PITTSBURGH — This week, the Shapiro administration and acting health secretary Dr. Debra Bogen announced that the sedative tranquilizer xylazine, also known as tranq, would be listed as a Schedule III controlled substance.
The administration said the categorization was an attempt to curb deaths and restrict illicit supply. “The steps we are taking today will help ensure this dangerous drug can’t be diverted from legitimate sources to the drug dealers harming our communities, while preserving its important use on animals,” said Gov. Josh Shapiro in the news release. Xylazine is not approved for use in humans and has been tagged by the DEA as a public safety concern when mixed with fentanyl.
But officials working on the ground with communities impacted by xylazine say the scheduling will not reduce tranq from the drug supply and will instead promote the criminalization of those who use and sell drugs, when evidence shows Black and brown people often get harsher sentencing compared to their white counterparts.
Alice Bell, the overdose prevention project coordinator for Prevention Point Pittsburgh, confirmed that xylazine had reached Pittsburgh’s drug supply, but that there was no way to tell to what extent.
“We are seeing an increase in wounds suggestive of xylazine,” she said. The drug causes necrotic sores, sometimes at the site of injection but not always. Skin rots and blackens, leading to infection and possible amputation. And xylazine carries severe anxiety symptoms during withdrawal, trapping users in a cycle of managing their sores and staving off sickness.
Dr. Raagini Jawa, an infectious disease and addiction medicine physician at UPMC and a physician at Prevention Point’s wound care clinic, said she has seen a massive rise in patients who come in saying “they don’t feel right” after using their substances, reporting weird symptoms, insisting something is off.
“Here in the Pittsburgh area, we are noticing more and more that xylazine is being mixed in with other illicit drugs,” she said. “We’re seeing more harms associated with it as time goes by.” Dr. Jawa also treats patients with addiction-related injuries at UPMC Mercy.
The drug has been present in Philadelphia for at least five years. In 2021, the Philadelphia Department of Public Health released a report revealing 91% of fentanyl samples contained xylazine, skyrocketing from 26% of samples in 2019.
But “making it Schedule III is going to do nothing,” said Bell, who has worked in the harm reduction and recovery space for more than a decade.
What experts say they need — hearing from users themselves — is accurate information about tranq, tools for safer drug use, evidence-based strategies to reduce overdose deaths, and a regulated drug supply.
“Xylazine test strips are a great new tool,” said Bell. “People are really asking for them. They’re not cheap, and we hope we can get funding.”
If xylazine stops coming from the prescription-grade supply, dealers may be diverted to even more illicit origins, often which are more potent, cheaper to produce and less consistent in their makeup.
A similar trend occurred with the opioid crisis, said Dr. Jawa. As regulations around prescription pills tightened in the 2010s and they became increasingly difficult to obtain, the illicit opioid market grew to include fentanyl. In the span of a few years, the potent opioid has replaced heroin on the streets and was involved in 86% of overdose deaths in Allegheny County in 2022.
“When our patients don’t have access to harm reduction services, they’re at higher risk of drug-related harms,” said Dr. Jawa. Harm reduction services include safer drug tools like clean syringes, test strips and the opioid-reversal medication Narcan.
Robert Ashford, the executive director of Unity Recovery, called the scheduling “a temporary solution.”
He said larger systems and policies are at the root of the problem. “People deal drugs because they don’t have other opportunities,” he said. “We need to try something different, which is treating people as human.”
Jawa said that scheduling will put her patients at higher risk of criminalization. “I don’t think scheduling will benefit the patients I serve,” she said.
“My patients don’t like xylazine and many don’t even know it’s in their supply,” she said. Punishing them for its presence and further limiting their ability to get life-saving treatment, she went on, could have a negative impact.
Data from the Bureau of Justice Statistics states that arrests for drug possession (mainly for cannabis and mainly against people of color) climbed throughout the 1980s and ‘90s, while arrests for the sale and manufacturing of drugs remained mostly stagnant.
“Putting people in jail for possession of drugs has never worked to control that supply of drugs,” said Bell.
Ashford echoed this: “The law enforcement approach to drug policy has failed time and time again.”
Scheduling drugs can also thwart research efforts, as scientists and public health experts face bureaucratic barriers in accessing the substances. Studying xylazine is important for safely administering the drug to animals, and Dr. Jawa worries research could be delayed due to the scheduling. She recognized the move from the administration is one strategy among many to combat the drug crisis.
Across the state, in Philadelphia, syringe service nonprofit The Everywhere Project is working to reduce drug deaths and arm people with safe resources, as xylazine continues to ravage parts of the city’s population.
Shannon Ashe, the cofounder of the nonprofit, said xylazine’s worst impacts are “everything you can possibly imagine. It’s as scary and bad as it sounds.”
She knows of a Philly resident with a tranq wound who fell asleep for three hours with his shoulder pressed up against a wall. When he awoke, the wound had gotten so bad that his shirt was fused to his skin.
Pittsburgh residents should expect to see more people on the streets with these open, necrotic sores because of this scheduling, said Ashford.
Groups like Prevention Point are giving out xylazine test strips and educating users on what to expert from xylazine. This includes how to tend to wounds and keep them clean and covered, what symptoms to look out for, and how to adjust overdose response to account for xylazine’s presence.
Local organizations are also working to train physicians on what tranq wounds look like, how to equip people with recovery resources and how best to respond to overdoses.
Because tranq is not an opioid, Narcan will not work to reverse its effects. All experts interviewed mentioned the misconception that Narcan is simply “tranq-resistant,” which Bell called a misnomer (It doesn’t work to reverse cocaine overdose either, because cocaine is not an opioid).
Those who witness opioid overdoses are used to people “popping right back up” after administering Narcan, said Dr. Jawa, but if drugs contain tranq, it might take longer for the person to come to. Tranq sedates and suppresses breathing, so the best way to manage this situation is to administer rescue breathing and oxygen. Giving more Narcan won’t target the xylazine and can catapult the person into painful withdrawal, causing vomiting and flu-like symptoms.
Shapiro has said he opposes supervised consumption, and that it encourages illicit drug use. There’s evidence from other cities and countries, like New York and Canada respectively, that this method works to reduce overdose deaths, giving people more time and opportunity to enter recovery if they want to.
“My patients are just like anybody else,” said Dr. Jawa. “They have moms, dads, children, jobs. When we don’t have surveillance, testing, or a safe drug supply, we are putting all those people at risk. It could be your family member, your friend, or your neighbor. We have to normalize the fact that people with substance use disorders are human.”
“People are going to use drugs, and that’s OK,” said Ashford. “How do we move people to believe everybody deserves help, period? It’s never going to get better unless we try something different.”
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