CNN’s Anderson Cooper 360 program ran a powerful segment on March 7 that focused on how xylazine-infused fentanyl is harming intravenous drug users in the Kensington District of Philadelphia. Drug dealers mix the veterinary tranquilizer, which users call “Tranq,” with fentanyl because the tranquilizer enhances the potency of opioids, thus making it easier to smuggle in smaller sizes and subdivide into a greater number of units to sell. As I explained in my written and oral testimony before a March 1 House Judiciary Committee Subcommittee on Crime and Federal Government Surveillance hearing, Tranq is just the latest manifestation of what drug policy analysts call “the iron law of prohibition:” the harder the law enforcement, the harder the drug.

According to the CNN report, xylazine is now found in “9 out of 10 lab-tested dope in Philadelphia.” In some cases, bags of purported fentanyl contain only xylazine. Like opioids, xylazine can cause chemical dependency, and people can become addicted to it. Unlike opioids, overdoses from xylazine, which cause people to stop breathing, cannot be reversed with the opioid overdose antidote naloxone. Xylazine also causes blood vessels to constrict; if injection gets outside of the blood vessel and into surrounding tissues, the constriction can cause tissue necrosis and chronic ulcers. Some of these ulcers have become so severely infected that surgeons had to perform lifesaving limb amputations.

Dr. Joseph D’Orazio, who operates a clinic in Kensington, is aware of the iron law of prohibition. CNN’s Elle Reeve interviewed him for the segment and stated, “D’Orazio warns that cracking down on Tranq will just push dealers to introduce other, more dangerous drugs.” I told the Subcommittee the same thing in my opening statement.

And the iron law of prohibition isn’t stopping with Tranq. Beginning in 2019, labs in Europe and the U.S. have been detecting the synthetic opioid isotonitazene, or “iso,” in a growing number of overdose deaths. Nitazenes are a class of synthetic opioids believed to be roughly 20 times the strength of fentanyl.

Rather than doubling down on law enforcement and incentivizing the creation of more deadly drugs, policymakers should take steps to reduce the harms that come from accessing drugs in the deadly black market that prohibition generates. As I explain in my briefing paper published last week, Overdose Prevention Centers (OPCs) have been preventing overdose deaths and the spread of disease in much of the developed world since the first official one opened in Bern, Switzerland in 1986. Canada has 38 OPCs. Germany has 25. Switzerland has 14.

Unfortunately, 21 U.S.C. Section 856 (also known as the “crack house statute”) makes it a federal crime to operate one. In this regard, the United States is an outlier among developed countries.

Sadly, a privately-funded non-profit group has been trying to open an OPC called Safehouse in the Kensington District of Philadelphia since 2019 but has been blocked by the U.S. Department of Justice. Imagine all the lives that could have been saved had the federal government gotten out of the way of this group of Philadelphians who wanted to help save their neighbors’ lives.

Meanwhile, on November 31, 2021, New York City authorized OnPointNYC, a non-profit harm-reduction organization, to open two OPCs in Manhattan, in defiance of federal law. By April 2022, the OPCs reversed 230 overdoses. Those are 230 people who would have died if not for the OPCs. The Justice Department has yet to respond to New York City’s defiance.

This Friday, March 10, at Noon EST, I will be moderating an online event discussing the history and benefits of OPCs that will have Kailin See, who was the project lead and oversees the OPCs in New York City, on the panel. The panel will also feature Darwin Fisher, the manager of Insite in Vancouver, B.C., North America’s oldest sanctioned OPC, and Chelsea Boyd, a harm reduction researcher at the R Street Institute in Washington, DC. You can register to view the event and ask the panelists questions here.