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As feds try to crack down on xylazine, the animal sedative in Philly’s volatile drug supply, advocates warn the move could bring on severe withdrawal in people with addiction

Philadelphia's health department is warning that the move could harm people who use drugs in a city where many are already physically dependent on “tranq dope.”

Jen Shinefeld, a volunteer, cleans the wounds on the hands of a man named C.J. at Savage Sisters, an outreach organization based in Kensington, in Philadelphia in January. The staff at Savage Sisters help treat wounds from xylazine, an animal tranquilizer that has contaminated much of the city's opioid supply. Recently, the Food and Drug Administration announced that it would restrict imports of the drug, prompting some advocates to raise concerns that people who use drugs in Philadelphia, many of whom are already dependent on xylazine, will suffer serious withdrawal.
Jen Shinefeld, a volunteer, cleans the wounds on the hands of a man named C.J. at Savage Sisters, an outreach organization based in Kensington, in Philadelphia in January. The staff at Savage Sisters help treat wounds from xylazine, an animal tranquilizer that has contaminated much of the city's opioid supply. Recently, the Food and Drug Administration announced that it would restrict imports of the drug, prompting some advocates to raise concerns that people who use drugs in Philadelphia, many of whom are already dependent on xylazine, will suffer serious withdrawal.Read moreHeather Khalifa / Staff Photographer

The Food and Drug Administration this week announced that it would place restrictions on the import of xylazine — the animal tranquilizer that has contaminated much of Philadelphia’s illicit opioid supply, causing serious wounds and intense withdrawals that aren’t easily treated.

The new rules will allow FDA agents to more closely scrutinize and detain shipments of xylazine and drug products that contain it, the agency says. In Philadelphia, the move was applauded by a city Council member who — with unanimous support from the rest of Council — has called for state legislators to list xylazine, which is legal for veterinary use, as a controlled substance.

“I think restricting the import of it or ensuring that it’s going to the appropriate hands — that of veterinarians — is important,” said Councilmember Quetcy Lozada, who represents parts of Kensington, where xylazine use is prevalent, and sponsored the resolution.

It’s unclear what immediate effect the new restrictions might have on the street; the Washington Post reported Feb. 28 that an FDA spokesperson said the agency does not “fully understand” the sources of xylazine for illicit use.

But the city’s health department is warning that the move could harm people who use drugs in a city where many are already addicted to a combination of fentanyl and xylazine known as “tranq dope.” If xylazine disappears from the drug supply, those people will risk serious withdrawal that many doctors don’t know how to treat, department staff say.

“You still have a lot of agencies catching up on information about [xylazine] and educating participants. Medical establishments are learning how to deal with the side effects and withdrawal,” said Elvis Rosado, a harm reduction educator at the city health department. “If [the drug supply changes again], we’re back to square one.”

Serious wounds, serious withdrawal

Xylazine began making its way into 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 turning up in 90% of the dope samples the health department regularly tests.

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

Xylazine isn’t an opioid, but it also slows the 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.

The drug also causes serious withdrawal symptoms — severe chills, sweating, anxiety, and agitation among them — that doctors around the region are only just learning to treat. City health officials are concerned that restricting xylazine imports might cause an influx of people dealing with several tranq withdrawals, the department said in a statement.

Xylazine has been detected in dozens of states now. But it’s taken particular hold in Philadelphia, prompting Lozada and others to call for restrictions on it. Lozada said she believes it’s crucial to crack down on dealing and use of newer drugs like xylazine.

But, she added, she also understands concerns about prompting withdrawals in people who are already used to xylazine. Most people who use xylazine weren’t seeking it out, health officials say, but became dependent on it once it was added to the dope supply.

“I don’t think there’s enough support for folks who are dopesick now. You add something like going through xylazine withdrawal, and it makes it worse,” Lozada said. “And hospitals and medical professionals have said they don’t know or are just learning how to treat xylazine withdrawal. We should continue to push for ways of addressing the withdrawal, as well as ensuring that xylazine’s entrance onto our streets is prevented.”

‘There’s a possibility the drug supply is going to change’

Advocates who work to reduce the harmful effects of drug use in Philadelphia say that they’re concerned a crackdown on xylazine will harm people who have found themselves dependent on it, especially in a city where it’s already dominated the drug supply. And, they worry, another illicit substance, one potentially more powerful than xylazine, could fill the void.

“Is the criminal drug market going to increase the fentanyl supply to make up [for the lack of xylazine]?” said Sarah Laurel, whose outreach organization, Savage Sisters, treats a number of clients addicted to tranq dope. “How are they going to satisfy the demand? And what is that going to look like for my friends? How many funerals am I going to go to?”

Rosado said that it’s crucial health-care workers and advocates prepare for another shift in the drug supply if the FDA crackdown leads to severe withdrawals in people who use opioids.

“The only thing we have right now is to educate folks and make sure we start putting the message out there — that there’s a possibility the [drug supply] is going to change, and to be mindful to look after each other,” he said.