The flesh-rotting sedative known as xylazine, or “tranq,” is spreading across the country, and with it, growing urgency for state and federal lawmakers to address it. 

Xylazine, an animal tranquilizer that is not approved for humans but is used by dealers to cut illicit opioids such as fentanyl, is emerging as a new wave of the drug crisis. The visible effects of xylazine — causing users to walk in a hunched-over position and with flesh wounds — have earned it the nickname “zombie drug” by many in the press and on viral TikTok videos.

Legislation is being considered by several state and federal lawmakers seeking to regulate it— including bills in South Carolina, New York, and Virginia that would penalize possession. 

Support is growing in Congress for the “Combating Illicit Xylazine Act” since it was introduced last year by Senators Grassley and Cortez Masto. The bill would classify xylazine as a controlled substance but wouldn’t target simple possession of it, a representative of Mr. Grassley tells the Sun, adding that the bill would improve public safety while preserving access to it for its intended use by veterinarians. 

The White House declared xylazine to be an “emerging threat” in 2023, but in Philadelphia’s Kensington neighborhood, it’s not emerging — it’s been a problem for years, a treatment provider for xylazine patients at the Philadelphia area, Geri-Lynn Utter, tells the Sun.

“The rest of the country has a lot of catching up to do,” she says. 

Philadelphia’s xylazine crisis — and debate in the city about how to address it — has become a microcosm of a larger national debate about harm reduction approaches versus punitive measures in the effort to combat illicit narcotics. 

Harm reduction groups have been “under attack” in Philadelphia, Ms. Utter says, adding that it’s “disheartening” to see a lack of education about it from political leaders. With the election year ramping up, drug issues have suddenly become “exploited from a political perspective,” she says, but when it’s over “is Kensington going to be left behind again?” 

“The streetside medicine care that is being provided to individuals in Philadelphia from various harm reduction services is something that should be templated and manualized across the country,” Ms. Utter says, adding that street care providers offer education services, provide medical care, and seek treatment options for users. “You have to meet the patient where they are,” she says, adding that “forced treatment” isn’t effective in practice. 

As state and federal lawmakers weigh legislation on classifying xylazine as a controlled substance, Ms. Utter says one question to consider is if regulations would target the way the sedative is being purchased. 

“You can purchase xylazine in the comfort of your home in front of your computer, on the dark web, anywhere from $6 to $20 a kilo,” she says. When it comes to state-level bills targeting possession or use of xylazine, Ms. Utter adds, “there’s not a subgroup that is chomping at the bit to just go get xylazine.” Rather, users are made to be dependent on it by drug dealers who use the cheap adulterant to cut the drug supply, often without the user’s knowledge. 

Care is greatly improving to treat the flesh wounds caused by xylazine, but medical and mental health providers are still trying to find medications and treatment options to reverse withdrawals. 

“We’re trying to figure out what to do to help these patients that are going through acute xylazine withdrawal because they’re suffering, and we don’t have a gold standard protocol,” Ms. Utter says. “We’re just not there yet.”

Illicit fentanyl first spread to the west from the east and it’s “very plausible” xylazine will follow a similar trajectory, especially because drug economics indicates it would be profitable. Xylazine is “easy to get, it’s cheap, and it makes drug dealers a lot more money,” she says. 

As xylazine has proliferated on the streets, especially at Philadelphia’s Kensington district, the “zombie” terms to describe it in the news and on social media have sparked concerns from some treatment providers, who say it dehumanizes people suffering from devastating addiction. 

“It’s a shame,” Ms. Utter says, that some lawmakers are starting to use the term as well. As legislation moves forward, she adds, lawmakers have resources in the medical community that can help inform them on xylazine and using terms that don’t stigmatize constituents.