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Fentanyl combined with xylazine designated an emerging threat to the United States


This veterinary tranquilizer has a growing role in overdose deaths across the country

Photo: Todorean Gabriel/Adobe Stock

Photo: Todorean Gabriel/Adobe Stock

Fentanyl adulterated or associated with xylazine was officially designated an emerging threat to the United States by Rahul Gupta, MD, MPH, FACP, MBA, director of the White House Office of National Drug Control Policy (ONDCP). This designation authority is being used for the first time since it was established by Congress in 2018.

“As a physician, I am deeply troubled about the devastating impact of the fentanyl-xylazine combination, and as President Biden’s drug policy advisor, I am immensely concerned about what this threat means for the nation,” said Gupta, in a White House press release.1 “By declaring xylazine combined with fentanyl as an emerging threat, we are being proactive in our approach to save lives and creating new tools for public health and public safety officials and communities across the nation.

"To parents, loved ones, community leaders, and those affected by xylazine use: I want you to know that help is on the way,” she continued.

According to the release,1 the ONDCP is required to monitor novel and evolving patterns of substance use, establish criteria to determine when a substance or combination of substances should be designated an emerging threat, and then declare emerging threats when the director deems appropriate based on the criteria.1 Published earlier this year, the criteria focuses on the geographic presence of the emerging threat and impact measured by metrics like overdoses in a year.

Gupta's decision to make this designation is because xylazine combined with fentanyl is illicitly being sold and has created significant and quickly worsening negative health consequences.1 Findings from the DEA include:2

  • Between 2020 and 2021, forensic laboratory identifications of xylazine rose in all 4 United States census regions, most notably in the South (193%) and the West (112%).
  • Xylazine-positive overdose deaths increased by 1127% in the South, 750% in the West, more than 500% in the Midwest, and more than 100% in the Northeast.

The Biden-Harries Administration will follow the designation by taking steps to publish a whole-of-government response that includes evidence-based prevention, treatment, and supply reduction, according to the White House. The federal government now has the power to put together resources to help counteract the illegal supply of xylazine combinations found across the US. The ONDCP will create an interagency working group to help create the national response plan, including comprehensive data systems, work on xylazine testing, strategies to reduce illicit supply, rapid research to understand the interactions between fentanyl and xylazine, and treatment and supportive care protocols.1

Additionally, on March 28, 2023, the Combating Illicit Xylazine Act was introduced to Congress in response to the drugs increasing presence on the street. The American Veterinary Medical Association (AVMA)-backed bill will help law enforcement by providing additional tools to trafficking xylazine while preserving a veterinarian’s ability to use xylazine legitimately.3 The AVMA has also issued a call to action, urging veterinary advocates to reach out to support the legislation to their members of congress.


  1. Biden-⁠Harris Administration Designates Fentanyl Combined with Xylazine as an Emerging Threat to the United States. News release. The White House. April 12, 2023. Accessed April 13, 2023. https://www.whitehouse.gov/ondcp/briefing-room/2023/04/12/biden-harris-administration-designates-fentanyl-combined-with-xylazine-as-an-emerging-threat-to-the-united-states/
  2. The Growing Threat of Xylazine and its Mixture with Illicit Drugs. Dea.gov. Accessed April 13, 2023. https://www.dea.gov/sites/default/files/2022-12/The%20Growing%20Threat%20of%20Xylazine%20and%20its%20Mixture%20with%20Illicit%20Drugs.pdf
  3. Illicit xylazine, fentanyl combination decreed ‘emerging threat’. News release. American Veterinary Medical Association. News release. American Veterinary Medical Association. April 12, 2023. Accessed April 13, 2023. https://www.avma.org/news/illicit-xylazine-fentanyl-combination-decreed-emerging-threat?utm_source=delivra&utm_medium=email&utm_campaign=todays-headlines-news
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