Xylazine—a tranquilizer approved as a sedative for veterinary medical use but not for any use in humans—is currently worsening the opioid crisis. Known on the street as “tranq,” xylazine has become a common additive to substances like fentanyl, heroin, and cocaine, whether taken orally, by smoking or snorting it, or by injecting it.

It creates a double whammy, enhancing the psychotropic effects of fentanyl and posing a risk of toxic and potentially lethal side effects, such as respiratory depression (a reduced breathing rate), hypotension (abnormally low blood pressure), bradycardia (abnormally low heart rate), and decreased consciousness.

Xylazine also can produce severe skin abscesses or necrotic ulcerations (dead tissue) at or distant from an injection site, sometimes leading to limb amputation or worse. (Warning: The following hyperlink contains a graphic and disturbing photograph of the necrotic effects of xylazine, so caution is advised: [Photo found here].)

But we haven’t bottomed out yet.

The standard first-responder treatment of an opioid overdose is administration of antagonists that counteract the effect of opioids, such as Narcan and naloxone.  Yet the Centers for Disease Control and Prevention warns that those drugs are not effective in reversing the effects of a xylazine overdose.

That does not augur well for users, who have increased in number over the last decade. Between 2010 and 2015, xylazine was found in only 2% of fatal heroin or fentanyl overdose cases. In 2019, there was a startling increase in the number of fentanyl-xylazine overdose cases, with xylazine detected in 262 out of 858 of them, accounting for 31% of such fatalities.

Atop that, the accessibility of xylazine is alarming. Xylazine is not a controlled substance, and online Chinese suppliers offer a kilogram of xylazine powder at remarkably low prices, typically ranging from $6 to $20 per kilogram—compared to between $10,000 and $90,000 for a kilogram of fentanyl. Delivery is provided directly to your chosen address by private express carriers.

Such ready affordability and accessibility encourages traffickers to use it as a cheap adulterant, enabling them to boost profits by incorporating it into their mixtures of more expensive drugs. With its independent psychoactive effects, traffickers can reduce the quantity of fentanyl or heroin used in the blend while maintaining desired psychotropic outcomes.

How large a problem is xylazine? The startling reality is that currently, it is not feasible to obtain a comprehensive tally of xylazine overdose deaths in the United States. We don’t know the current prevalence of fentanyl-xylazine mixtures sold on the streets or the precise number of instances in which xylazine is solely responsible for fatalities. That’s for two reasons: Drug testing protocols vary across the 50 states (and within each one), and the Centers for Disease Control and Prevention excludes xylazine from its national overdose statistics.

Nonetheless, the Drug Enforcement Administration concluded in 2022 that the drug has been “reported as an adulterant in an increasing number of illicit drug mixtures [and] has also been detected in a growing number of overdose deaths,” typically in combination with fentanyl, heroin, cocaine, or other drugs.

First appearing in Puerto Rico and the Northeast, xylazine use, according to Rahul Gupta, director of the Office of National Drug Control Policy, “is rapidly spreading throughout the country.” As of March 2023, a fentanyl-xylazine mixture has been found in 48 states, with the South witnessing the most substantial surge—a staggering 193% increase in xylazine instances—followed by the West, which experienced a 112% rise over the course of two years (2020-2021).

The Office of National Drug Control Policy has officially recognized xylazine as an emerging threat and has proposed a response. But the Biden administration’s plan flies at the 30,000-foot level and doesn’t address many of the root sources of the problem.

Just as it has no plan to halt the flow of fentanyl over the Mexican border, the administration has offered no concrete steps to stem the xylazine problem. Nor did the administration address the chemical suppliers in China. They are responsible for the presence of 50.6 million fentanyl-laced, fake prescription pills and more than 10,000 pounds of fentanyl powder seized within our nation’s borders, and they might be shipping liquid or powdered xylazine to this nation, too.

There has not been so much as a peep from President Joe Biden regarding China’s role in the supply chain. In 2019, China took action by including all fentanyl-type drugs on its list of controlled substances, effectively reducing the flow of finished fentanyl from China to the U.S. Yet Chinese manufacturers continue to serve as the primary suppliers of the chemical precursors essential for fentanyl production.

Those chemical components find their way to criminal organizations in Mexico, including two principal threats, the Sinaloa and Jalisco cartels, which process them into finished fentanyl and clandestinely smuggle the drug into the U.S.

In testimony before the Senate Foreign Relations Committee this year, Drug Enforcement Administration chief Anne Milgram asserted, “Since 2019, the [Chinese] government has repeatedly declined diplomatic and congressional requests to stop precursor chemicals from going to Mexico for the production of illicit fentanyl and methamphetamine.”

Recognizing the importance of targeting illicit fentanyl supply chain elements beyond U.S. borders, a bipartisan group of 66 senators, including 29 Democrats, has proposed the FEND Off Fentanyl Act, which would stem the ever-growing supply chain of fentanyl into the U.S. Targeting money laundering, the bill would strengthen the sanctions aimed at disrupting the supply chain, starting from the chemical suppliers in China and extending to the cartels responsible for trafficking those drugs from Mexico into the United States.

Congress could also use the Department of Defense appropriations bill to address fentanyl trafficking. It could authorize, fund, and require the Defense and Treasury Departments, along with agencies comprising the intelligence community, to conduct investigations into the existence and extent of China’s money laundering on behalf of the Mexican cartels.

The nation ought to fervently demand a response from the Biden administration for the thousands of lives lost to fentanyl and xylazine, successfully delivering a significant blow against the illicit fentanyl supply chain and safeguarding American lives from the devastating impact of this deadly drug trade.

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