xylazine.

In March, however, the Canadian distributor BTNX began offering xylazine test strips for sale to harm reduction groups for $200 per box of 100, or $2 per strip. Given limited supply and high price, however, the test strips remain hard to come by. 

“We’re also working hard to make xylazine test strips available to people who need them, just like fentanyl test strips,” Gupta told reporters on Monday.

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.