New York City’s leaders are waking up to the latest problem in the ever-worsening drug crisis: xylazine, a sedative spreading like wildfire through the country.
The Adams administration caught heat over the weekend for a new Health Department ad campaign warning residents about the drug, sometimes called “tranq,” which is now cut into much of the city’s fentanyl. The literature tells users to get their drugs tested for xylazine by one of several nonprofits and encourages them to avoid using xylazine-tainted drugs, “especially alone or in a place where it might be dangerous to be unconscious for a long time.” The advertising encourages those with potentially tainted drugs to take them to one of the city’s controversial supervised-consumption sites.
Staten Island representative Nicole Malliotakis echoed many critics of the administration’s approach when she slammed it as “enabling drug use and addiction, by operating injection centers and vending machines with free drug paraphernalia.” This is a reasonable criticism; an even more trenchant one is that the city’s approach is totally inadequate to the problem it faces.
Like basically everywhere else in the United States, New York is experiencing a deadly drug crisis, of unprecedented proportions. Provisional data reported to the CDC indicate nearly 2,900 overdose deaths in the five boroughs last year—a 10 percent increase over 2021, and a nearly 90 percent rise over 2019. The lion’s share of those deaths were driven by synthetic opioids like fentanyl, which has not only replaced heroin on the streets of major metros but also entered into the supply of other drugs.
Xylazine is the latest step in the drug market’s evolution. A commonly used horse tranquilizer currently not on the schedule of controlled substances, the drug seeped into the northeastern U.S. drug supply over the past five years and is now spreading elsewhere. It is commonly added to fentanyl, with the combination sometimes called “sleep cut” or “tranq dope.” The addition of xylazine extends fentanyl’s unusually short high but brings with it deep sedation and added risk of poisoning. In New York City, xylazine-involved deaths rose 36 percent in the first ten months of 2022, according to the Office of the Special Narcotics Prosecutor and the New York Post. When it doesn’t kill, xylazine still does severe damage, giving its users necrotic, unhealing wounds.
The Health Department’s response—encouraging people to use more “safely” and to patronize its supervised-consumption sites—is part of a broader “harm reduction” strategy that’s been at the forefront of the city’s response to drugs since the de Blasio administration. Fears about xylazine also came up at the city’s rollout of a “harm reduction” vending machine, which dispenses pipes, test strips, Narcan, and other “safe use” paraphernalia.
Paradoxically, the emergence of xylazine means such strategies are about to become even less effective. One of the saving graces of New York’s crisis is that it has been, to this point, driven primarily by opioids, overdoses from which can be reversed by the administration of naloxone. But with the spread of a non-opioid sedative into the drug supply, the city finds itself in the same position as areas struggling with the methamphetamine crisis, that is with no readily available antidote to the poison. The products in the harm-reduction vending machine appear similarly ineffectual. What good does it do to hand out crack pipes? (The common answer—that it prevents disease transmission—is almost laughably unscientific.) Certainly, people can go to one of the city’s supervised-consumption sites, but that just means that someone will be around when they overdose, not that they are less likely to overdose from ever more potent drugs.
What is needed, as I argued in a recent National Affairs essay, is not to make using safer but to get people to stop using. Doing that means, first and foremost, treatment for the thousands of New Yorkers whose compulsive use puts them at serious risk for overdose. That care needs to be evidence-based and medication-assisted. Newer, long-acting injectable or subcutaneous applications promise to facilitate treatment adherence among those who struggle to make regular visits to a methadone clinic or take a daily dose of suboxone.
Mayor Adams, who has shown willingness to compel inpatient and outpatient treatment for seriously mentally ill people, should extend that willingness to those whose non-compliance puts them at imminent risk of overdose death. That will require more patient beds and more coordination across courts and the city’s public-service providers. It will also require the mayor to argue forcefully that the poisoning crisis justifies compelling people to help themselves.
Though these interventions should prioritize New Yorkers with the most active and harmful addictions, casual users are at risk, too, unaware that their weekend fun can now be deadly. The city has focused its public messaging on “safer use,” but New Yorkers need to understand that drug use is simply much more dangerous than before. Critics of prevention programming often cite the Just Say No campaigns of the 1980s, with their exaggerated messages about the dangers of marijuana. But it is no exaggeration to say that a single dose can now kill. If the average New Yorker understood this, he might be a little less eager to get high next Saturday night.
Prevention and treatment policies require real investment and substantial political effort to accomplish. It is far easier to hand out naloxone and crack pipes, but as the drug crisis continues to evolve, such stop-gap measures will do little to abate the ever-rising tide of death.
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