The fight over a drug that is great for horses but horrific for humans
Penny, a 3-year-old sorrel mare with a white blaze, had been slobbering her feed and fighting her bit, signs of a likely toothache. An exam confirmed that she needed two wolf teeth extracted and the sharp edges of some molars ground down, procedures that required propping her jaws open with a speculum.
To protect Penny from pain, and to protect himself from the kick of a horse who outweighed him tenfold, Boyd Spratling, Penny’s veterinarian, gave her a shot of xylazine, a common animal tranquilizer. Within moments, her long neck drooped and her eyelids fluttered at half-mast. Forty-five minutes later, dental surgery done, Penny sauntered out of the clinic in rural Nevada and into her trailer.
To Spratling, xylazine is a vital analgesic and sedative, which he also occasionally uses in cattle, for procedures such as C-sections in cows and penile injury repairs in bulls. It’s a staple for zoo veterinarians, too.
But in the past few years, the drug has also turned into something else: a cheap, addictive adulterant to illicit fentanyl that is contributing to the rise in overdose deaths around the country. The xylazine-fentanyl combo, known in the drug trade as “tranq dope,” is a life-threatening mix that depresses breathing, heart rate and blood pressure, and can cause blackened, chemical burnlike flesh wounds that can lead to amputation.
In a xylazine alert in March, the Drug Enforcement Administration said that in 2022, it had detected the drug in nearly one-fourth of the confiscated fentanyl samples in 48 states.
Last week, the White House’s Office of National Drug Control Policy designated the drug mix as an “emerging drug threat,” a classification that requires the office to devise a governmentwide intervention plan. But addressing the threat is proving to be a tricky balancing act involving stakeholders in areas as disparate as addiction medicine, commercial livestock and law enforcement. The challenge is to walk a careful line by managing a drug that is essential for veterinarians but is fueling a public health crisis.
Law enforcement agents are pressing for xylazine to be listed as a controlled substance, which would criminalize distribution for human use. Currently, police can’t arrest a person for sales or distribution of xylazine. Their resources to track down its production are modest. A controlled-substance designation would make a crucial difference, law enforcement officials said.
But veterinarians fear that if that happened, their access to the medicine would be heavily regulated. They would have to maintain separate logbooks for federal inspection. More worrisome: Production of a classified drug would require additional quality control and security measures so costly that a manufacturer could raise the drug’s price or just stop making it altogether.
“When we first starting seeing on the news that xylazine was being mixed with fentanyl, we were horrified,” said Spratling, who keeps his xylazine in a double-locked container.
But, he added, “let’s not shoot from the hip because then the people who really pay the price, regulatory-wise, are the ones who have been using it in a responsible manner all along.”
Some addiction-medicine specialists and harm-reduction groups have different worries. They fear that new tough restrictions could set off a domino effect of the sort that contributed to the fentanyl crisis, including criminal charges against people with substance-use disorders.
Authorizing a drug to be listed as a federal controlled substance can be done either by Congress or jointly by the Food and Drug Administration and the DEA.
A state can also list the drug. On Tuesday, Gov. Josh Shapiro of Pennsylvania, where the Philadelphia neighborhood of Kensington is ground zero for tranq dope, announced that his administration was doing so.
Shapiro spokesperson Manuel Bonder said the governor had decided to move ahead with the designation “rather than wait for any future possibilities in D.C.”
Xylazine was approved by the FDA for veterinary procedures in 1972. Since then, it has been used for procedures on sheep, deer, elk, and even cats and dogs, as well as horses and cattle. Earlier trials in humans had been shut down because the drug led to respiratory depression, so manufacturers never sought approval for human use. Until now, there has been insufficient incentive to research its impact on people. Its causal relationship to the flesh wounds that can result from its use is not understood. And unlike the protocols for opioids, those for reversing tranq-dope withdrawal or managing rehabilitation have not been standardized.
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