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News — The emergence of xylazine in the illicit drug supply marks a new chapter in the ongoing overdose crisis. This veterinary tranquilizer, often mixed with fentanyl, poses significant risks to public health and challenges our existing strategies for combating drug abuse and overdose deaths.

Xylazine, known on the streets as "tranq," has rapidly spread across the United States. The Drug Enforcement Administration reports that xylazine and fentanyl mixtures have been seized in 48 out of 50 states. In 2022, approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine. This widespread presence indicates a growing threat that demands immediate attention.

The dangers of xylazine are multifaceted. When combined with opioids like fentanyl, it increases the risk of fatal overdose. Xylazine can cause dangerous decreases in breathing, heart rate, and blood pressure. Unlike opioid overdoses, xylazine-related overdoses do not respond to naloxone, the standard overdose reversal medication. This complicates emergency response efforts and puts additional strain on our healthcare system.

Moreover, repeated xylazine use is associated with severe skin wounds, including open sores and abscesses. These wounds can lead to tissue death and, in extreme cases, require amputation. The medical community is still grappling with how to treat these xylazine-related injuries effectively.

As we confront this new crisis, we must learn from our experiences with the opioid epidemic. The rapid spread of xylazine mirrors the trajectory of fentanyl, which began in white powder heroin markets in the Northeast before expanding nationwide. This pattern suggests that xylazine use will likely increase and become more prevalent in the illicit drug supply.

To address this emerging threat, we need a comprehensive, multi-faceted approach. This includes increased awareness, expanded testing capabilities, and the development of targeted treatment strategies. Healthcare providers, first responders, and harm reduction organizations need to be educated about xylazine and its effects to provide appropriate care and interventions.

Research is crucial in understanding xylazine's impact on the body, its role in the overdose crisis, and potential treatment options. The National Institute on Drug Abuse is supporting studies to explore these areas, but more resources and attention are needed.

Policymakers must also consider the regulatory landscape surrounding xylazine. While it is not currently a controlled substance under federal law, some states have begun to place it on their controlled substances lists. In Pennsylvania, Governor Josh Shapiro signed into law Act 17 of 2024, bipartisan legislation to permanently list Xylazine as a controlled substance.  A balanced approach that restricts illicit use while maintaining legitimate veterinary access is necessary.

It’s one of the reasons we are organizing the symposium “The Next Chapter of the Opioid Epidemic in Pennsylvania: The Xylazine Crisis" and making it free for medical professionals and students. By bringing together state government policymakers, physicians, and surgeons, this event will foster crucial discussions on the current state of the crisis and evidence-based treatment strategies.

As we face this new challenge, collaboration between government agencies, healthcare providers, researchers, and community organizations is essential. We must act swiftly and decisively to prevent xylazine from exacerbating the already devastating impact of the opioid crisis. By learning from past experiences and adapting our approaches, we can work towards mitigating the harm caused by xylazine and protecting public health.

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Dr. Asif Ilyas is President of the Rothman Opioid Foundation in Philadelphia, a Professor of Orthopaedic Surgery at Thomas Jefferson University, and an Associate Dean of Clinical Research at the Drexel University College of Medicine.