Philly’s health chief backs restricting xylazine, the animal tranquilizer in city opioids

Philadelphia’s health commissioner says her department supports new Food and Drug Administration restrictions around shipments of xylazine, the veterinary tranquilizer that’s contaminated most of the city’s illicit opioid supply — and has been advocating for classifying the drug as a controlled substance.

Commissioner Cheryl Bettigole’s remarks came a day after the department issued a statement from its harm-reduction division, raising concerns about the implications of the FDA’s decision, which was announced earlier this week.

That statement said the department understood the FDA’s new restrictions, which would allow agents to more closely scrutinize and detain shipments of xylazine, were “motivated by concern for the welfare of people who use drugs.”

But, the statement continued, the division was concerned that if xylazine were to disappear from the drug supply, it would send people addicted to it into serious withdrawal. Because xylazine is not an opioid, many doctors are only just beginning to learn how to treat its withdrawal symptoms — severe chills, agitation, and anxiety.

In the statement and a subsequent interview Friday, staffers said they were also concerned that the move could lead dealers to introduce newer, unfamiliar, and possibly more potent drugs to the city’s illicit supply to get around restrictions on xylazine.

On Saturday, Bettigole said she’s also concerned about treating withdrawal and the possibility of new drugs emerging in the city. But, she said, her staffers’ statements “didn’t express the full flavor of our position.”

She and Mayor Jim Kenney have personally advocated for xylazine to be classified as a controlled substance at the federal level, she said. In an August letter to Pennsylvania’s congressional delegation, Kenney requested that the Drug Enforcement Administration issue an emergency declaration classifying xylazine as a Schedule I controlled substance, which he said would restrict sales of xylazine and require legitimate buyers to keep records of their inventories that could be inspected by federal agents.

Xylazine emerged in Philadelphia’s drug supply around 2020. Many drug users here did not seek it out. Rather, it’s believed dealers added it to fentanyl, the deadly synthetic opioid that’s replaced most of the city’s heroin, to deliver a longer-lasting high. Fentanyl is more powerful than heroin but has a shorter half-life, meaning its effects wear off more quickly, forcing people with addiction to inject multiple times a day to avoid withdrawal.

Xylazine’s side effects, however, have wreaked havoc for drug users and the people who care for them in Philadelphia. It isn’t an opioid, but it also slows the breathing, and its effects can’t be treated with naloxone, the drug used to reverse opioid overdoses. Its effect on the vascular system is also believed to be behind the serious wounds that many xylazine users suffer — wounds that open easily and heal slowly, putting people at risk for infections and even amputations.

It’s unclear what immediate effect the new restrictions might have on the street; the Washington Post reported Feb. 28 that an FDA spokesperson said the agency does not “fully understand” the sources of xylazine for illicit use.

While she believes it’s necessary to restrict xylazine shipments, Bettigole said the department will still prepare for treating the withdrawals that restrictions might produce and will monitor the drug supply for the emergence of any new drugs that could replace xylazine. In recent months, the department has worked to publicize protocols for physicians treating xylazine withdrawal.

The department would follow a similar protocol around efforts to block other drugs, she said. “If we could get rid of fentanyl, if we could just block fentanyl from coming into the U.S., we would have to worry about withdrawal and about other opioids that might enter the drug market,” she said. “We would need to be prepared for that. But tens of thousands of lives would be saved.”