The number of statewide reported overdose deaths involving xylazine during that time jumped from 90 to 575. But because the drug is frequently combined with fentanyl — a highly toxic synthetic opioid — researchers have yet to determine just how fatal or addictive xylazine is on its own.

Schedule III controlled substances, per the U.S. Drug Enforcement Administration, have a moderate to low potential for physical and psychological dependence.

“But from a criminal justice standpoint, it does lead to pretty significant sentences that impact a lot of marginalized communities,” said Dr. Divya Venkat, co-director of Allegheny Health Network’s clinic for formerly incarcerated people.

Many patients, Venkat said, worry they will be at risk of reincarceration if they enter a health care setting with the complex tissue wounds often associated with xylazine use.

“Instead of making it scary for someone to interact with health care, we should be really investing in programs like overdose prevention and ways to make sure that the people who are using drugs are kept the most safe and healthiest,” she continued.

Sofronski with PAHRN said the state should take a “public health approach” and invest in treatment and drug-checking programs instead.

She shared those priorities in a meeting with Acting Secretary Bogen prior to the order last week, but she said officials failed to provide concrete public health measures that will supplement the order.

In an email to WESA, health department officials maintained they are taking a “multidisciplinary approach” by investing in intervention, treatment, prevention and public safety efforts. They did not specify further action.

But the effort to curb the spread of xylazine won’t stop other fatal substances from emerging to take its place.

“Criminalizing a substance — scheduling a substance — doesn’t stop the drug supply from evolving. It never has,” said Jordan Scott, a field organizer with PAHRN. “All it does is fuel an unregulated drug supply.”