Philly may get more federal money to address opioid crisis as alarm grows over xylazine, a dangerous and increasingly common drug additive

Nationwide alarm over fentanyl laced with xylazine, an additive that can lead to festering wounds, amputations, and overdoses, could bring new federal funding for enforcement and treatment to Philadelphia.

Last week, the White House Office of National Drug Control Policy designated the mix of fentanyl and xylazine an emerging national threat, which is prompting a review of federal resources to prevent the drug’s spread and mitigate its harm.

The White House has 90 days to give Congress a plan of action, said Rahul Gupta, director of the federal drug policy office, in a visit to Philadelphia on Wednesday. That could include diverting funds for wound care to injuries caused by xylazine, or allocating money dedicated to drug testing strips to boost the supply of tests for the additive.

“We are working right now with all the agencies within federal government, whether it’s Health and Human Services, Department of Justice, and others, to look at what exists right now, and how some of that funding could be utilized,” Gupta said.

Some of these funds could be available quickly, he said, though he didn’t say exactly how much might become available. The White House is also seeking additional funding from Congress, Gupta said, through a budget proposal that includes $46.1 billion for drug control.

Public health officials’ priority, said Cheryl Bettigole, Philadelphia’s health commissioner, is to keep people from dying of substance abuse.

“Our first and most fundamental responsibility is to keep people alive until they’re ready for treatment and then to connect them with the treatment they need,” she said.

About 75% of people who have had substance abuse disorders are in recovery, Bettigole said, giving hope that most people struggling with addiction can eventually manage it.

Gupta’s visit to Philadelphia will include stops in Kensington, the neighborhood hardest hit by the opioid crisis, and the Curran-Fromhold Correctional Facility. He noted about 65% of jail and prison inmates nationwide have some form of substance abuse disorder. Gupta said he hoped to learn fentanyl and xylazine response strategies in Philadelphia that could be expanded nationwide.

Xylazine is an animal tranquilizer approved for veterinary use but not human consumption. It began appearing in Philadelphia’s dope supply around 2020. (“Dope” is a catch-all term the city health department uses to denote drugs marketed as heroin or fentanyl, since the actual products are so variable.) By 2022, it was present in 90% of dope samples the health department tested.

In Philadelphia, xylazine was involved in more than 550 fatal overdoses in the city over the last two years, health officials said at the Wednesday news conference. In 2020, xylazine was involved in 377 deaths statewide.

Xylazine isn’t an opioid, though it also slows 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.

Nationwide, xylazine is one example of a shift toward more deadly, and entirely synthetic, drugs, Gupta said. Heroin, by contrast, is organic, since it is derived from poppies.

There are big gaps in drug experts’ knowledge of synthetic substances. Authorities aren’t certain whether the xylazine used in illegal drugs is being diverted from legally available supplies, or being made specifically for use in illicit drugs. It’s also unclear if it is coming from foreign or domestic sources, Gupta said.

Another class of synthetic opioids, nitazenes, 40 times more powerful than fentanyl, is emerging in the city, but health department officials say they are uncertain of how widespread that drug is.

Meanwhile, Gupta said, health officials are seeing a proliferation of social media accounts that promote drug use to young people. Federal authorities have launched their own social media campaign to inform people that fentanyl can be present in pills, and that it is legal to carry drugs that counteract fentanyl’s effects, like naloxone.

Health officials believe xylazine was initially added to fentanyl to produce a longer-lasting high. Fentanyl, a deadly synthetic opioid that replaced most of the heroin in the city’s drug supply in the mid-2010s, is more powerful than heroin, but its effects wear off more quickly, forcing people with addiction to inject multiple times a day in order to avoid withdrawal.

Many people who now take xylazine did not initially seek out the drug, but became dependent on it when it was added to the dope supply.

The drug causes serious withdrawal symptoms — severe chills, sweating, anxiety, and agitation among them — that many doctors are just learning to treat.

The threat from xylazine is increasingly spurring government action. On Tuesday, Pennsylvania Gov. Josh Shapiro declared it a Schedule III controlled substance. That will allow the state more scrutiny over the drug, including requiring that it be stored in locked facilities and making it possible to prosecute people for illegally possessing and selling it.

Last month, the Food and Drug Administration introduced restrictions that allow the agency to more closely scrutinize and detain shipments of xylazine and drug products that contain it.

Some advocates for reducing the harmful effects of drug use have raised alarms about cracking down on possession of xylazine and nitazenes. The Pennsylvania Harm Reduction Network, a statewide advocacy organization, said in a statement that it was concerned that such efforts would further criminalize and stigmatize drug users, and make it more difficult to conduct research.

While Bettigole has said she supports FDA restrictions on xylazine, harm reduction specialists in the health department have expressed concerns that the measure could send people addicted to it into withdrawal or prompt dealers to add new drugs to the supply to avoid the restrictions.