White House Releases National Response Plan to Address Fentanyl Mixed With Xylazine

In July the White House Office of National Drug Control Policy (ONDCP) released a National Response Plan to coordinate the government’s response to the threat of the veterinary tranquilizer xylazine mixed with fentanyl. According to a statement issued by the White House, the goal of the National Response Plan is the termination of fentanyl combined with xylazine as an emerging threat. Meeting this goal will require a 15% reduction of xylazine-positive overdose deaths in at least three of four U.S. census regions by 2025.

The plan focuses on the following six pillars of action:

• Testing, including creating standardized practices across drug analysis laboratories, medical examiners and coroners, and public health laboratories, and scaling up forensic testing and postmortem toxicology testing to better estimate population-level usage of or exposure to xylazine, alone or in combination with other drugs, especially fentanyl.

• Data collection, including developing a comprehensive epidemiologic data system, creating a central repository of key data, and developing a “dashboard” of the spread and impact of xylazine-adulterated fentanyl on counties across the country.

• Evidence-based prevention, harm reduction, and treatment, including developing and disseminating best practices in the clinical stabilization of patients exposed to xylazine, withdrawal management, and treatment protocols.

• Supply reduction, including identifying the illicit supply chain of xylazine and regulating the supply chain to ensure the availability of xylazine for legitimate use in animals and research.

• Scheduling, including scheduling of xylazine while simultaneously maintaining the legitimate supply of xylazine in veterinary medicine and discussing whether any potential regulatory actions should be xylazine-specific or for a broader class of drugs or pharmacologically similar substances that could replace xylazine as a fentanyl adulterant.

• Research, including studying drug-drug interactions involving xylazine, the effects of xylazine on human physiology and behavior, and potential antidotes for use in humans.

“It is essential that psychiatrists and other mental health professionals take a proactive role in addressing the emerging threat of xylazine and offer guidance to policymakers,” said APA President Petros Levounis, M.D., M.A. “We see firsthand how substance use disorders and xylazine affect our patients, and we can use our experience and expertise to provide input on the kinds of treatments and harm reduction efforts that will have the greatest chance of success.” ■