Xylazine, Three Years Later: Why Veterinary Practices Are Still in the Spotlight

In March 2023, we warned veterinary practitioners that xylazine, a common veterinary sedative, was moving into DEA's criminal and regulatory crosshairs. Since then, the story has grown. The drug has drawn federal emergency designations, import restrictions, a wave of state scheduling, and ongoing pressure in Congress. A newer veterinary sedative has also begun appearing in the illicit drug supply.

If your practice stocks xylazine, or other alpha-2 agonists such as medetomidine or dexmedetomidine, here's what has changed and what it means for you.

A quick refresher

Xylazine was developed by Bayer in 1962 as a potential blood pressure medication, but the FDA never approved it for human use because of dangerous side effects, including heavy sedation, low blood pressure, and slowed heart rate. It was approved for veterinary use instead, and it's sold under trade names such as Rompun®, Anased®, Sedazine®, and Xylamed®.

On the street, known as "tranq," xylazine is mixed with fentanyl, heroin, or cocaine to stretch the supply and extend the high. The human toll has been severe. Users develop wounds that can turn necrotic and lead to amputation, and they report withdrawal that is as bad as heroin withdrawal or worse.

Because xylazine is not an opioid, naloxone does not reverse its sedative effects. That makes xylazine-involved overdoses harder to treat.

What's changed since 2023

Federal emergency status. In April 2023, the White House Office of National Drug Control Policy designated fentanyl adulterated with xylazine an "emerging threat to the United States." It was the first time any substance had received that designation. The move triggered a national response plan and more federal attention on where the illicit supply comes from.

Import restrictions. In early 2023, the FDA moved to restrict imports of xylazine ingredients and finished products to stop illegitimate shipments while preserving access for veterinary use.

State scheduling. Many states didn't wait for federal action. Pennsylvania, Ohio, and a growing number of other states have added xylazine to their controlled substance schedules, most with exceptions for legitimate veterinary use. In those states, xylazine already comes with controlled substance obligations for storage, recordkeeping, and reporting. Check your own state's current requirements.

Federal legislation. The Combating Illicit Xylazine Act would place xylazine in Schedule III while protecting veterinary access. It has been introduced in multiple sessions of Congress. As of this writing, xylazine is still not federally scheduled, but the direction of travel is clear.

The American Veterinary Medical Association (AVMA) continues to advocate for a scheduling level no higher than necessary, a reasonable transition period, and continued access for livestock, zoo, and wildlife use.

A new adulterant: medetomidine. Since 2024, public health officials in Philadelphia, Chicago, Pittsburgh, and elsewhere have reported medetomidine in the illicit drug supply, in some areas replacing xylazine. Like xylazine, medetomidine is a veterinary alpha-2 agonist.

That's a signal that regulators and investigators won't stop at one drug. Practices should expect questions about their whole class of veterinary sedatives, not just xylazine.

What this means for your practice

"After nearly 30 years with the agency, I know the playbook DEA follows," says Teitelman, a retired DEA Supervisory Special Agent. Even where xylazine is not federally controlled, its connection to fentanyl, heroin, and cocaine makes it a target for DEA's criminal investigators.

On the regulatory side, investigators inspecting a veterinary clinic will still review controlled substance recordkeeping and security. But they'll also ask about xylazine and related sedatives: how much you buy, how you use it, and how you secure it.

Investigators decide which practices to inspect and audit by gathering and analyzing intelligence, such as:

• Purchasing patterns (e.g., large or frequent purchases)
• Whether the practice has been inspected before
• Complaints and tips from current or former employees, ex-spouses, other practitioners, or confidential informants
• Investigations by state veterinary boards or other agencies
• Past DEA regulatory violations and sanctions

Steps to take now

The practices in the best position are treating xylazine as if it were already scheduled. That means:

• Storing it securely with limited access.
• Keeping purchase, dispensing, and waste records that reconcile.
• Running periodic inventory counts.
• Having written policies that cover xylazine and similar sedatives.

If your state has already scheduled xylazine, these steps aren't optional; they're the law.

"TITAN's clients are prepared for DEA visits," says Teitelman. "But I still warn them that once DEA steps through their doors, everything is fair game. Whether it's xylazine, controlled substance records, employees, drug purchasing, drug disposal, or any other topic on their minds, investigators will be asking a lot of questions. And our clients are ready to answer."

Is your xylazine secure? Are you ready for DEA's questions? Take TITAN's Free Risk Assessment. You may be surprised at what you find.