The couple sat at a round table at Unity Recovery, a support center on the South Side, nibbling on chocolate croissants while Netflix’s “The Sandman” played on a large TV. It was a brief respite from the outdoors for them and the numerous others — most also unhoused — who had arrived on a recent Wednesday morning seeking rest, a hot shower, and Narcan or materials for wound care.
Together for 16 years, Ryan and L., whose full names are being withheld for privacy concerns, have been homeless for about a year and a half, all while using fentanyl and xylazine.
Both have the tell-tale wounds common in those who use drugs tainted with xylazine, also known as “tranq,” a veterinary sedative that has firmly established itself in the area’s drug supply — and which leads to necrotic skin lesions that can worsen until amputation is required.
Xylazine has marched westward in the past few years, from early detection in Philadelphia to more recent appearances in Pittsburgh’s street drug supply.
In an effort to curb the drug’s illicit availability, Gov. Josh Shapiro on Wednesday signed a bill into law that classifies xylazine as a Schedule III drug, criminalizing possession but with exceptions for veterinary use.
“This bill helps to ensure xylazine isn’t diverted from legitimate sources to drug dealers, and still allows for important veterinary use on animals,” said Gov. Shapiro in a news release about the bill’s passage. “While we hold drug dealers accountable, my administration will continue to pursue a multidisciplinary approach to the opioid epidemic — investing in law enforcement, treatment, and prevention. We will continue to work with harm reduction professionals to expand access to treatment and recovery services across the Commonwealth.”
Ryan and L. shook their heads in disapproval when they heard about the bill. Many experts worry the approach mimics futile patterns seen during the War on Drugs of persecuting the marginalized.
Xylazine’s presence has spiked across the country in recent years, with Pennsylvania labeled a hotspot. Prior to 2021, most county medical examiners in the state, including in Allegheny, didn’t check for the presence of xylazine in toxicology exams. At the time, it wasn’t a meaningful threat in most areas — with the exception of Philadelphia, where 90% of samples tested included xylazine by that time. It was first detected by medical examiners in Philly in 2006.
Locally, the substance is now a companion in nearly half of all fentanyl deaths, according to preliminary Allegheny County data, underscoring its increasing presence in the area’s drug supply.
The sedative has been found in 48 states, according to the Drug Enforcement Administration, which announced a public safety alert for xylazine last March.
That was followed by Mr. Shapiro and the Pennsylvania Department of Health temporarily scheduling xylazine via executive order in April 2023, in an effort to curb access and slow what on-the-ground workers call a new crisis.
House Rep. Carl Metzgar, R-Somerset, prime sponsor of the just-signed bill, said in an interview earlier this month that he was motivated by a lack of structure in the courts leading to an inability to prosecute those cutting xylazine into fentanyl.
“People are losing parts of their body to this drug,” he said, supporting the dual effort to criminalize illicit tranq and educate communities about its harms.
Aimee Mengel, lead harm reduction specialist at Unity, would rather see a safe and regulated drug supply. Her blue T-shirt, with “We Need Safe Supply” in white and orange lettering, made that clear, as she discussed the severity of withdrawal symptoms from xylazine as compared to fentanyl.
“People are puking, they have a fever, a runny nose, they’re miserable,” she said. Ms. Mengel has also seen xylazine withdrawals last longer than other drugs.
And although many of the people she serves aren’t happy to be addicted to xylazine, removing it from the supply entirely may make them feel worse and push them toward deadlier alternatives — or toward an irreversible overdose.
“This is going to be very bad,” she said. “I would rather have it to where we can monitor what people do, so we can help them whichever way they want to go.”
Unity offers free fentanyl and xylazine test strips, in addition to the overdose-reversal medication naloxone (sold as Narcan) and wound care kits so people can dress sores themselves once they leave the center.
But Ryan and L. said there’s no point in using the test strips anymore.
“We are not able to find fentanyl without xylazine,” said L., 40. She has a bachelor’s degree in psychology and hopes to return to working as a support specialist in classrooms again one day.
The pair wants to get sober and secure housing. Ryan, 38, started on methadone, a medication prescribed for opioid use disorder, earlier that day and was hoping to begin a detox process.
Both are, they said, exhausted from the “hamster wheel” of addiction.
L. said xylazine is wreaking havoc on her body like nothing she’s experienced since she started using heroin nearly two decades ago.
“I never once had an abscess until six months ago,” she said.
She recently developed a xylazine-related wound on her knee; it worsened over the course of a couple of days, to the point that she couldn’t walk. She finally went to a local hospital to get it treated. To avoid being stigmatized, she said she tends to avoid hospitals until she’s “nearly dying.”
Ryan believes that scheduling xylazine will drive street drug prices up and potentially make it harder for the couple to prevent debilitating sickness. Other than that, he doesn’t see the legislation having a meaningful impact. He’d rather get help with housing or a warm meal.
“There’s already other stuff out there,” he said, referring to drugs such as medetomidine, an animal sedative 200 times more potent than xylazine that has begun to show up in the Philadelphia street supply. “They’ll just make different variants.”
Tranq has also changed his high and precluded him from feeling OK for long periods of time. He recalled waking up early one recent morning, so sick from withdrawal he could barely move. He was able to buy dope — but his stomach dropped when he saw its brown, gritty color.
This, they said, was a rare bag of pure “dope” — a colloquialism for heroin that, these days, more often refers to fentanyl — meaning it would do nothing to dispel his withdrawal symptoms.
The pair pointed out collections of dime-sized wounds that had cropped up on their arms, hands and legs from xylazine.
Unity has its own wound care clinic, with staff trained to dress ulcers. The wounds can and want to heal over time, doctors who treat xylazine wounds have said, but hygiene is key. Persistent dressing matters, as does keeping sores clean, which can be difficult when sleeping on the street.
Ms. Mengel recalled one unhoused person who had frequently stopped into Unity to have wounds cleaned; she hasn’t seen him in about a month. During the cold months of winter, she watched numerous people’s wounds improve, she said, because they were spending more time at the center and receiving regular wound care. After not seeing the man for two weeks, the wounds on his hands had progressed so severely that his wrist bone was visible.
Ryan and L. said they feel mentally, physically and emotionally exhausted being stuck in the loop of using. They’ve been cleared for an apartment but haven’t secured one yet, and Ryan worries the new methadone prescription won’t be enough to quell withdrawal symptoms, due to a high opioid tolerance.
To avoid excruciating withdrawal, physicians recommend weaning someone off an addictive drug — something that’s not possible with an unregulated and unpredictable drug supply.
“I’ve had significant overdoses with xylazine to the point where it scared me,” said Ryan. “The last overdose, I was out for nine minutes.”
Debra Bogen, the state’s Acting Secretary of Health and former director of the Allegheny County Health Department, said in the Wednesday release that the focus would remain on harm reduction, reducing stigma and providing training to reduce overdoses.
Hanna Webster: hwebster@post-gazette.com
First Published: May 16, 2024, 11:23 p.m.
Updated: May 17, 2024, 5:30 p.m.
