Xylazine: The Emerging Threat in the U.S. Drug Supply and Policy Responses
The rapid spread of xylazine, a veterinary sedative, within the U.S. illicit drug market is causing significant concern among public health officials. A study published in July 2024 in the International Journal of Drug Policy by HPM faculty members Olivia Sugarman, PhD; Sara Whaley, MPH, MSW, MA; Brendan Saloner, PhD; and Alex McCourt, JD, PhD, MPH, systematically identified and categorized proposed and enacted policy measures addressing human consumption of xylazine. By analyzing legal databases such as LexisNexis and Thomas Reuters Westlaw, researchers identified 58 unique policy initiatives, the majority of which were introduced in 2023. These initiatives are predominantly concentrated in the Northeastern states, where xylazine has the most impact.
Xylazine, used initially for sedating large animals, has become an additive in street drugs, particularly opioids like fentanyl, to enhance and prolong their effects. Its increasing presence is linked to a spike in fatal overdoses and severe, sometimes necrotic, wounds among drug users. In response, state and federal authorities have launched various policy initiatives to combat this emerging public health threat.
Xylazine was first detected in the U.S. illicit drug supply in 2015, with significant prevalence in the Northeast. By November 2022, xylazine had been found in 48 out of 50 states and was linked to nearly 11% of all fentanyl overdoses, marking a 279% increase from 2019. The sedative is often combined with fentanyl to extend its high from approximately 30 minutes to up to 72 hours. However, xylazine increases the risk of overdose due to its muscle relaxant properties, which can cause respiratory depression, and there is no known antagonist to counteract its effects.
Considering the rising threat, several policy initiatives have been introduced at both state and federal levels. The study identified that penalties for xylazine possession, often tied to changes in state drug scheduling, were the most common provision. Of the 58 initiatives, 34 proposed penalties, with Schedule III being the most frequently suggested level.
Other legislative measures include enhancing access to xylazine test strips, increasing public awareness and education, promoting xylazine-specific research, and improving drug surveillance. New York, New Jersey, and Pennsylvania are leading the efforts, each with multiple legislative measures.
One significant challenge in combating xylazine is its continued legal use in veterinary medicine. Any scheduling or restriction must balance public health concerns with the needs of veterinary practice. For instance, Florida classified xylazine as a Schedule I drug in 2016, but the substance has still seen a dramatic increase in illicit use.
Critics of drug scheduling argue that such measures may lead to harsher penalties and exacerbate racial inequities in incarceration rates for drug offenses. Moreover, strict scheduling can limit researchers' access to the substance, hindering scientific understanding and the development of effective countermeasures.
While scheduling xylazine is a prominent approach, it must be complemented by harm reduction and treatment initiatives. Enhancing access to test strips and increasing public education about the risks of xylazine are crucial. Additionally, more robust drug surveillance systems, like the National Drug Early Warning System (NDEWS), are needed to detect and respond to drug supply changes rapidly.
The study highlights the urgent need for further research to measure the impact of these policies on xylazine-related health outcomes. Policymakers must also consider the broader implications of scheduling xylazine, including potential effects on the veterinary industry and the creation of a flexible framework that can adapt to new drug threats.
The rise of xylazine in the U.S. drug supply represents a significant public health challenge. State and federal policymakers have introduced various initiatives to address this issue, focusing primarily on scheduling and establishing penalties. However, the effectiveness of these measures remains uncertain. Complementary efforts in harm reduction, education, and research are essential to mitigate the impact of xylazine and protect public health. The ongoing policy response to xylazine underscores the need for a dynamic and adaptive approach to emerging drug threats.
