A state commission led by two western Massachusetts politicians is urging the state to expand low-barrier treatment, improve drug monitoring and coordinate statewide education efforts to address the growing risks of xylazine in the illicit drug supply.
The Special Commission on the Public Health Effects of Xylazine submitted its final report and recommendations this spring, outlining numerous problems and detailing safety recommendations for healthcare workers, first responders, and people who use drugs.
Xylazine, an animal sedative and analgesic that is not approved for human use by the U.S. Food and Drug Administration, has been identified in both the opioid and non-opioid illicit drug supply in Massachusetts.
According to the Massachusetts Drug Supply Data Stream (MAADS), “As of the second quarter of 2022, xylazine was present in 5% of opioid-overdose related deaths in the Commonwealth. That same year, 19% of samples collected by MADDS tested positive for xylazine.”
By 2024, that number had increased to 26%. By June 2025 it had decreased to 13%, but “drug checking performed by MADDS show the almost simultaneous rise in the presence of other sedatives like medetomidine, another veterinary drug that produces its own host of public health and safety issues.”
According to the report, “Xylazine found in the illicit drug supply is most often non-pharmaceutical grade, obtained online from international vendors,” and comes in liquid and powder form. It can be purchased for less than $10 per kilogram, and it “mimics the sedative effects of opioids.”
“Xylazine exposure produces many health harms, including severe skin ulcers when injected even beyond the injection site and wounds that can take months or years to heal and may not heal without medical care,” the report states. It is a “powerful sedative that lasts much longer than the substances to which it is usually added.”
Immediately upon exposure, “xylazine causes extreme sedation that can impact a person’s ability to breathe.” Days later, “individuals can develop severe wounds beyond the site of injection that can take weeks or even months to heal and often do not heal without consistent wound care.” Long-term effects include “physical dependence on xylazine” and opioid “withdrawal symptoms.”
In 2022, the FDA and the Department of Justice issued warnings about an increase in the number of reports of xylazine abuse and the public health risks associated with it.
The 13-member Massachusetts Special Commission first met in 2025. It was established by the Legislature “to assess the public health and safety concerns associated with xylazine,” and was co-chaired by Sen. John C. Velis, D-Westfield, and Rep. Mindy Domb, D-Amherst, who co-chair the Joint Committee on Mental Health, Substance Use and Recovery.
The commission was charged with developing findings and recommendations to address xylazine exposure and wound care needs, long‑term health outcomes, appropriate overdose responses, and challenges for emergency and frontline providers. Its work also included examining regulatory gaps, training and educational needs, veterinary and pharmaceutical oversight issues, and the “rapidly evolving street‑drug supply.”
The final report was organized into three “areas of inquiry,” each with specific “key findings” and recommendations: “Oversight and Enforcement,” “Outreach and Treatment,” and “Education and Training.”
Oversight, enforcement
The commission found that xylazine in the illicit drug supply is sourced from international online vendors, not diverted from veterinary or research uses, and that Massachusetts is not a major manufacturing source.
Because of this, the commission recommended against rescheduling xylazine in Massachusetts, warning it could restrict legitimate access to the drug.
According to the Commission, “efforts to curtail xylazine contamination in the Commonwealth’s illicit drug supply should focus on public health policies that reduce the harms associated with xylazine exposure rather than implementing additional penalties or restrictions on xylazine.”
The Commission also recommended that public health and drug checking databases be compiled and frequently updated to monitor the presence of xylazine in the illicit drug supply.
Outreach, treatment
The commission found that while comprehensive xylazine training programs exist for health and public safety workers, access to them is uneven across regions and audiences, and public awareness of available resources remains limited. It recommends that “state agencies, harm reduction programs, and medical organizations work to compile existing resources and coordinate outreach efforts, with a focus on ensuring geographical outreach and access.”
The commission also found that low-barrier care and mobile intervention programs are highly effective at increasing awareness, providing harm reduction supplies and encouraging individuals exposed to xylazine to reach out for treatment and care. As such, the report recommends that “low-threshold care be expanded wherever possible, particularly in rural areas where transportation remains a barrier,” including “mobile care services, street outreach campaigns, and physical treatment sites that offer walk-in services, frequent operating hours, and convenient access.”
Sen. Velis, who is currently on active-duty deployment with the Massachusetts National Guard and could not be reached for comment, was a member of the team that studied outreach and treatment.
“This report offers strong recommendations to improve community‑level and system interventions for people struggling with addiction and reduce the serious health risks posed by xylazine,” said Velis in a statement. “Most importantly, the report provides a comprehensive example for how the Commonwealth can respond swiftly to other harmful emerging contaminants in the drug supply to ultimately save lives.”
Education, training
The commission also found a “need for universal access to consistent, accurate, and current information on contaminants and other changes in the drug supply,” and recommended that trainings and educational materials should include general information on xylazine, signs and symptoms of xylazine exposure, steps to take when exposed to, or when encountering, assessing, or treating a person exposed to xylazine, information about xylazine-related wounds and withdrawal symptoms, and harm and risk reduction measures.
The commission found that clinician awareness of xylazine’s risks varies widely across the state and recommended standardized training and educational materials developed by public health agencies in collaboration with experts.
It was also found that “people who have been exposed to xylazine may delay seeking care for wounds if they are not aware of how they got the wounds or if the wounds are not yet severe,” and recommended that “educational materials for people who use drugs and people in recovery address what xylazine is, signs and symptoms of xylazine exposure, steps to take if exposed to xylazine, wound care, harm and risks associated with xylazine exposure, and harm and risk reduction measures.”
The commission found that drug users may also encounter other dangerous adulterants, such as medetomidine and nitazenes, and recommended education on these contaminants, including how to access and use drug-checking tools.
Rep. Domb, a member of the “Education and Treatment” inquiry area, did not respond to repeated requests for comment.
In a statement about the report, Domb said “The final report of the Commission reflects the diligent work of dedicated Commission members and staff. I’m confident that its findings and recommendations will support residents and policy makers to better understand, identify, and respond to the harms posed by xylazine’s presence in the illicit drug supply.”