(COLUMBUS, Ohio) — Ohio Governor Mike DeWine signed an executive order directing the State of Ohio Board of Pharmacy to immediately classify xylazine as a Schedule III controlled substance, making Ohio one of the first states in the nation to schedule xylazine as a controlled substance drug.

Xylazine is a central nervous system depressant used in veterinary medicine as a sedative, anesthetic, and muscle relaxant. The substance, which is not approved for human consumption, has increasingly been found in the illicit drug supply in Ohio, frequently mixed with heroin, fentanyl, or new synthetic opioids (NSOs) such as nitazene.

"This lethal drug has dangerous side effects which can’t be reversed by naloxone, so there is no way to reverse its impact on people,” said Governor DeWine. “The rate of overdose deaths involving a mixture of xylazine and other drugs is increasing at an alarming rate, which is exactly why we need to take action now."

According to the Ohio Department of Health, overdose deaths involving xylazine have increased each year in Ohio since 2019, with 15 overdose deaths in 2019, 45 in 2020, and 75 in 2021. Although 2022 mortality data is not yet complete, the Ohio Department of Health recorded 113 xylazine-involved overdose deaths as of March 14, 2022. Of these 248 unintentional drug overdose deaths, 99.2 percent also involved fentanyl.

When used in combination with an opioid, xylazine may worsen respiratory depression in the event of a drug overdose. Human consumption of xylazine is also known to cause debilitating skin ulcers that cause tissue decay and bacterial infections, which can lead to amputation at higher rates than those who inject other drugs.

Executive Order 2023-08-D WARNING: This executive order contains graphic  photographs of xylazine-related skin ulcers.

 The emergency order was prompted by intelligence gathered as part of an early detection process developed by the Ohio Narcotics Intelligence Center (ONIC) in partnership with RecoveryOhio, the State of Ohio Board of Pharmacy, and local drug toxicologists and chemists. The early detection process, which includes the proactive collection of reports from Ohio’s criminal justice system and forensic labs, allows ONIC to identify, analyze, and triage information on emerging drugs of abuse that are not controlled substances. In 2022, ONIC intelligence led Governor DeWine and the State of Ohio Board of Pharmacy to add nine emerging dangerous substances to Ohio’s controlled drug schedule. Xylazine is the first dangerous substance added to Ohio's controlled drug schedule in 2023.

ONIC PUBLIC BULLETIN:  Emerging Drug Trends:  Xylazine and New Synthetic Opioids Increase Dangers in Ohio Illicit Market

According to ONIC, some crime labs in Ohio estimate that 25 to 30 percent of today's fentanyl cases also include xylazine. The presence of xylazine in illegal drugs and the number of overdoses involving xylazine, however, are believed to be underreported because most toxicology and crime labs do not test for the presence of uncontrolled substances. Scheduling xylazine as a Schedule III controlled substance will allow for more robust testing and will make the sale and trafficking of xylazine for illicit use a criminal offense. 

Veterinary practices may still administer xylazine to animals but must obtain a Category 3 Terminal Distributor of Dangerous Drugs license by June 30, 2023, to be permitted to order xylazine from a licensed wholesaler.

If you believe you or someone else is in immediate danger of a drug overdose, call 911 immediately. Naloxone should always be administered anytime an overdose is suspected, even if the overdose is believed to be caused by xylazine. Multiple doses of naloxone may be needed to reverse an overdose involving an NSO.

For more information on obtaining free naloxone, visit: naloxone.ohio.gov.

For more information regarding the emergency scheduling of xylazine by the State of Ohio Board of Pharmacy visit www.pharmacy.ohio.gov/xylazine.