What drug users and the people who work with them in Philadelphia talk about is the smell. The smell of rotting flesh from open infected wounds.
Some users say they feel ashamed of their body condition, but more feel a sense of urgency. They need help. Their wounds kill them.
“It’s absolutely horrible. That’s the reality, though,” said James Sherman, known as Sherm in Philadelphia’s Kensington neighborhood, where he once used drugs and where he now tries to help those still on the streets.
The need for help has become more pressing in the past three years as the animal tranquilizer xylazine, also called tranq, has become a larger part of Philly’s street fentanyl supply. Xylazine can cause large sores that won’t heal no matter where you inject it, and they can appear even if you snort it or smoke it. Infections are common and can even lead to amputations.
“Some people aren’t ready to see that yet,” Sherman said. “People’s flesh is literally rotting and you can smell it.”
Kensington has seen the changing nature of America’s addiction crisis. It was well known as a place to buy heroin under the elevated railway line, a short distance but a world away from the business and tourist centers of the city centre.
Heroin was eliminated by the more powerful synthetic opioid fentanyl. But fentanyl’s effects don’t last as long as heroin, so xylazine was added to street fentanyl to “give it legs,” according to Sarah Laurel, who founded Savage Sisters, the harm reduction group that concerns Sherman.
Xylazine is not approved for humans, but is widely available to veterinarians to sedate large animals such as horses. Like an opioid, it can kill pain, but it can’t be reversed with Narcan, also known as naloxone, which is used to treat opioid overdoses, according to the U.S. Drug Enforcement Administration. As xylazine is usually mixed with fentanyl, naloxone can help a person who has overdosed by neutralizing the opioid, although other measures may be needed. Workers at Savage Sisters now carry oxygen tanks with them.
The drug has side effects such as “quiet walking,” where people seem oblivious to their surroundings, along with sores and sores.
One user, Maggie, told CNN what she saw. “You shoot and miss, you get hurt. You don’t take care of your wound, you end up in a hospital with a hole,” he said. It had happened to her. It started as a pimple, and then it got bigger, and then her skin peeled off and she had a wound the size of a half dollar. “I could have lost my arm.”
Tranq made his mark on the Philadelphia street drug scene about three years ago. That’s when doctors, users and those trying to help them saw the difference.
Dr. Joseph D’Orazio, an emergency physician and addiction medicine specialist at Temple University Hospital, said patients began to have major injuries that were different from typical injection drug use. “These wounds were much deeper, much more severe, there were large necrotic areas,” he said. “It was deep into the tendons. Sometimes you can see the bones, and we started to see more patients who needed amputations.”
Initially, there was no demand for xylazine.
“No one was coming to Kensington to buy tranq, they were coming to get heroin,” said Laurel of the Savage Sisters group. “You don’t go to your drug dealer and say, ‘Do you have a nutrition label on this?’ … You take what you get and you don’t get upset.” And whatever you pick up, eventually you feel a physical compulsion to do it, he said.
D’Orazio, who also runs a clinic down the road in Kensington, said: “I’ve heard some people say, ‘Everything has fentanyl but fentanyl.’ , helping to drive overdose deaths in the US to record highs. But in Kensington, now the supply of fentanyl has adultery. Xylazine was found in 9 out of 10 drug samples tested at the Philadelphia lab. “What we’re seeing is that the fentanyl bags sometimes don’t have fentanyl in them … it’s just xylazine,” he said.
Xylazine is most concentrated in Philadelphia, according to Dr. Rahul Gupta, director of the Office of National Drug Control Policy. But it’s in all 50 states, he told CNN.
The White House is looking at xylazine as a potential “emerging threat,” which would trigger the development of a federal plan to deal with it, he said.
And last week the US Food and Drug Administration announced it had taken action to stop illegal imports of xylazine.
This could slow the spread of xylazine, first noted in Puerto Rico in the 2000s, across the nation. But in Kensington, there could be more unintended consequences.
Xylazine withdrawal can cause severe anxiety and distress, D’Orazio said, and medications used to treat opioid withdrawal don’t work well for xylazine. This exacerbates the public health crisis. “People avoid the hospital because they feel that withdrawal can’t be treated properly,” he said. “They are further along and the disease is getting worse before they come.”
Dana, who came to Savage Sisters to heal her wounds, said she was violently ill while in xylazine withdrawal. “I’d rather get off fentanyl and heroin together than off xylazine,” he said.
There is also the fear that something even worse could replace today’s cheap and widespread xylazine if it becomes more difficult to obtain.
Neither D’Orazio nor Laurel believes cutting supply will do much for the addicted and homeless people in Kensington.
D’Orazio said there needs to be more affordable housing, more access to health care, fewer restrictions on drugs that treat addiction and less stigma on what he says is a chronic disease like diabetes. But he added that there also needs to be more emphasis on substance use disorder prevention, which means mental health care needs to be considered. His patients tended to have suffered childhood trauma, such as abuse and neglect. There needs to be more “early intervention for people with trauma in their lives,” he said.
Maurice, whose voice has been hoarse since being injected with sedation and fentanyl in his throat a few months ago, said: “A lot of people have pain from their past that they’re dealing with and trying to numb.”
In conversations with CNN about why they came to Savage Sisters, several people brought up painful past experiences like rape or abuse almost immediately, as if those memories were simmering just below the surface. Maggie said that, at 66, “It’s been a long life, believe me, doing this sh*t… stuff I have to deal with. I need to do some kind of therapy. This thing happened to me when I was five years old that shouldn’t have happened to me.”
Laurel, a recovering heroin addict, calls everyone she meets and tries to help her “friend” in Kensington.
“People who are out here numbing their pain with substances, whether it’s heroin, alcohol, cocaine, we need to address the pain, we need to stop isolating the substance and look beyond it,” he said.
Savage Sisters offers several mental health programs for people in their recovery centers, and Laurel says it’s very expensive, but worth it. He had to work hard to raise money. “Until it directly affects them, nobody cares. It’s ugly. It’s not a cute, fun thing to donate your money or time, is it? It’s hard. It’s rough. It’s sad. It’s painful. … I had to find ways to convince people that we deserve to be saved.”
Some news organizations have called xylazine “the zombie drug.” Laurel hates that term. “The only way you can get rid of a zombie is to kill their brain,” he said. “Why are you saying this about my friends? Why would you say that about a human? It’s already hard enough trying to get people to care about us.”