Scheduling doesn’t keep dangerous drugs out of our communities, but reducing demand could

On Sept. 15, 2026, lawmakers passed the Combating Illicit Xylazine Act out of the House of Representatives. If the bill becomes law, it would place illicit xylazine—a powerful animal sedative that has spread through the illicit drug supply in recent years—on Schedule III of the Controlled Substances Act (CSA). This would subject the non-veterinary possession, manufacture, and distribution of the substance to criminal penalties. Supporters argue that scheduling xylazine will help law enforcement keep our communities healthier and safer by getting the drug off American streets. 

This is a reasonable goal; after all, xylazine is not a risk-free drug. Though its impact on overdose risk is complex and not fully understood, it can cause significant sedation, unpleasant withdrawal symptoms, and serious skin wounds. Yet in an era dominated by synthetic drugs, the evidence suggests that scheduling does little to get them off the streets. In fact, the supply can become even more dangerous. 

An October 2026 study revealed that banning xylazine at the state level has failed to eliminate it from the supply. The study compared drug seizure trends from 1999 to 2025 in states that had scheduled xylazine versus those that had not. They found that scheduling xylazine did not lead to substantial relative declines in seizures of the tranquilizer. What the states with scheduled xylazine did see were major increases in the seizure of a different tranquilizer: medetomidine. 

These findings are important for two reasons. First, they provide early, systematic evidence that scheduling—including at the federal level—is unlikely to keep xylazine out of U.S. communities. Second, they suggest that scheduling xylazine federally may encourage manufacturers and traffickers to introduce new and potentially more dangerous substances in its place. As previously described, xylazine is not without its harms. But medetomidine is the more dangerous drug. It causes more significant and longer-lasting sedation, and its rapidly progressing withdrawals are associated with serious cardiac risks, including heart attack. 

Although this new study is the first to look systematically at xylazine scheduling and its impact on seizures, its findings are consistent with what we have seen with fentanyl and the synthetic drug supply more broadly. In recent decades, synthetic drugs have overtaken natural and naturally derived substances in the U.S. illicit drug supply. Fentanyl, the most common and well-known synthetic drug, has been responsible for hundreds of thousands of American deaths since it started spreading in 2013. Pharmaceutical fentanyl has been on Schedule II since the CSA’s inception in 1970. The Drug Enforcement Administration placed the predominant illegally manufactured version on Schedule I in 2013, and many of its analogs are now banned as well. Nonetheless, fentanyl-involved overdose deaths skyrocketed from 2013 through 2022. Deaths have declined in recent years; however, this is mainly due to the expansion of harm reduction and reduced barriers to addiction treatment. Fentanyl remains present in the supply and continues to drive addiction and overdose across the United States.

Understanding why prohibition tends to be ineffective against drugs like fentanyl and xylazine requires looking at the synthetic supply chain itself. A market dominated by synthetic drugs is not sensitive to the same pressures as one dominated by natural or naturally derived substances. For example, heroin dominated the illicit opioid market before fentanyl usurped it. The semi-synthetic drug is created in a lab from morphine, which is, in turn, made from poppies. But growing enough poppies to meet the demand for heroin required swathes of land, time to cultivate the plants (often in areas geographically far from the North American drug market), and a human workforce. This made heroin production risky both legally and economically. When law enforcement disrupted heroin operations at any point in the process, starting over took considerable time and effort. This drove up prices on the street and, in some instances, drove demand down—at least temporarily. 

Manufacturing fully synthetic drugs requires a lot of knowledge, but not much risk tolerance. Even if law enforcement destroys a laboratory, new locations are not so geographically limited and can be re-established much more easily than a supply chain that starts with a farm. For years, experts have noted that addressing the overdose and addiction crises through an enforcement-first or enforcement-only approach is unlikely to effectively reduce either demand or supply. Furthermore, with synthetics, chemical formulas for existing drugs can be tweaked quickly to skirt new scheduling efforts or to become more potent (and therefore easier to hide and transport). This is consistent with the “Iron Law of Prohibition,” which states that criminalization, especially when unaccompanied by demand reduction, incentivizes more potent drugs. 

This is exactly what we have witnessed in the past decade with fentanyl and what is currently unfolding with xylazine. The key takeaway for lawmakers is not that law enforcement approaches are futile: Prohibition opens the doors to criminal organizations and violence related to manufacturing and distributing illicit drugs, and addressing these issues at a higher level can benefit communities. However, prioritizing bans is unlikely to stem supply or suppress demand. Instead, it makes the supply more volatile. And a constantly changing supply makes it harder to keep individuals alive, treat addiction, or protect communities. 

Prioritizing health interventions can keep people safer and healthier right now while reducing the demand for drugs and the burden of substance use disorder on our communities. This may include reducing barriers to obtaining medications for opioid use disorder, ensuring that funding targets the most effective and cost-effective treatments, and protecting or expanding access to lifesaving interventions like naloxone and fentanyl test strips. By facilitating recovery, these policies get at the root of the challenges so many communities are currently struggling with and help inhibit the discovery and proliferation of ever more potent and lethal substances.