Xylazine Threat Means More Veterinary Scrutiny
Q: What FDA-approved drug is used by veterinarians throughout the United States, and may be in your clinic and your local news headlines right now?
A: It’s xylazine, the latest deadly street drug. It’s on the way to becoming a controlled substance, and is moving into the DEA’s criminal and regulatory crosshairs.
That means smart practitioners are getting ready for more recordkeeping, and a greater chance of their practices being scrutinized.
When it was developed as an antihypertensive agent in 1962 by Farbenfabriken Bayer in Germany, the Food and Drug Administration (FDA) refused to approve it for human use due to dangerous side effects including sedation, hypotension and bradycardia. Eventually approved for veterinary use by FDA, xylazine is currently sold under the trade names such as Rompun®, Anased®, Sedazine®, Chanazine®, and Xylamed®. But just like fentanyl, xylazine has made the jump from legitimate veterinary uses into a popular street drug mixed with heroin, cocaine, fentanyl – or injected on its own. The result is a cheaper, longer-lasting, opioid-like high than using fentanyl alone.
The messages from the DEA are grim. The number of xylazine-positive overdose deaths between 2020 and 2021 rose 103 percent in the Northeast, 516 percent in the Midwest, 750 percent in the West and 1,127 percent in the South. More people with substance use disorder are using xylazine itself and are developing soft tissue injuries that turn necrotic, leading to amputations. Additionally, users with physical dependence on xylazine itself report that withdrawal symptoms are as, or more, severe than from heroin.
With the growing use of xylazine as a cheap street drug adulterant, veterinarians should be prepared to feel the effects of ramped up regulatory actions, security demands, and recordkeeping requirements. The DEA started the process of scheduling the drug in 2021, according to news reports. Andrew Kolodny, MD, an expert in opioid policy and addiction medicine at Brandeis University in Massachusetts, was interviewed as part of a February 23, 2023 article in MedPage Today, and said that xylazine is probably widely diverted because it's unscheduled. "For sure, you would not see xylazine all over the place if it was scheduled," Kolodny said.
Meanwhile, the American Veterinary Medical Association (AVMA) has been lobbying Congress to prevent xylazine from being scheduled federally at a higher level than necessary. The AVMA is also advocating for a reasonable implementation timeframe to allow for manufacturers to transition to a scheduled status, and pushing for provisions to allow dispensing of xylazine for use with livestock, zoo, and wildlife species by appropriate personnel.
Titan Group CEO Jack Teitelman (a retired DEA special agent), recently conducted a webinar on xylazine and noted that while efforts are under way to disrupt the illicit supply train of xylazine, law enforcement has no other choice but to start investigating xylazine manufacturers, distributors, and even customers. “After nearly 30 years with the agency I know the playbook they’re following,” he said. According to Teitelman, even though xylazine is a non-controlled substance it has a nexus to drugs like fentanyl, heroin, and cocaine, which makes it a target for criminal investigators at DEA. On the regulatory side of the agency, they may call for more inspections of veterinary clinics. Investigators will still inspect controlled substance recordkeeping and security (including policies and procedures), but they will begin asking more questions about xylazine purchases and use.
Teitelman explained that investigators will target practitioners for inspections and audits after gathering and analyzing intelligence, such as:
- Purchasing patterns (e.g., large or frequent purchases)
- Whether the veterinary practice has ever been inspected before
- Complaints and tips (e.g., from current or former employees, angry ex-spouses, other practitioners, confidential informants)
- Investigations conducted by state veterinary boards or other agencies
- Histories of DEA regulatory violations and sanctions
“Titan’s clients are prepared for DEA visits”, said Teitelman. “But I still warn them that once DEA steps through their doors, everything is fair game. Whether it’s xylaxine, controlled substance records, employees, drug purchasing, drug disposal, or any other topics on their minds, investigators will be asking a lot of questions. And our clients are ready to answer.”
Is your xylazine sufficiently secure? Are you ready for DEA’s questions? Take Titan’s Free Risk Assessment – you may be surprised at what you find.
