White House Releases National Response Plan to Address Fentanyl and Xylazine Combination

Staff report

WASHINGTON, DC – July 11, 2023

The White House Office of National Drug Control Policy (ONDCP) has unveiled a National Response Plan aimed at combating the lethal combination of fentanyl mixed with xylazine. The plan seeks to coordinate a comprehensive response across various government agencies to counter this emerging threat. Earlier this year, ONDCP Director Dr. Gupta utilized executive designation authority to declare the mixture of fentanyl and xylazine as a significant danger to the United States, demonstrating a proactive approach to addressing this peril.

Dr. Gupta emphasized the efforts undertaken since the announcement of the drug threat earlier this year. The National Response Plan will now facilitate a concerted endeavor across the government, utilizing all available resources to safeguard public health, ensure public safety, and save lives. Drawing on firsthand experiences as a doctor witnessing the devastating consequences of the fentanyl-xylazine combination and as President Biden’s drug policy advisor, Dr. Gupta remains committed to leveraging evidence-based practices and employing every possible measure to confront this new challenge. The implementation of the plan will require an all-hands-on-deck approach, but Dr. Gupta expressed confidence in the collective action to eradicate this emerging threat.

Xylazine has been detected in nearly every state in the country, prompting the Biden-Harris Administration to make this designation for the first time in U.S. history due to its increasing role in overdose deaths nationwide. The Centers for Disease Control and Prevention (CDC) has reported a continuous rise in xylazine-related overdose deaths, as indicated by a recent release. Between January 2019 and June 2022, the monthly percentage of illicitly manufactured fentanyl-involved deaths with xylazine detected surged by 276%, escalating from 2.9% to 10.9%.

The National Response Plan represents a pioneering effort, delineating immediate and long-term actions that the federal government will pursue to address this threat, provide prompt relief to affected communities nationwide. The plan focuses on six key areas of action: testing, data collection, evidence-based prevention, harm reduction and treatment, supply reduction, scheduling, and research.

Each department and agency within the federal government will be responsible for specific action steps outlined in the plan. These entities are directed to develop and submit an Implementation Report to the White House within 60 days. The National Response Plan, in accordance with the SUPPORT Act and the Criteria for Designating Evolving and Emerging Drug Threats, aims to terminate the fentanyl-xylazine combination as an emerging threat. This goal necessitates a 15% reduction in xylazine-positive drug poisoning deaths (compared to the baseline year of 2022) in at least three of the four U.S. census regions by 2025.

Over the past months, the Biden-Harris Administration has escalated its national response efforts. Dr. Gupta held a listening session in December with public health and public safety leaders and subject matter experts from various states and territories to discuss trends related to xylazine and the measures taken to address these trends. In January, the Evolving and Emerging Threats Committee was convened to examine 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, acknowledging the growing public health concern. Additionally, in March, the U.S. Drug Enforcement Administration issued a public safety alert to warn the American public about the sharp increase in the trafficking of fentanyl mixed with xylazine.

Since the designation in April, ONDCP has been collaborating with federal government departments and agencies to develop and implement the National Response Plan. Furthermore, ONDCP has engaged with state and local leaders, subject matter experts, and various organizations, including Drug Free Community grantees, High Intensity Drug Trafficking Areas (HIDTA) grantees, the Association of State and Territorial Health Officials, the American Veterinary Medical Association, State Attorneys General, law enforcement leaders, frontline healthcare providers, emergency services providers, individuals with lived experience, and others. The National Institute on Drug Abuse (NIDA) has also facilitated discussions among healthcare professionals and federal partners to review current best practices regarding testing, treatment, and wound care related to xylazine, thereby informing evolving best practices in the field.

Healthcare providers are encouraged to remain vigilant for signs and symptoms of patients exposed to fentanyl adulterated with xylazine and to provide effective care for overdose and wounds while initiating or transferring care to opioid use disorder treatment services whenever necessary. State, county, and city health authorities are advised to actively seek out individuals believed to be consuming fentanyl adulterated with xylazine, offering mobile, low-threshold care before their conditions worsen.

Addiction treatment and emergency responders are urged to consult with experts on xylazine detoxification methods to stay informed about emerging practices. Law enforcement and elected officials are urged to coordinate with public health colleagues to enhance the effectiveness of their efforts in reducing and disrupting the illicit supply chain, targeting traffickers. Community-based programs are recognized as pivotal partners in these endeavors as they are often the first point of contact for individuals vulnerable to fentanyl adulterated with xylazine.

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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