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Pennsylvania health officials issue temporary order criminalizing xylazine, also known as 'tranq'

 A syringe disposed in sand.
Elaine Thompson

State officials have taken formal action to regulate the spread of xylazine, a powerful veterinary tranquilizer increasingly found in street opioid supplies.

A temporary order classifying xylazine as a Schedule III controlled substance took effect in Pennsylvania during the weekend. The move will allow law enforcement to impose additional penalties on those charged with manufacturing or distributing the drug, according to Acting Secretary of Health Debra Bogen.

“This action will protect veterinarians and other legitimate users and manufacturers of xylazine, which is an important medication for animal sedation, while also creating penalties for people who add illicit xylazine to the drug supply that is harming people in our communities,” Bogen said in a statement Friday. “Our focus remains on developing strategies that help connect people with substance-use disorder to treatment and other resources.” 

Xylazine, when consumed by humans, can depress breathing, heart rate and blood pressure to critical levels. But because the sedative is not an opioid, the overdose-reversal drug naloxone — commonly sold as Narcan — can’t reverse its effects alone. (Health officials still recommend responders administer naloxone when signs of an overdose are present because xylazine is most often mixed with opioids such as fentanyl.)

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Under the state’s 1972 Controlled Substance, Drug, Device and Cosmetic Act, anyone who manufactures or distributes a class III narcotic could face up to five years in prison, as well as a $15,000 fine.

“Scheduling xylazine will allow law enforcement and prosecutors to investigate and hold drug traffickers seeking to sell it in our communities, often to unsuspecting users, accountable,”  said Greg Rowe, executive director of the Pennsylvania District Attorneys’ Association.

The one-year order cements penalties while lawmakers wait for further federal action to regulate the drug. While representatives in the U.S. House introduced legislation to schedule xylazine in March, the bill has yet to make it out of committee.

Pennsylvania is one of five states — including West Virginia, Florida, Delaware and Ohio — that have scheduled the drug locally in the meantime.

Officials will have the chance to extend the order for one additional year next June, although permanent scheduling would require a change in regulation or through legislation. A DOH spokesperson said the agency has taken this action while it works with the General Assembly to address the issue legislatively.

Some advocates, however, are concerned that the order will increase the risk faced by people who are addicted to the drug.

“It doesn't limit the penalties to these mass producers that are putting this in the drug supply,” said Carla Sofronski, executive director of the Pennsylvania Harm Reduction Network. “We know that typically when law enforcement cannot capture their target points, they go for the low-level dealers who typically are people who suffer with a substance-use disorder.”

Xylazine was found in just one Pennsylvania county in 2017, but by 2021 it had spread to 37 of the state’s 67 counties, according to preliminary overdose death records.

The number of statewide reported overdose deaths involving xylazine during that time jumped from 90 to 575. But because the drug is frequently combined with fentanyl — a highly toxic synthetic opioid — researchers have yet to determine just how fatal or addictive xylazine is on its own.

Schedule III controlled substances, per the U.S. Drug Enforcement Administration, have a moderate to low potential for physical and psychological dependence.

“But from a criminal justice standpoint, it does lead to pretty significant sentences that impact a lot of marginalized communities,” said Dr. Divya Venkat, co-director of Allegheny Health Network’s clinic for formerly incarcerated people.

Many patients, Venkat said, worry they will be at risk of reincarceration if they enter a health care setting with the complex tissue wounds often associated with xylazine use.

“Instead of making it scary for someone to interact with health care, we should be really investing in programs like overdose prevention and ways to make sure that the people who are using drugs are kept the most safe and healthiest,” she continued.

Sofronski with PAHRN said the state should take a “public health approach” and invest in treatment and drug-checking programs instead.

She shared those priorities in a meeting with Acting Secretary Bogen prior to the order last week, but she said officials failed to provide concrete public health measures that will supplement the order.

In an email to WESA, health department officials maintained they are taking a “multidisciplinary approach” by investing in intervention, treatment, prevention and public safety efforts. They did not specify further action.

But the effort to curb the spread of xylazine won’t stop other fatal substances from emerging to take its place.

“Criminalizing a substance — scheduling a substance — doesn’t stop the drug supply from evolving. It never has,” said Jordan Scott, a field organizer with PAHRN. “All it does is fuel an unregulated drug supply.”

Jillian Forstadt is an education reporter at 90.5 WESA. Before moving to Pittsburgh, she covered affordable housing, homelessness and rural health care at WSKG Public Radio in Binghamton, New York. Her reporting has appeared on NPR’s Morning Edition.