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Biden unveils plan to combat xylazine-spiked fentanyl overdoses

Biden unveils plan to combat xylazine-spiked fentanyl overdoses

US Senator Charles Schumer speaks while holding a photo of a bottle containing the drug xylazine and mentions a letter from the Drug Enforcement Administration (DEA) warning of the danger of mixing fentanyl with xylazine during of the briefing in the lobby at 875 3rd Avenue in Manhattan on the association of the drug xylazine with overdose deaths.

Lev Radin | flare | Getty Images

The Biden administration on Tuesday unveiled a plan to eliminate the growing threat of xylazine-spiked fentanyl, an illegal street drug cocktail fueling a spate of overdose deaths.

The plan directs several federal agencies, including the Centers for Disease Control and Prevention and the Food and Drug Administration, to expand access to overdose testing, prevention and recovery resources. One of the aims is to disrupt the illegal xylazine supply chain.

These agencies must produce an implementation report and submit it to the White House within 60 days.

Fentanyl is a highly potent synthetic opioid with its own rapidly increasing death toll. Xylazine, also known as “Tranq”, is a cheap animal tranquilizer not intended for human consumption.

The plan is the government’s first concrete action to deal with the dangerous combination since it declared it an “emerging threat” in April.

It also builds on President Joe Biden’s national drug control strategy aimed at tackling the country’s addiction and overdose epidemic, and his administration’s other efforts to crack down on illicit fentanyl.

“While we are working to save lives from illegal fentanyl, this administration has been extremely vigilant in responding to changes in drug supply like xylazine,” said Dr. Rahul Gupta, director of the White House Office of National Drug Control Policy, during a call with reporters Monday.

The long-term goal of the White House plan is a 15 percent reduction in xylazine-positive drug overdoses in at least three of four U.S. census regions by 2025.

According to a CDC report released last week, through June 2022, xylazine was detected in nearly 11% of fentanyl overdose deaths, a dramatic increase from about 3% of cases in January 2019.

“The proportion of xylazine-related deaths is steadily increasing and is of great concern. Every single one of these numbers is tragic,” White House domestic policy adviser Neera Tanden said during a call with reporters. “They represent divided individuals, families and communities.”

The US has been grappling with an opioid epidemic for years, and xylazine is only making it worse.

Drug dealers often mix the sedative with fentanyl to prolong the opioid’s duration of action, which can include relaxation and euphoria. But traders can also use Xylazine as a cheap bulking agent to increase their fentanyl supply.

Xylazine can cause major damage in the human body, including severe skin ulcers, soft tissue wounds and necrosis – sometimes described as rotting skin – in drug users, which can lead to amputation.

Treatment, testing and supply reduction

Xylazine spiked fentanyl poses several health risks, including severe hypoventilation, the development of severe wounds, and extreme withdrawal symptoms.

Bags of heroin, partially laced with fentanyl, are displayed before a news conference at the New York Attorney General’s office about a major drug bust September 23, 2016.

Drew Angerer | Getty Images

To address these health challenges, the government’s plan calls for the development and implementation of a treatment framework for patients exposed to xylazine. This includes identifying the most effective approaches to managing withdrawal and clinically stabilizing or restoring a patient to constant and stable performance.

The plan will also evaluate and implement overdose reversal strategies that can be used by healthcare providers, first responders, harm reduction workers, drug users and bystanders in the community.

These strategies will focus on the use of assisted breathing, hand-only CPR and naloxone, the first drug approved in the US to reverse opioid overdose.

Naloxone, marketed as Narcan, is effective against fentanyl but may not respond adequately to xylazine since the tranquilizer is not an opioid.

Even then, Gupta said, “I want to emphasize that these drugs should continue to be used anyway.”

The plan also aims to expand testing for xylazine in other drugs.

This includes developing and approving rapid test strips for use in clinical settings, as well as deploying testing “at all levels of the supply chain, from seized wholesale amounts to retail amounts within communities,” the plan says.

This includes standardizing testing practices among medical examiners, coroners, public health laboratories and drug testing laboratories.

“Currently, community and law enforcement testing is being conducted, but not in sufficient volume,” Gupta said on the call. “We need more testing.” Gupta said Xylazine can be bought from online retailers in China and Puerto Rico. According to Gupta, some drug dealers in Mexico “to a lesser extent” mix xylazine with fentanyl.

Another important part of the plan will be to identify the specific sources of xylazine and determine whether the tranquilizer was diverted from legal sources or synthesized for illicit use. The plan will also improve the Biden administration’s ability to regulate the xylazine supply chain while maintaining the tranquilizer’s availability for legitimate uses in animals in research.

According to the plan, the government will also explore potential regulatory options to disrupt the production, distribution and sale of illicit xylazine.

This could potentially include the classification of xylazine under the Controlled Substances Act, which would classify the tranquilizer according to its risk of abuse.

The government will also explore possible avenues to prosecute those who manufacture, import, export, sell or distribute xylazine to support the fentanyl trade.

The final two components of the plan are to intensify research efforts on xylazine-containing fentanyl and to develop an epidemiological data system to track the spread and impact of the drug combination.

The “good news” is that many of the measures outlined in the plan “are already underway,” Gupta said.

For example, in March, the Drug Enforcement Administration warned the American public about a sharp increase in trafficking in fentanyl mixed with xylazine. A month earlier, the FDA restricted the illegal import of xylazine into the United States

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