Jessie never injected xylazine. She only snorted it mixed with fentanyl in a combination known commonly in the drug world as “tranq.” It also goes by another name: the “zombie drug,” due to the waking blackout state it induces and the grotesque wounds users develop with repeated use. So despite not injecting the drug, her legs developed sores all the same.
“My whole body swelled up but my legs got the worst of it,” Jessie said. “It was so itchy.” When she scratched, her “skin would fall off with the scab” and her legs “looked necrotic.”
Xylazine is a common animal tranquilizer typically used on horses and other large livestock. However, in recent years, it’s been used to cut other drugs like fentanyl and heroin. This has created yet another hurdle that further complicates the fight against the opioid crisis and exposes a glaring gap in U.S. drug policy—with deadly consequences for some.
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In April, the U.S. Office of National Drug Control Policy (ONDCP) designated fentanyl mixed with xylazine an “emerging threat” that is worsening the already devastating opioid crisis. In addition to increasing the risk of overdose, repeated xylazine use has been associated with abnormally large and persistent skin lesions and abscesses that occasionally result in limb amputation.
Unlike normal wounds that can be treated with antibiotics, tranq wounds sometimes cover “half of an arm or leg, and stay open for up to six months at a time,” said Brendan Hart, an emergency room doctor at Temple University Hospital in Kensington, Philadelphia—widely considered ground zero for the xylazine crisis. Some days, Hart estimates he sees more than a dozen patients with tranq-related wounds per shift.
“It’s incredibly distressing,” Hart told The Daily Beast. “People are worried they are going to lose their hand or arm.”
But because of the nature of addiction, it can be nearly impossible to stop.
Xylazine has been used for decades by veterinarians to put animals to sleep and sedate them for surgery. It is not approved for use in humans, however. When it was first synthesized in the 1970s, the FDA quickly shut down human trials after it was found to lower heart rate and breathing to a dangerous extent. How wounds develop on humans after exposure is still something of a mystery—-animals treated with xylazine like horses don’t appear to get them.
Since xylazine is not approved for human use, the government currently does not track or monitor it in any way. This leaves officials relatively clueless about where it is coming from—and thus how to stop the influx.
Congress is currently considering a bill that would add xylazine to the Controlled Substances Act. This would result in the drug’s scheduling, which would criminalize possession in certain cases and better enable the government to track its supply.
However, the bill has encountered some resistance from veterinarians and others who rely on xylazine to treat animals. They claim that increased regulations would make it harder to get for legitimate purposes.
Experts believe that some xylazine is being diverted from the veterinary supply to dealers and users via clinic robberies or, more commonly, by employees clandestinely taking it and selling it on the black market. In 2022, the DEA reported that it had found vials of xylazine labeled for veterinary use in stash houses during multiple raids. But there are no hard numbers since no federal agency is tracking supply.
Veterinary medicine uses the same scheduling system as all other drugs. At the federal level, controlled veterinary medications must be “stored in a secure place” in a way that “limits who has access,” Lauren Forsythe, an assistant professor of pharmacy at the University of Illinois Veterinary Teaching Hospital, told The Daily Beast. They also have to keep records and report any discrepancies to the Drug Enforcement Agency.
How strictly those regulations are enforced depends on the state. “Some states get really specific about the exact requirements and some do not,” Forsythe said.
Since xylazine isn’t scheduled, “there are no requirements on how they have to be secured or not,” she explained. “There are no requirements for record keeping. It's good fiscal practice but it's not a legal requirement. You can keep on hand as much or as little as you want.”
So, at present, we have no idea how much xylazine is being diverted from the veterinary supply—but we know diversion is likely a huge culprit. After all, it's a significant issue in human healthcare in general, with some studies estimating that as much as 10 percent of human hospital employees have stolen drugs for personal use or sale.
Forsythe speculates that drug diversion is “at least as much of a problem” in veterinary medicine as in human healthcare, “if not more.”
But veterinary diversion is just one part of the equation. Drug policy experts are also pointing to the influx of the drug from overseas as a cause of the rising xylazine problems. Beau Kilmer, co-director of the RAND Drug Policy Research Center, told The Daily Beast that it is possible to buy xylazine online from websites that are “not necessarily checking if you're a vet.”
It’s also possible that some of the xylazine is being mixed in with fentanyl at the source in countries such as Mexico and China, where most fentanyl is produced. Sheila Vakharia, deputy director of research and academic engagement at the Drug Policy Alliance, told The Daily Beast that she believes the current wave of xylazine is mostly getting shipped from factories in China and other parts of central Asia.
How the government deals with the xylazine crisis will “depend a lot on where the mixing is happening,” Kilmer said, adding that this was the main argument for scheduling: so that the government can learn where and how that is happening.
However, representatives from the agricultural and veterinary industries have argued that the more onerous tracking requirements related to scheduling xylazine would make it “impossible for them to afford it and get it to treat their animals,” Vakharia said. In its current iteration, though, the xylazine bill before Congress would exempt veterinarians from the reporting requirements.
Although the current bill does not “formally” schedule xylazine, it does link non-veterinary possession to penalties typically associated with schedule III drugs, such as ketamine and anabolic steroids. However, Vakharia thinks the focus on penalties is a mistake.
“The problem with our laws is that they are written so that only certain molecular compounds are criminalized,” she said. This motivates suppliers to develop new drug compounds and look for other loopholes to stay ahead of the law. “It’s a tragic situation where we keep repeating the same mistakes that we made over the past few decades and expecting different results."
“We turned it into this game of whack-a-mole,” Vakharia added.
Instead, Vakharia and Hart argue that drug policy should focus on better treatments and harm reduction programs. Decades of research suggests this would make the biggest impact when it comes to saving lives and preventing injuries related to illegal drug use. Additional research is also needed to better understand xylazine’s malignant effects on humans and how to treat it, Hart said.
Currently, though, Congress—in classic fashion—is just playing catch up when it comes to regulating the drug. Scheduling xylazine is a step forward that could save lives, but critics say it’s still not enough to fully address the full-blown crisis that continues to hurt and kill drug users across the country every day.
For Jessie, those days are mercifully over for her. She got clean when she found out she was pregnant in 2022. “I couldn’t bring a baby into that,” she said. Her daughter was born healthy, and she has been sober for more than a year at the time of reporting.
But, if you ask any former drug user like Jessie, they’ll all tell you the same thing: There are some wounds from their past that will just never heal. “The scars are still there,” she said. “I still hide my legs.”
