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   From: let.addicts.die@gmail.com   
      
   What drug users and 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 the state of their bodies, but more   
   feel a sense of urgency. They need help. The wounds are killing them.   
      
   “It is absolutely horrible. That’s the reality, though,” said James   
   Sherman, known as Sherm around 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 urgent over the last three years, as the   
   animal tranquilizer xylazine, also called tranq, has become a bigger part   
   of Philly’s street fentanyl supply. Xylazine can cause large wounds 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. “It’s literally   
   people’s flesh rotting, and you can smell it.”     
      
   Kensington has seen the changing nature of America’s addiction crisis. It   
   has been well known as a place to buy heroin under the elevated rail line,   
   a short distance but a world away from the business and tourist centers of   
   downtown.     
      
   Heroin was edged out by the more powerful synthetic opioid fentanyl. But   
   fentanyl’s effects don’t last as long as heroin, and so xylazine was added   
   to street fentanyl to “give it legs,” according to Sarah Laurel, who   
   founded Savage Sisters, the harm-reduction group that employs Sherman.    
      
   Xylazine is not approved for humans, but it’s widely available for   
   veterinarians to sedate large animals like horses. Like an opioid, it can   
   kill pain but it cannot be reversed with Narcan, also known as   
   naloxone, which is used to treat opioid overdoses, according to the US   
   Drug Enforcement Agency. As xylazine is usually mixed in with fentanyl,   
   naloxone can help an overdosed person by counteracting the opioid, though   
   other measures may be needed. Workers at Savage Sisters now carry oxygen   
   tanks with them.   
      
   I could have lost my hand   
      
   Maggie   
      
   The drug has side effects like “tranq walk,” where people seem unaware of   
   their surroundings, along with sores and wounds.     
      
   A user, Maggie, told CNN what she’s seen. “You shoot up and you miss, you   
   get a sore. You don’t take care of your sore, you’ll wind up in a hospital   
   with a hole,” she said. It had happened to her. It started out like a   
   pimple, and then it got bigger, and then the skin came off and she had a   
   half-dollar-sized wound. “I could have lost my hand.”    
      
   Tranq made its mark on Philadelphia’s street drugs about three years ago.   
   That’s when doctors, users and those who try to help them saw a   
   difference.    
      
   Dr. Joseph D’Orazio, an emergency physician and addiction medicine   
   specialist at Temple University Hospital, said patients started to have   
   major wounds that were different from typical injection drug use. “These   
   wounds were a lot deeper, a lot more severe, there were big necrotic   
   areas,” he said. “They were deep down into tendons. Sometimes you can see   
   the bones, and we were starting to see more patients that were requiring   
   amputations.”     
      
   Synthetic opioids, like fentanyl, are fueling the rise in overdose deaths   
   Over the last several years, deaths by synthetic opioids have been on a   
   sharp incline while overdose deaths by heroin have dropped off.   
      
   Drug overdose deaths per 100,000 US residents, 2001 to 2021   
      
   Initially, there was no demand for xylazine.     
      
   “Nobody 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 with this?’ … You get   
   what you get, and you don’t get upset.” And whatever you get, you   
   eventually feel a physical compulsion to do, she said.    
      
   D’Orazio, who also runs a streetside clinic in Kensington, said: “I’ve   
   heard some people say, ‘Everything has fentanyl in it except the   
   fentanyl.’” That’s the way fentanyl has been found as an adulterant in   
   many other drugs, helping to drive US overdose deaths to record highs. But   
   in Kensington, now the fentanyl supply has adulterants too. Xylazine is   
      
   [continued in next message]   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)