The White House has announced an official plan to address the "emerging threat" of fentanyl combined with xylazine, a drug combination proven lethal in an increasing number of Americans.
Though the opioid fentanyl has already been an action item for the White House, its association with the non-opioid drug xylazine created a worsening issue to tackle.
Xylazine was originally approved by the Food and Drug Administration in 1972 for use in animals as a sedative and analgesic, but it's not approved for use in humans. Its use, however, rose in all four U.S. census regions between 2020 and 2021, according to the DEA.
A report released last month shows the monthly percentage of illegally manufactured fentanyl-involved deaths with xylazine detected increased 276%, from 2.9% to 10.9%, between January 2019 and June 2022.
With the increased use came increased overdose deaths, with a 1,127% jump in the South and more than 100% in all other regions. And besides death, xylazine's combination with fentanyl has been associated with severe morbidity, including deep flesh wounds and even limb amputation.
The combination was formally designated as an emerging threat in April — an action that prompts multiple federal follow-ups, including the response plan released Tuesday. Its goal is to reduce xylazine-positive drug poisoning deaths by 15% in at least 3 of 4 U.S. census regions by 2025.
"There is an urgent need to determine the source of xylazine and how to reduce the illicit supply; to develop evidence-based testing and overdose response protocols; and to determine how to treat those who have become dependent on the dangerous fentanyl and xylazine combination," said Dr. Rahul Gupta, director of the Office of National Drug Control Policy or ONDCP.
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The ONDCP's response plan lists multiple actions the federal government will take to address the drug combination including testing methods, data system management and prevention efforts.
Though xylazine testing is already being done, it's uneven across the U.S. The plan says forensic testing will now become standardized and scaled up, with hopes of better understanding xylazine's prevalence alone or in combination with other drugs. New tests will also be developed and deployed for clinical settings, and tests will be further deployed within communities, with special focus on those who indicate they could have used xylazine before.
There will also be enhanced epidemiological data processes to track the spread and impact of xylazine-fentanyl, including by using wastewater testing and by assessing where social disparities are present, which could lead to xylazine use, the report says.
Because xylazine isn't an opioid, it isn't affected by reversal agent naloxone, which does affect fentanyl. That's partly why a treatment framework will now be a focus, including withdrawal treatment and overdose strategies with which first responders, service providers and the public will be equipped.
Besides those three efforts, the plan details how the xylazine supply chain and research into the drug will occur, with interception and monitoring plans in the near future.
"While this plan outlines action steps the federal government will pursue to address this threat, we need a whole-of-society effort to save lives," the plan stated. "Partnering with the community, especially community-based programs with experience working with individuals actively using fentanyl adulterated with xylazine, will be critical for maximum impact."
The ONDCP's next step to tackle the emerging threat is to issue implementation guidance to agencies within 120 days of the April designation. The agencies then have to provide a specific report as to how they will implement the guidance within 60 days, and finally, the ONDCP has to publish a national implementation report on the response plan.
