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A new drug is worsening the fentanyl crisis and complicating treatment


The opioid epidemic is ravaging American neighborhoods, including one we reported on last week - Philadelphia's Kensington.


RICKY SCHWETZ: Some guy just falls over, and he dies right on the ground. Nobody pays attention to somebody that's dead, like, on the ground, and people are just sort of stepping over him.

SIMON: More than 111,000 people died of overdoses in America in the past year. Most involved synthetic opioids, including fentanyl. But complicating both treatment and intervention is a relatively new drug that dilutes the fentanyl supply. It is a veterinary sedative called xylazine. On the streets, it's known as tranq. The drug causes horrific complications in human beings. Authorities, including Dr. Rahul Gupta, director of the Office of National Drug Control Policy, warn of its dangers. We began by asking the doctor how in a country as wealthy as the United States, so many people are caught in the grip of drug addiction.

RAHUL GUPTA: It is not only the issue of the disease of addiction, which is certainly true and real, but it is the drivers that get us there. Whether it's the challenge of income inequality, the challenge of housing, transportation, child care, childhood trauma. But at the same time, what we're seeing is a drug environment that is the most dangerous ever seen in human history. Now we're seeing synthetic drugs become much more lethal as opposed to what we've had for thousands of years, which is organics like heroin or cocaine. Secondly, the way drugs are being bought and sold has changed. Today, on an app on your phone, you can purchase what could be the last drug you will ever take. And the way drugs are consumed has changed. Now we see a lot more pills - especially counterfeit pills - and polysubstance use, the mixture of stimulants and depressants, has become a norm rather than an exception.

SIMON: Anne Milgram, of course, administrator of the Drug Enforcement Administration, said last year that xylazine is making the deadliest drug that our country has ever faced, fentanyl, even deadlier. What are your feelings about that, and what do you think could be done to address it?

GUPTA: As we see the combination of tranq and fentanyl together, called tranq-dope, become more and more available, we've seen almost 300% increase in deaths associated with this combination in the last few years. This is the reason, precisely, that I declared this combination as an emerging threat earlier this year and put the entire federal government agencies to work to figure out a treatment. I mean, one would think that this is a controlled substance. It's not. One would think we would know how to manage the combination. We do not because some of the challenges that are coming - there are no best practices.

SIMON: What do you mean there are no best practices?

GUPTA: Well, this combination - fentanyl is an opioid, and tranq, so-called, xylazine is a sedative. This has not happened before where a combination such as this has emerged very quickly. And yet physicians and providers do not know how to reverse overdoses when this combination happens. Often, there aren't best practices of how to manage the terrible flesh wounds, some of the worst ones I've seen in my 25 years of practice. So it becomes imperative to ensure that we get ahead of this by not only controlling the supply but also helping develop those protocols.

SIMON: When you say controlling the supply, does that include making xylazine illegal for human consumption?

GUPTA: Well, technically, xylazine is already illegal for human consumption because it has never been approved for human consumption. However, that hasn't stopped the drug dealers from mixing it in with the illicit fentanyl. So this becomes a hybrid problem where on one hand, we must make sure that the veterinary partners continue to have a safe supply of a drug that's critical to their business, at the same time, stop the diversion of xylazine that is being used now to mix with fentanyl.

SIMON: And how do you do that, Doctor?

GUPTA: Well, you do it in several ways. We've had now the FDA make sure that any importation that is happening for illicit purposes does not occur. Several states - more than half a dozen - have scheduled xylazine now.

SIMON: When you say scheduled, help us understand that term of art in your line of work. Scheduled sounds like you're prescribing it. It's just the opposite, though.

GUPTA: Scheduled means basically that it has become part of the Controlled Substances Act. That means that it cannot be utilized beyond on regular drugs like Motrin or Tylenol. You need a special prescription, even for animals, to be able to do that.

SIMON: We were just back from a reporting trip to Philadelphia, and I wonder what you've said to residents of Kensington and other neighborhoods who will say, look - they feel left out of this equation. There's so much consideration of what do you do to stop drug overdoses? What do you do to stop the traffic of drugs? - and not enough consideration to what do you do to prevent the drug trade and drug users from taking over in our neighborhoods and making where I live unlivable?

GUPTA: So it's really important when we look at that we begin to look at root causes. And that's the reason why the presence - Unity Agenda includes addressing the opioid crisis as a top priority. It also talks about the two drivers of this crisis across the nation, which is, one, untreated addiction, and, two, the profits that fuel this trade. And this is why we are putting unprecedented investments into this challenge. So far in the last two years, only $83 billion have gone into treatment. That's 42% more than the entire four years of the previous administration.

SIMON: Dr. Rahul Gupta, who is director of the Office of National Drug Control Policy, thank you so much for being with us, sir.

GUPTA: Thank you for having me, Scott. Transcript provided by NPR, Copyright NPR.

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Scott Simon is one of America's most admired writers and broadcasters. He is the host of Weekend Edition Saturday and is one of the hosts of NPR's morning news podcast Up First. He has reported from all fifty states, five continents, and ten wars, from El Salvador to Sarajevo to Afghanistan and Iraq. His books have chronicled character and characters, in war and peace, sports and art, tragedy and comedy.