FAAX | The “Emerging Threat” Of Illicit Fentanyl & Xylazine

In the United States, most drug overdose deaths involve synthetic opioids such as fentanyl. Recently, the U.S. government identified another substance taking over the illicit drug supply: xylazine. This veterinary tranquilizer is often laced in fentanyl, a highly dangerous mixture.

On April 12th, 2023, the White House Office of National Drug Policy (ONDCP) declared fentanyl-adulterated or -associated xylazine (or “FAAX”) an emerging threat to the nation. Here’s what that means.

What Is Xylazine?

Xylazine (also known as “tranq” or “tranq dope”) is a non-opioid central nervous system depressant. The Food and Drug Administration (FDA) has approved it for use as a tranquilizer in horses and other large animals. It’s not approved for human use. 

When ingested by humans, xylazine can cause serious health problems, including:

• respiratory depression (slow, ineffective breathing)
• changes in blood pressure
• changes in heart rate
• skin ulcers and abscesses 
• skin necrosis (tissue death), which may lead to amputation 

In addition, people who regularly use xylazine may become physically dependent on it. If they stop using it, they may experience withdrawal symptoms such as anxiety, restlessness, and chest pain. 

Overdose Risk

Xylazine also poses a high risk of overdose, especially when mixed with other drugs that cause respiratory depression (including fentanyl). 

Because xylazine is not an opioid, it won’t respond to naloxone. Naloxone (brand name Narcan) is a medication that can quickly reverse an opioid overdose. This means overdoses involving xylazine are often harder to treat than overdoses that only involve opioids.

That being said, if an overdose is suspected, public health officials recommend you administer Narcan anyway.

Prevalence In U.S.

The U.S. Drug Enforcement Administration (DEA) first identified xylazine as an illicit drug adulterant in the early 2000s. At that time, it was only found in Puerto Rico. In 2006, it appeared in Philadelphia, Pennsylvania. Since then, it has slowly made its way to all 50 states. 

Dangerous Adulterant

Between 2020 and 2021, forensic laboratory identifications of xylazine increased throughout the country. The most significant increases occurred in the south (193%) and the west (112%).

Studies show that many people who ingest xylazine do so unknowingly. That’s because some drug traffickers secretly add xylazine to other illicit drugs, especially fentanyl. In 2022, xylazine appeared in 23% of fentanyl powders and 7% of fentanyl pills seized by the DEA.

Xylazine-Laced Fentanyl

The rise in xylazine-laced fentanyl has led to a significant increase in xylazine-related overdoses. 

From 2015 to 2020, overdoses involving xylazine in Pennsylvania (the first state to detect the drug) increased from 2% to 26%. The drug was also involved in 10% of Connecticut overdose deaths in 2020 and 19% of Maryland overdose deaths in 2021. 

Between 2020 and 2021, fatal overdoses involving xylazine increased over 100% in the northeast, over 500% in the Midwest, 750% in the west, and 1,127% in the south.

FAAX Officially Declared An “Emerging Threat”

To reduce overdose deaths, the White House Office of National Drug Control Policy (ONDCP) designated fentanyl-adulterated or -associated xylazine (FAAX) as an emerging threat to the United States. 

According to the White House announcement, xylazine is seriously threatening the nation’s ability to prevent overdose deaths and fight the opioid crisis.

This designation marks the first time that an administration has declared a drug an emerging threat to the country. The administration now has 90 days to announce a national response. This response will include strategies such as:

• xylazine testing, treatment, and supportive care
• strategies to decrease the illicit xylazine supply
• comprehensive data systems, including information on drug sourcing and supply
• rapid research, including research on interactions between xylazine and fentanyl

According to Dr. Rahul Gupta, Director of the ONDCP,  the designation sends a clear message to drug traffickers that the ONDCP is prepared to fight the rise of FAAX and save numerous lives.

The Combating Illicit Xylazine Act

The ONCDP’s emerging threat declaration is not the government’s only response to xylazine-laced fentanyl. In March, the Combating Illicit Xylazine Act was introduced in the House and Senate. This bipartisan bill seeks to:

• classify xylazine as a Schedule III Controlled Substance
• establish harsher penalties for people who manufacture and sell xylazine 
• require legal xylazine manufacturers to send production and distribution reports to the DEA so it can more easily detect black market diversion

If passed, this bill could help reduce overdoses and other health problems caused by xylazine-laced drugs.

If you or someone you love struggles with substance use, please reach out to an Ark Behavioral Health specialist. Our board-certified healthcare providers offer medical detox, behavioral therapy, and other evidence-based treatments to help you or your loved one stay drug-free.