well the White House is labeling xylazine an official emerging drug threat to the nation it's the first time any drug has been given that designation it's also known as trank it's a powerful sedative that's FDA approved as a large animal tranquilizer and it's increasingly being found mixed with opioids used as a low-cost cutting agent in drugs like fentanyl to extend a user's High the U.S drug enforcement agency issued an alert last month warning about a sharp increase in the trafficking of fentanyl mixed with xylazine about a quarter of all fentanyl powder seized by the DEA in 2022 contained the drug it'll soon be classified as a schedule 3 controlled substance in nearby Pennsylvania and is associated with severe wounds if used repeatedly well Dr Lewis Nelson chair of emergency medicine for Rutgers University Medical School says there's still little known about exactly how xylazine affects human and he joins me now Dr Nelson talked to me first about what you are seeing in terms of use of this drug and what's happening to folks who are in fact maybe cutting it or are unaware that it's being cut into their other street drugs well great yeah thanks for having me I think it's a it's a really important issue that we're starting to see uh increasingly here in New Jersey uh and and in some parts of the country um xylazine is an additive or an adulterer and something that's being used is with something called a cutting agent to add bulk to the drug Supply fentanyl which is the drug that most people are out trying to seek is nearly invisible in the amount that we want to use so that they want to use which means it has to be added to something to give it some heft to make it visible and usable that could be many things often it's a sugar or storage like inositol but increasingly they're adding xylazine as the base those other products are are inactive xylazine actually has some activity and it's it's used as an animal sedative by veterinarians and it's been used for decades like that it's never been approved for human use um what it does is it sedates you I mean you know animals humans not all that different and when we take it into our bodies we become States so it adds to the effect of the opioid I mean it's not an opioid um it doesn't really behave like an opioid but it adds to the effect of the opioid as it would if you took another sedative like a benzodiazepine is it possible to overdose on it or what type of side effects does someone have when they do take it yeah you know there have been cases and I've actually managed people who have overdosed on xylazine period with nothing else in it years ago when it was only something you would get from a veterinarian's office um it's really not likely to to kill you independently um it's a it is a good sedative and like many sedatives it doesn't produce the depth of respiratory depression that the opioids produce when they when they lead to death but combined with an opioid obviously it can increase the effect in a way of both leading to some chance at least that you're going to overdose more more intensely or or have more intense effects but independently it's probably not a drug we have to be very concerned about when that happens though does an overdose reversal agent like a naloxone still work or is there a different effect because this drug is now involved you know it's a little bit of a tricky question because naloxone shouldn't reverse xylazine just like it does in reverse the benzodiazepine it doesn't reverse alcohol it will reverse the opioid though and if you took xylazine plus an opioid say Fentanyl and you weren't breathing and you gave analoxone the naloxone will work but remember you have to Define what work means work means make you breathe work does not mean wake you up you will probably not wake up because you've reversed the opioid but you haven't touched the xylazine and xylazine is a sedative so it's not expected to wake you up but we don't necessarily need people to wake up after they get analoxone we need them to breathe and as long as that happens that's a great end point in fact maybe at some level a better end point because it allows people to get brought to a hospital but we can actually manage them and hopefully even get them to agree to go to treatment right how concerned are you though Dr Nelson about xylazine and its emerging threat as it's now been labeled yeah it's funny to talk about the risks of the illicit drug Supply you know being more you know more problematic or less problematic I mean fentanyl is the 800 pound gorilla here I think adding xylazine has some effects um at some level it may even have some protective effects Believe It or Not uh that we're still looking into um it though does produce you know a deeper sedation than the opioid alone but what most would do if if they could if the drug dealers were perfect as a pharmaceutical company might be is they would reduce the dose of the fentanyl that they're giving you if they increase the amount of sedative they're giving you now they don't always work that well in that way so sometimes the combination does become a little bit more sedating I think that the implications to the general public are actually fairly small in the overdose from an overdose perspective I think we see a little bit more on the medical side when we're trying to get people into treatment right sometimes starting some of the treatment drugs we use like buprenorphine which is called Suboxone is the brand name can be a little bit more difficult in people who use a lot of of xylazine the big issue that we're not seeing here in Newark where I am but they're seeing down in Camden in Philadelphia that seems to be related to the xylazine in the drug and the drug Supply are wounds right and there are some terrible wounds that they're seeing down there which may be related to xyzine probably are but for whatever reason there's a big north-south split in this state where we're just not seeing that I don't know I mean that's what makes me you know skeptical that it's the xylazine in and of itself and maybe there's some other adulterative contaminants in the drug Supply in the southern part in this of the state in Philadelphia um or maybe there's differences in The Roots through which people use maybe there's more intravenous drug use there and more intranasal drug use here although I think that that would not be a great explanation you know because we have plenty of both in in both ends of the state um well so we don't know you know interestingly I just was in a meeting where we spent a lot of time talking about this exact issue and all of the the nuances and and things that we're seeing related to the increasing prevalence of xylazine in our drug Supply we don't really understand all the implications of it clearly it's not a good thing to mix drugs right it's hard to say though that using pure fentanyl is a good thing either right so you know in in general um I think it's probably a little bit over hyped as to the risks but I don't think we know enough yet to really say that but the we're still looking and hopefully we'll have some more information in the near future well and certainly any of the illicit drug use uh is all uh you know risky um Dr Lewis Nelson chair of emergency medicine for Rutgers University Medical School thank you so much oh my pleasure anytime I appreciate it