Illicit xylazine, fentanyl combination decreed ‘emerging threat’

The Biden administration designated fentanyl combined with xylazine as an “emerging threat” to the U.S. on April 12.

The designation will allow the federal government to put together resources to counteract the illegal supply of the drug combination found nationwide.

It’s the first time the United States has declared a drug an emerging threat, a category enabled by a 2018 federal bill, said Rahul Gupta, MD, director of the Office of National Drug Control Policy (ONDCP) in a press release from the administration.

The White House

Illicit xylazine’s growing role in being sold illegally and overdose deaths nationwide prompted the White House to make this designation.

“By declaring xylazine combined with fentanyl as an emerging threat, we are being proactive in our approach to save lives and creating new tools for public health and public safety officials and communities across the nation,” Gupta said in the release.

Following the public declaration, the administration will publish a response plan within 90 days that includes evidence-based strategies for prevention, treatment, and supply reduction.

“The ONDCP is convening an interagency working group to inform the development of the national response plan,” according to the announcement. “The response will include work on xylazine testing, treatment and supportive care protocols, comprehensive data systems (including information on drug sourcing and supply), strategies to reduce illicit supply of xylazine, and rapid research (such as work on the interactions between xylazine and fentanyl).”

Xylazine is a safe and effective prescription sedative and analgesic used in dogs, cats, cattle, horses, as well as elk, deer, and many other species to calm them and facilitate safe handling and to perform diagnostic and surgical procedures. The AVMA believes that there is not significant xylazine diversion from veterinary channels.

Xylazine is not approved for use in people and may cause serious and life-threatening side effects. Illicit xylazine has been identified as a contaminant found in combination with opioids, such as fentanyl, or in combination with stimulants such as methamphetamine and cocaine. People who use these drugs may not be aware of the presence of xylazine.

On the legislative side, the bipartisan, AVMA-backed Combating Illicit Xylazine Act was introduced into Congress on March 28 also in response to the street drug’s increasing presence. The bill’s provisions would equip law enforcement with additional tools to stop xylazine trafficking while maintaining veterinarians’ ability to legitimately use xylazine.

If it becomes law, the legislation will make the manufacture, distribution, dispensing, or possession of illicit xylazine for trafficking subject to Schedule III penalties under the federal Controlled Substances Act. Illicit use of xylazine includes any use, or intended use, in people and would address any diversion of xylazine from veterinary sources. At the same time, the legitimate veterinary uses would remain an FDA-regulated prescription veterinary drug.

In a recent blog, the AVMA voiced its support for the bill, stating that the Combating Illicit Xylazine Act strikes the right balance of protecting communities from illicit xylazine while preserving its legitimate veterinary use. The proposed legislation culminates months of sustained advocacy and work with congressional offices and federal agencies.

A call to action urging veterinary advocates to reach out in support of the legislation to their members of Congress was also recently featured by the AVMA’s Congressional Advocacy Network.