Penny, a 3-year-old sorrel mare, was blazing with white flames, drooling at food and fighting clenching.Her examination confirmed that she needed two of her wolf teeth The teeth were extracted, the sharp edges of some molars were shaved, and a procedure was performed that required holding the jaw open with a speculum.
To protect Penny from pain and horse kicks that outnumbered him tenfold, Penny’s veterinarian, Boyd Splatling, injected her with xylazine, a common animal tranquilizer. In a moment her long neck drooped and her eyelids fluttered on her half-mast. Forty-five minutes later, after her dental surgery, Penny left the clinic in rural Nevada and climbed into her trailer.
For Dr. Spratling, xylazine is an important analgesic and sedative, and is occasionally used in cattle for procedures such as caesarean sections in cattle and repair of penile injuries in bulls. It’s also a must-have for zoo veterinarians.
But in the last few years, the drug has also changed into something else. It’s a cheap and addictive adulteration to illicit fentanyl that’s contributing to a rise in overdose deaths across the country. , is a life-threatening mixture that can lower blood pressure and cause blackened, chemical burn-like flesh wounds that can lead to amputation.
and xylazine alert In March, the Drug Enforcement Administration announced that the drug would be found in nearly a quarter of fentanyl samples seized in 48 states in 2022.
Last week, the White House’s Office of National Drug Control Policy designated drug mixtures as a “new drug threat.” This is a classification that requires the development of a government-wide intervention plan. Addressing this threat, however, is proving to be a difficult balancing act, involving stakeholders from various sectors such as addiction medicine, commercial livestock and law enforcement. is to take a prudent path by controlling drugs that are essential to veterinarians but are contributing to a public health crisis.
Law enforcement agencies are seeking to list xylazine as a controlled substance that criminalizes distribution for human use. Currently, police cannot arrest anyone for selling or distributing xylazine. Their resources for tracking its production are modest. According to law enforcement officials, the designation of controlled substances would make a crucial difference.
But veterinarians fear access to the drug will be severely regulated if that happens. They will have to maintain separate logbooks for federal testing. However, the additional quality control and security measures required to manufacture classified medicines are so costly that manufacturers may increase the price of the medicines or stop manufacturing them altogether. There is something.
“When we first started seeing the news that xylazine was being mixed with fentanyl, we were horrified,” said Dr. Spratling, who keeps xylazine in double-lock containers.
But he said, “The people who really pay the price when it comes to regulation are the people who have been using it in a responsible way all along, so let’s not shoot it out of the hip.”
Some addiction medicine experts and harm reduction groups have different concerns. They fear the new stringent restrictions could trigger the kind of domino effect that contributed to the fentanyl crisis, including criminal prosecution against people with substance use disorders.
Approving drugs for listing as federally controlled substances can be done by Congress or jointly by the Food and Drug Administration and the DEA.
States can also list drugs. Pennsylvania Gov. Josh Shapiro said on Tuesday that Kensington’s Philadelphia area is ground zero for Trunk Dope. announced what his administration was doing.
A spokesman for Gov. Manuel Bonder said Shapiro had decided to go ahead with the designation “rather than wait for future possibilities in D.C.”
Xylazine was approved for veterinary treatment by the FDA in 1972. sheep, deer, moose Not only for cats and dogs, but also for horses and cows. Earlier trials in humans were discontinued because the drug caused respiratory depression, so the manufacturer did not seek approval for human use. So far, there have been insufficient incentives to study the impact on people. A causal relationship with the bruising of the flesh that may result from its use is not understood. Also, unlike protocols for opioids, there is no standardized protocol for reversing trunk his dope withdrawal or administering rehabilitation.
last month, bipartisan bill Proposed to both houses of Congress by members of local states including Nevada, Iowa, New Hampshire, California, Florida, Texas and Colorado. , suggesting that those who use it for “illegal” purposes, i.e. for sale or distribution for human use, face the same problem. penalties As if it were listed as a Schedule III drug, including fines of up to $500,000 and imprisonment of up to 10 years.
Regulated substance They are classified according to their medical need and potential for abuse or addiction. Schedule III includes buprenorphine and the anticonvulsant gabapentin. By comparison, Schedule I includes heroin and LSD Schedule II includes oxycodone and fentanyl prescribed for pain.
Legislators said the road was a hard-fought middle road for bipartisan support and they wanted a fast track to passage.
“Due to the devastating effects we are seeing, we must ensure that human use is outlawed, but we are working with ranchers and ranchers in my state to ensure that horses and large animals are Nevada Democratic Senator Catherine Cortez Mast, along with Iowa Republican Senator Chuck Grassley and New Hampshire Democratic Senator Maggie Hassan, introduced the bill. .
Their bill is endorsed by the veterinary, rancher, and police associations. If enacted, the manufacturer would be required to strengthen record keeping for xylazine and send tracking reports to her DEA database. Law enforcement can track dealers.
However, it exempts the legal use of xylazine for “administration to non-human species”.
Domestically produced veterinary-grade xylazine usually comes as a liquid in a vial, whereas bulk xylazine is labeled as an inexpensive powder and is likely imported. Did.
Beau Kilmer, co-director of the RAND Center for Drug Policy Research, said: The DEA reports finding empty xylazine bottles in caches in the United States, so there is commingling going on here, but is commingling in the US responsible for the majority or minority of cases?”
But at this stage, it’s unclear what impact scheduling will actually have on human consumption and health, he said.
Many harm reduction groups and drug policy experts question the long-term effectiveness of xylazine scheduling.
The history of recent efforts to tighten prescription pain medication management highlights some of their concerns. As federal and state agencies imposed strict regulations on prescription opioids, drug dealers and drug users turned to using illicit opioids such as heroin, counterfeit pills, and illegal fentanyl. Many people arrested as sellers are dependent on those drugs.
Maritza Perez Medina, director of federal affairs at the Drug Policy Alliance, a nonprofit harm reduction organization, said she fears that criminalizing xylazine will not materially address the problem. The crackdown has put us in a game of whack-a-mole: when you try to eradicate one drug, a new one comes out.”
Xylazine began appearing sporadically in the 2000s as an addictive alternative to heroin. In 2011, Observed studies People in rural Puerto Rico were injecting their horses with anesthesia and developing serious lesions.
Around 2006, drugs were found in Kensington, near Philadelphia. sizable Puerto Rican population. began to be used there escalate Around 2018, then spread all over northeastwhich follows the route of fentanyl.
Addiction medicine experts said their main concern is mitigating the health hazards caused by xylazine. It urged that the newly introduced xylazine test strips be as widely distributed as the fentanyl test strips.
But Dr. Joseph Drazio, director of medical toxicology and addiction medicine at Temple University Hospital in Philadelphia, who has treated hundreds of patients about the effects of trunk dope, says street drugs are far too common. are mixed with different additives, and the strip falls short of what is needed to save a life.
He said the immediate focus should be on developing better therapies to manage acute withdrawal from xylazine. This is because current medications are not sufficient to compete with the doses of fentanyl and xylazine found on the street.”
Dr. Spratling is amazed that xylazine has become a wildfire. “I have been using xylazine for his 45 years and have never seen a horse develop skin ulcers or lesions. rice field.
Young mare Penny not only thrived on injections of xylazine, but also recovered quickly from dental surgery. Her spirit and mouth healed, and a few weeks ago she performed well at a local county equestrian competition.
But Dr. Spratling, who uses xylazine for treatment at least six times a week, is concerned. He said many veterinarians would have a simple reaction if the government regulated the drug for him and his colleagues. rice field.
