DEA Issues Public Safety Alert for Fentanyl Mixed with Xylazine

On Wednesday, April 12, 2023, the United States Drug Enforcement Administration (DEA) issued a public safety alert on fentanyl mixed with xylazine. Linked to a press release by the Biden Administration, the announcement warns against the increasing amount of fentanyl tainted with the veterinary drug, sometimes referred to as tranq.

“Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” said DEA Administrator Anne Milgram in the safety alert. “DEA has seized xylazine and fentanyl mixtures in 48 of 50 States. The DEA Laboratory System is reporting that in 2022 approximately 23% of fentanyl powder and 7% of fentanyl pills seized by the DEA contained xylazine.”

Earlier this year, the Philadelphia Department of Health announced that roughly 90% of opioid samples tested included xylazine. The drug, linked to sedation, altered mental status, wounds, skin ulcerations, hypotension, bradycardia, and high blood pressure, can be fatal.

Its effects on the central nervous system and side effects of respiratory depression make the drug a significant contributor to overdose deaths when mixed with opioids. Before the rise of xylazine contamination, overdoses in the US were predominantly linked to opioids. Officials believe that the new integration of xylazine into the illicit drug market will likely cause a rise in opioid overdoses and deaths.

In November 2022, the FDA warned healthcare professionals about xylazine exposure from illicit drug use. The announcement noted no data on naloxone efficacy in reversing the effects of xylazine, eliminating one harm-reduction strategy commonly used to minimize overdose deaths.

An attempt to produce a harm-reduction strategy by the Philadelphia Department of Health and the Center for Forensic Science Research and Education helped develop xylazine test strips. The strips, produced by BTNX Inc, detected xylazine with 85% specificity, 91% precision, and 100% sensitivity.

Researchers believe this tool could help minimize the effects of xylazine as its presence increases in the US illicit drug market. While additional research is necessary, investigators anticipate that distributing these strips can help drug users detect contaminated fentanyl.

As the opioid crisis progresses, healthcare providers are urged to consider the effects of xylazine when providing drug counseling and treating patients with a history of substance use.