As opioids mixed with animal tranquilizers enter Kensington, troubling health problems are emerging

Sarah SmithFebruary 15, 2023

Many people living on the streets of Philadelphia’s Kensington neighborhood – the largest open-air drug market on the East Coast – are full-blown addicts, openly snorting, smoking, or injecting illicit drugs hunched over crates or on porches. Syringes litter the sidewalks, and the stink of urine pollutes the air.

The suffering of the area dates back to the early 1970s, when the industry left and the drug trade took hold. With each new wave of drugs, the situation is getting bleaker. Now, with the advent of xylazine, the veterinary tranquilizer, new complications are taking a toll on an already overburdened system.

“It’s all hands on deck,” said Dave Malloy, a longtime Philadelphia social worker who does mobile work in Kensington and around the city.

Dealers use xylazine, which is not controlled by the federal government and is cheap, to cut down on fentanyl, a synthetic opioid that is 50 times more potent than heroin. The street name for xylazine is “trank”, and fentanyl mixed with xylazine is “trank dope”. Mixed with the drug, xylazine enhances and prolongs the effects of fentanyl or heroin.

But it also has dire health consequences: it leaves users with necrotic ulcers that won’t heal because xylazine restricts blood flow through skin tissues. Also, since xylazine is a sedative and not a narcotic, tranquilizer overdoses do not respond to the common antidote, naloxone, which only reverses the effects of the latter.

According to the Drug Enforcement Administration, xylazine has been spreading across the country for at least a decade, starting in the northeast and then moving south and west. In addition, it has proven easy for offshore scammers to produce, sell, and ship in large quantities, eventually making it to the US, where they are often distributed by express delivery.

First discovered in Philadelphia in 2006, by 2021, xylazine was found in 90% of street opioid samples in the city. According to city statistics, 44% of all fentanyl-related unintentional overdose deaths that year were attributable to xylazine. Because autopsy testing procedures vary widely from state to state, the country does not have comprehensive data on xylazine-positive overdose deaths, according to the DEA.

Here in Kensington, the results are on display. Exhausted users walk the streets with necrotic wounds on their legs, arms, and hands, sometimes going to the bone.

Efforts to treat these ulcers are complicated by the constriction of blood vessels that xylazine causes, as well as the dehydration and unsanitary living conditions faced by many homeless people, says Silvana Mazzella, deputy executive director of Prevention Point Philadelphia, a nonprofit public health organization, a group that provides services known as harm reduction.

Stephanie Clipp, a wound care nurse and active harm reduction worker in Kensington, said she has seen people “literally living with what’s left of their limbs – things that obviously need to be amputated.”

Fatal overdoses are on the rise due to xylazine’s resistance to naloxone. In case of respiratory depression with a sedative, CPR is performed and transferred to a hospital for connection to a ventilator. “We have to keep people alive long enough to treat them, and every day it looks different,” Clipp said.

If the patient is admitted to the hospital, the focus is on treating acute tranquilizer withdrawal, which is risky. There is virtually no research on how xylazine works in humans.

Melanie Beddis lived with her addiction on and off the streets of Kensington for about five years. She remembers the cold heroin detox cycle. It was terrible, but usually after three days of pain, chills and vomiting, she could “digest food and possibly sleep.” According to Beddis, current director of the Savage Sisters Recovery program, which offers housing, outreach and harm reduction in Kensington, the tranquilizer upped the ante.

She recalled that when she tried to kick the concoction in prison, she couldn’t eat or sleep for about three weeks.

There is no clear formula for what helps detox from opiates mixed with xylazine.

“We really need an effective prescription,” said Dr. Ginmari Perrone, founding director of the Pennsylvania Medical Center for Addictions and Politics.

Perrone said she treats opioid withdrawal first and then, if the patient is still uncomfortable, she often uses clonidine, a blood pressure medication that also reduces anxiety. Other doctors have tried gabapentin, an anticonvulsant medication sometimes used for anxiety.

Methadone, an opioid use disorder drug that blunts the effects of opioids and can be used to relieve pain, also appears to help people with tranquilizer withdrawal.

In the hospital, once the patient has stabilized, xylazine wound care may be a priority. This can range from cleaning or debridement to antibiotic treatment – sometimes intravenously for several weeks – to amputation.

Philadelphia recently announced the launch of mobile wound care as part of its opioid settlement fund spending plan, hoping it would help solve the xylazine problem.

The best wound care professionals can do on the street, Clipp says, is to clean and bandage sores, provide supplies, advise people not to inject into wounds, and recommend treatment at medical facilities. But many people get lost in the cycle of addiction and don’t follow it through.

While heroin has a window of six to eight hours before the user needs another dose, a tranquilizer wears off in just three or four hours, Malloy estimates. “This is the main reason why people do not receive proper medical care,” he said. “They can’t sit long enough in the emergency room.”

Also, although the resulting ulcers are usually very painful, doctors are reluctant to give users strong painkillers. “Many doctors see this as a search for a cure, not something that people go through,” Beddis said.

Meanwhile, Jerry Daley, executive director of the local branch of the grant program run by the Office of National Drug Control Policy, said public health officials and law enforcement should start cracking down on the xylazine supply chain and get the word out that xylazine companies are scammers.” literally cashing in on people’s lives and health.”

KHN (Kaiser Health News) is a national news service that produces in-depth journalism on health issues. Together with Policy Analysis and Polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a charitable non-profit organization providing health information to the nation.