Can Biden plan to curb an animal tranquilizer found in fentanyl prevent California overdoses?
.JPG "A syringe with fentanyl, the narcotic painkiller. Some illicit fentanyl in the U.S. has been laced with xylazine, a horse tranquilizer. The White House announced a path to address this.")
The White House says it has a plan to curb the use of a veterinary tranquilizer that, when combined with the already-deadly fentanyl, only heightens the danger of fatal overdose.
Xylazine laced with fentanyl — a powerful synthetic opioid drug used in medical settings for severe pain relief — has emerged in major California cities, according to local officials.
Sacramento County reported 10 cases where xylazine was mixed with fentanyl in 2022, according to the California Department of Public Health.
Also known as “tranq,” xylazine has been found in almost every state, federal officials say. And its prevalence is likely underestimated due to lack of testing and because its effects are similar to those of other opioids.
Tranq dampens human breathing, heart rate and blood pressure. It can cause abscesses at injection spots and elsewhere that could require amputations. Xylazine is approved by the U.S. Food and Drug Administration to sedate a wide range of animals, including horses, dogs and deer. It was never meant for human use.
The White House declared xylazine in fentanyl an emerging drug threat in April, kickstarting the plan.
“If we thought fentanyl was dangerous, fentanyl combined with xylazine is even deadlier,” Dr. Rahul Gupta, director of the Office of National Drug Control Policy, said in a call with reporters on Monday.
The White House is focusing on increasing testing for xylazine and collecting data on it spread. It also wants to limit the supply sent to the U.S. from China, Puerto Rico and Mexico.
What is California doing about xyalizine?
CDPH alerted local health officers to xylazine in March. Still, state health officials said, it is not yet common or widespread.
Under the 2023-24 California budget agreement, CDPH will provide funding and guidance to local health departments and community-based organizations to test drug samples for harmful contaminants, including xylazine.
In 2021, according to CDPH, xylazine was detected in less than 1% of overdose deaths, though the department said it probably underestimated, a spokesman told The Sacramento Bee.
Nationally, the monthly percentage of fentanyl-involved deaths with xylazine detected increased from about 3% to 11% between January 2019 and June 2022, according to the Centers for Disease Control and Prevention.
By 2025, the White House hopes to reduce xylazine-related deaths in at least three of four U.S. census regions by 15% under 2022 levels. In doing so, the drug would no longer be considered an emerging threat, according to senior administration officials who spoke with reporters on the condition of anonymity.
The White House also suggested states, counties and cities have:
▪ Health care providers seek out those suspected of taking fentanyl mixed with xylazine and offer mobile care.
▪ Addiction treatment specialists and emergency responders study xylazine detoxification methods.
▪ Law enforcement and other officials coordinate with public health colleagues to disrupt the illicit drug supply.
▪ Community-based leaders consult with officials, given that volunteers might see the impacts of xylazine before state-employed leaders do.
“The fact is that right now the medical community knows how xylazine adulterated with fentanyl affects individuals, but there is not a single agreed upon framework for treating that,” Gupta said.
Scheduling xylazine
Xylazine is not a scheduled drug under the U.S. Controlled Substances Act. The White House plan calls for pressuring Congress to act.
A bipartisan group of lawmakers have already introduced a bill to make it a Schedule III substance, meaning that it has some legitimate medical uses but less potential for abuse than drugs listed under Schedules I or II. Schedule III would align it with ketamine, aspirin and testosterone. It would also allow for more research into its properties and prevent it from spreading illegally.
Many buyers are unaware that xylazine is being cut into illicit drugs, the White House said, a situation similar to the emergence of fentanyl-infused heroin years ago. The DEA warned that xylazine was taking the same path as fentanyl, “beginning with white powder heroin markets in the Northeast before spreading to the South, and then working its way into drug markets westward.”
Its increased presence “may be driven in part by its low cost and lower risk of law enforcement scrutiny as it is not a controlled substance,” the DEA wrote in an October 2022 report.
Xylazine is not an opioid and has not shown that it responds to naloxone the same way that fentanyl does. Naloxone, sold under the brand name Narcan, is used to reverse the effects of an opioid overdose.
Regarding abscesses, Gupta said, “As a physician, I’ve never seen wounds this bad at this scale.”
The White House will employ multiple agencies along with the DEA, requiring those involved to report back within two months on implementation.
White House advisor Neera Tanden said that the administration has asked Congress allocate $46.1 billion to agencies in accordance with the White House Office of National Drug Control Policy requests for next fiscal year. — a significant increase.
Tanden said more than 109,000 people died last year from a drug overdose. About seven in ten succumbed to a synthetic opioid like fentanyl. “A recent CDC report found that xylazine was detected in nearly 11% of fentanyl deaths,” she said.
Responding to an overdose
Regarding xylazine, CDPH recommends reading this notice on symptoms, withdrawal and treatment. For longer-term solutions, take training in substance use prevention and medication for opioid use disorder.
Even though xylazine is not an opioid, officials recommend naloxone to reduce or reverse effects of the drugs its mixed with. Here is the Overdose Prevention Toolkit for the most current information on handling an opioid overdose:
▪ Call 911 and give naloxone.
▪ Keep the person awake and breathing.
▪ Lay the person on their side to prevent choking.
▪ Stay with the person until 911 responders arrive.
This story was originally published July 11, 2023 at 5:00 AM.
