The White House drug czar sounded the alarm Wednesday over an emerging threat called “tranq,” a veterinary medication that is being added to fentanyl and other illicit drugs and is leading to horrific skin ulcers, amputations and deaths in opioid users.
Dr. Rahul Gupta, director of the Office of National Drug Control Policy, also urged Congress to “stop playing politics” and help tackle the overdose crisis by permanently banning fentanyl. He told The Washington Times that banning fentanyl and its analogs would give him firm standing to pressure China to crack down on chemical shipments that fuel Mexican drug factories operated by cartels.
He said the peak and gradual decline in the rate of U.S. overdose deaths in 2022, after a multiyear rise, can be attributed to President Biden’s push to expand the use of opioid addiction treatment and overdose-reversing drugs.
Dr. Gupta said Congress, diplomats and White House officials have work to do at home and abroad to sustain progress against a death toll that remains unacceptably high.
In a wide-ranging interview with The Times, Dr. Gupta said he is considering whether to formally label xylazine, known in street slang as tranq, as an emerging threat. The designation would spur awareness and the development of sorely lacking treatments.
“Tranq is a problem,” he said. “We’ve seen a lot more use of it across the Northeast, typically, but it is getting more pervasive across the nation.”
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He said Congress has an opportunity to stop stonewalling and permanently schedule fentanyl and its analogs as banned substances instead of allowing temporary authority to expire in December 2024.
Fentanyl is a synthetic opioid that is 50 times stronger than heroin and 100 times stronger than morphine. Some types are legal under pharmaceutical use and can be prescribed to treat severe pain after surgery or for advanced-stage cancer.
Fentanyl manufactured in clandestine labs run primarily by two powerful cartels in Mexico is considered unlawful. It is sold illegally as a powder, which is dropped onto blotter paper, put into eye droppers and nasal sprays, or made into pills that look like other prescription opioids, according to the National Institutes of Health.
Congressional Democrats have pointed to the need to test fentanyl substances to ensure that drug prosecutions are connected to the cartels’ illicit, profit-seeking purposes rather than medicinal purposes.
During a recent House hearing, Rep. Tony Cardenas of California said a Republican crackdown plan did not lay enough groundwork for “the potential harmlessness of these fentanyl-related substances or even their potential therapeutic value.”
Mr. Biden called for stiffer penalties in his State of the Union address Tuesday. Dr. Gupta said congressional action would put the U.S. on par with China, which permanently scheduled fentanyl in 2019 under pressure from the Trump administration.
“When [the Chinese] look at us and say, ‘Well, you can’t get your act together,’ they’ve got a point. And I’ve got to deal with China every day,” Dr. Gupta said. “I want to make sure we are being at least as aggressive as they’ve been on the scheduling aspect.”
The fentanyl problem took off in the middle part of the past decade and bedeviled the Obama and Trump administrations, both of which worked with bipartisan lawmakers in Congress to authorize more funding for the fight while diplomats urged foreign governments to do their part.
Overdose deaths involving synthetic opioids have soared from nearly 10,000 in 2015 and 20,000 in 2016 — the period when fentanyl started to infiltrate the U.S. drug supply — to 56,000 in 2020 and more than 70,000 in 2021, according to the most recent federal statistics available based on death certificates.
Drug deaths accelerated during the early part of the COVID-19 pandemic, when users were cut off from support networks and Washington focused much of its attention on the coronavirus as its most pressing health crisis. Traffickers adapted by pressing fentanyl into counterfeit pills and selling a range of drugs beyond illicit heroin.
“It’s a problem, overall, that has seized the nation for a little over two decades,” said Dr. Gupta. He described how a prescribing issue evolved into a street heroin problem and then a crisis dominated by deadly synthetic opioids. “Now, we are seeing clearly a lot more fentanyl. Sometimes pure fentanyl and sometimes a majority of fentanyl is being cut into every drug supply we have. Then we’ve got all the things we’re seeing now with pills.”
About 110,000 people died of overdoses from all drugs in the 12 months ending last March, before the rate plateaued and eased slightly over the next several months. Roughly 107,000 people died from drug overdoses in the 12 months that ended in August, according to the most recent data.
The Biden administration is seizing on the decrease in fatalities as a glimmer of hope. It has credited several actions, including broader use of overdose-reversing naloxone.
“There are these tangible data points to show why, over five months, we’re seeing a decline in deaths,” Dr. Gupta said. “We’ve prevented about 3,000 deaths so far on an annualized basis.”
Tranq’s horrifying results
Despite some progress in cutting overdose deaths, new threats are emerging.
Xylazine was created decades ago as a drug to lower blood pressure in humans but, after disappointing results, it was repurposed as a veterinary tranquilizer. It’s now being added to fentanyl and other illicit opioids to extend highs or increase euphoria — and leading to horrific skin ulcers and abscesses that can lead to amputations.
“It causes increased sedation, it allows individuals to have effects longer,” Dr. Gupta said. “The problem with that increased sedation is sometimes [users] just check out and don’t get up for hours at a time, which often allows pressure ulcers to develop, some of the most deadly, dangerous ulcers you can have.”
Complicating matters, xylazine is not an opioid. NIH says experts are concerned that a growing prevalence of xylazine in the illicit opioid supply may render naloxone less effective for some overdoses.
“We don’t have antidotes and treatments available for this. I want to see that happen, so a lot more [research and development] is needed,” Dr. Gupta said. “But what we want to do, and what I’m very interested in, is being proactive about this and not reactive.”
Dr. Gupta said he is convening a committee that Congress established in the Support Act of 2018 to detect and respond to new drug threats before they become full-blown crises.
He said an emergency designation would trigger actions such as greater awareness of xylazine’s prevalence and speedier development of antidotes. The drug also could be scheduled in a class of banned substances.
“This is something that I’m looking at very closely right now,” he said. “I’ve talked to experts and folks across the country about it.”
Biden’s plans on fentanyl
Mr. Biden offered a rough outline of his plan to tackle the fentanyl scourge during his State of the Union address on Tuesday.
One plank involves “strong penalties to crack down on fentanyl trafficking,” an allusion to the debate about putting fentanyl-related substances on the Schedule I list, meaning there is no currently accepted medical use and a high potential for abuse.
There is broad agreement in Washington that fentanyl and all of its chemical cousins should be banned so traffickers do not tweak the compounds in their drugs and elude the letter of the law, but lawmakers in recent weeks have sparred over details.
The administration has said fentanyl-related substances should be exempted from mandatory minimum criminal penalties for offenses based on drug quantity.
“I worked in a local system and a state system, and I would like my judge to be able to make a decision based on what the circumstances are in their community,” Dr. Gupta said. “You talk to judges, they really don’t want handcuffs on.”
Republicans say the administration’s plan offers too many carve-outs for traffickers, and liberals criticize Mr. Biden for considering stiffer drug penalties at all.
“President Biden has previously said he supports a toothless ban on fentanyl-related-substances that would fail to stop dealers and criminals,” House Energy and Commerce Committee Chairwoman Cathy McMorris Rodgers, Washington Republican, said in response to Mr. Biden’s speech. “We cannot let this scourge of poison continue to proliferate in America.”
The White House said it tried to strike a balance in its proposal and that mandatory minimum terms would still apply to cases in which death or serious bodily injury could be directly linked to the drugs.
Dr. Gupta said it will be up to Congress to negotiate a solution.
“If everybody can quit playing politics with this important issue that’s killing an American every five minutes, we can get to a solution,” he said. “I think there is clearly a pathway to negotiating and getting an agreement the president will be happy to sign.”
Mr. Biden on Tuesday alluded to a plan to invest in 123 new scanners at points of entry along the southwest border by fiscal 2026. The White House said Customs and Border Protection will increase its inspection capacity from about 2% of passenger vehicles and about 17% of cargo vehicles to 40% of passenger vehicles and 70% of cargo vehicles.
“That’s going to be a game-changer when we get there,” Dr. Gupta said.
Forging partners abroad
The Drug Enforcement Administration told Congress this month that the Sinaloa and Jalisco cartels in Mexico remain the greatest criminal drug threats the U.S. has ever faced.
The alarming testimony underscored the manufacturing pathways that fuel addiction in U.S. communities. Criminal gangs in Mexico convert chemicals from China and India into deadly drugs and take them through ports of entry or trafficking corridors across the southern border.
Dr. Gupta said the U.S. is pressing China to properly label the chemicals it manufactures and scrutinize the chain of shipments out of the country.
“If you start shipping a particular compound of 400,000 pounds to a particular town in Mexico, you should know why that just happened. These are not rocket science things. These are easily implementable things,” Dr. Gupta said. “We continue to pressure China to do this.”
Some lawmakers have expressed skepticism about Mexican efforts. They point to a shake-up in DEA leadership in Mexico City and reports that the U.S.-Mexico relationship has deteriorated in recent months.
Dr. Gupta said there are signs of cooperation. Mr. Biden discussed the fentanyl problem with Mexican President Andres Manuel Lopez Obrador at a recent North American summit, and the U.S. is offering to assist Mexican authorities with Coast Guard training and intelligence-sharing to interdict drugs.
“Mexico can always do more. We’re going to continue to ask them to continue to do more,” Dr. Gupta said. “As long as we see Americans dying, Mexico can do more, there’s no question about it.”
A Cabinet-level job?
The Senate confirmed Dr. Gupta on a bipartisan vote in October 2021, making him the first medical doctor to serve as director of the Office of National Drug Control Policy.
He began his career as a doctor in private practice and served two West Virginia governors as the state health commissioner. Before joining the White House, he served as the chief medical and health officer, interim chief science officer and senior vice president at March of Dimes.
Given the scale of the overdose crisis, some lawmakers say, Mr. Biden should elevate the position to the Cabinet level. It was downgraded from the Cabinet at the start of President Obama’s first term.
The bicameral U.S. Commission on Combating Synthetic Opioid Trafficking last year called for reinstating the position to the Cabinet level.
“Since the director’s position was downgraded in 2009, members of the House and Senate have repeatedly called for the demotion’s reversal, and advocacy groups, trade associations, substance use disorder treatment facilities, and former ONDCP leadership all support its reinstatement,” Rep. David Trone, Maryland Democrat, and Sen. Edward J. Markey, Massachusetts Democrat, wrote in a Feb. 1 letter signed by lawmakers in both parties.
Lawmakers were hoping Mr. Biden would announce a promotion of the agency’s director in his State of the Union address, but he didn’t.
Asked about the idea, Dr. Gupta said the decision wasn’t up to him and he didn’t know whether there were top-level deliberations to promote his position.
“I just really focus on, ‘OK, what are the solutions?’” he said. “That’s what I’m good at.”