In Continued Fight Against Overdose Epidemic, the White House Releases National Response Plan to Address the Emerging Threat of Fentanyl Combined with Xylazine

Earlier this year, Biden-Harris Administration used executive designation authority for the first time to declare xylazine combined with fentanyl as an emerging threat to the United States

Washington, D.C. – Today, in the continued efforts to fight the dangerous and deadly combination of xylazine mixed with fentanyl, the White House Office of National Drug Control Policy (ONDCP) released a National Response Plan to coordinate a whole-of-government response against this threat. Earlier this spring, ONDCP Director Dr. Gupta used an executive designation authority to designate fentanyl combined with xylazine as an emerging threat to the United States and proactively address this dangerous threat head-on.

“Since we announced the emerging drug threat earlier this year, we’ve been working tirelessly to create the best plan of attack to address this dangerous and deadly substance head-on,” said Dr. Gupta. “Now, with this National Response Plan, we are launching coordinated efforts across all of government to ensure we are using every lever we have to protect public health and public safety, and save lives. As a doctor, I have seen the devastating consequences of xylazine combined with fentanyl firsthand. And as President Biden’s drug policy advisor, I am laser-focused on finding every tool we have and following the best evidence-based practices to take on this new challenge. This will be an all-hands-on-deck effort – but I am confident we can take action together and eradicate this emerging threat.”

Xylazine has been detected in nearly every state in the country. The Biden-Harris Administration made this designation for the first time in U.S. history due to xylazine’s growing role in overdose deaths nationwide, and since the designation, data from the Centers for Disease Control and Prevention (CDC) have continued to show an increase in xylazine-related overdose deaths. In a new report released last month, the monthly percentage of illegally manufactured fentanyl-involved deaths with xylazine detected increased 276% (from 2.9% to 10.9%) between January 2019 and June 2022.

A first-of-its-kind National Response Plan outlines action steps the federal government will pursue to address this threat, protect public health and public safety, and save lives. This includes both short- and longer-term action steps to provide immediate relief to communities across the nation, and to support the large-scale efforts needed to eradicate this threat.

The plan released today focuses on six pillars of action:

1. Testing
2. Data Collection
3. Evidence-Based Prevention, Harm Reduction, and Treatment
4. Supply Reduction
5. Scheduling
6. Research

The plan outlines action steps and key responsibilities for departments and agencies across the federal government, and directs them to develop and submit an Implementation Report to the White House in 60 days. As required by statute in the SUPPORT Act and the Criteria for Designating Evolving and Emerging Drug Threats (Dir. No. 2022-002), the goal of the National Response Plan is the termination of fentanyl combined with xylazine as an emerging threat. This will require a 15% reduction (compared to 2022 as the baseline year) of xylazine positive drug poisoning deaths in at least three of four U.S. census regions by 2025.

The Biden-Harris Administration has ramped up national response efforts over the last several months, including the following actions taken by agencies across government. In December, Dr. Gupta hosted a listening session with public health and public safety leaders and subject matter experts from several states and territories about trends they are seeing related to xylazine and efforts to address these trends. In January, Dr. Gupta convened the Evolving and Emerging Threats Committee to discuss the emergence of fentanyl adulterated with xylazine in the illicit drug supply. In February, the U.S. Food and Drug Administration took action to restrict the unlawful entry of xylazine active pharmaceutical ingredients and finished dosage form drug products into the country to address the growing public health concern. In March, the U.S. Drug Enforcement Administration issued a public safety alert to warn the American public of a sharp increase in the trafficking of fentanyl mixed with xylazine.

Since the designation on April 12, ONDCP has convened federal government departments and agencies to develop and implement the National Response Plan. ONDCP has also been meeting with state and local leaders and subject matter experts, including Drug Free Community grantees, High Intensity Drug Trafficking Areas (HIDTA) grantees, Association of State and Territorial Health Officials, the American Veterinary Medical Association, States Attorneys General, law enforcement leaders, frontline health care and emergency services providers, individuals with lived experience, and more. The National Institute on Drug Abuse (NIDA) also convened health care professionals and federal partners to review currently available best practices in xylazine-related testing, treatment, and wound care to inform evolving best-practices in the field.

While this plan outlines action steps the federal government will pursue to address the emerging threat, it will require a whole-of-society effort to save lives. The National Response Plan also notes practical steps states and individuals can take to help address this issue:

• Healthcare providers are encouraged to be on the alert for signs and symptoms of patients’ exposure to fentanyl adulterated with xylazine and to provide effective care for overdose and wounds, and initiate or transfer care to opioid use disorder treatment services wherever these patients are encountered.
• State, county, and city health authorities are encouraged to proactively seek out those believed to be consuming fentanyl adulterated with xylazine to offer mobile, low-threshold care before their conditions worsen.
• Addiction treatment and emergency responders should consult with experts on xylazine detoxification methods to understand emerging practices.
• Law enforcement and elected officials must coordinate with their public health colleagues in order to enhance the efficacy of their efforts to reduce and disrupt the illicit supply chain and go after traffickers.
• Community-based programs will be amongst the first to interface with individuals vulnerable to fentanyl adulterated with xylazine and will be key partners in these efforts.

Read the full National Response Plan to Fentanyl Combined with Xylazine HERE.

Read about the Biden-⁠Harris Administration’s efforts to crack down on illicit fentanyl supply chains HERE.

Read the Biden-Harris Administration’s National Drug Control Strategy HERE.

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