Philly’s opioid crisis

Health Department hiring two new specialists as ‘tranq’ infiltrates nearly all street drugs in Philadelphia

Use of xylazine, a horse tranquilizer, leads to wounds that are very difficult to treat.

Kensington is the epicenter of Philadelphia's opioid crisis

Kensington is the epicenter of Philadelphia's opioid crisis

Max Marin / Billy Penn
BALA CYNWYD, PA - JAN 12, 2019:  Courtenay Harris Bond and her husband Jeffery Bond stand in their renovated kitchen after a tree on their property fell on their home. "CREDIT: Will Figg for The Wall Street Journal"
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As the animal tranquilizer flooding the city’s drug supply causes a secondary medical crisis on top of the opioid epidemic, the Philadelphia Department of Health is hiring for two new positions intended to help: a wound care specialist and a field nurse.

Xylazine, referred to on the street as “tranq,” is usually used as a sedative for large animals, such as horses and cows. When humans use it, it constricts blood vessels in the skin, and makes it harder for the body to heal injection wounds — which can lead to infection, abscesses, and possible amputation.

Tranq is thought to have been circulating in the region for at least five years, but its popularity is growing.

Since the beginning of the pandemic, the Philly Health Department hasn’t tested a single bag of opioids that doesn’t contain xylazine, department field epidemiologist Jennifer Shinefeld told Billy Penn.

People with substance use disorders in Philly can’t avoid being exposed to it, said Kristi Petrillo, a wound care registered nurse at Prevention Point in Kensington. “Since no blood is getting to [the wounds], they progress very rapidly,” she said. “There can be a lot of drainage, and it can be foul smelling, so people are very ashamed of these wounds.”

At Prevention Point, where the wound care center is open 12 to 4 p.m. Mondays, Tuesdays, and Fridays, people come in regularly for help with xylazine wounds, from which the discharge seeps through their clothes. Often large areas of legs or arms need bandaging, Petrillo said.

These kinds of persistent wounds can trap people who use opioids in a chronic cycle, since they often keep people from being admitted to drug treatment centers.

The city’s new wound care specialist and field nurse will do boots on the ground outreach to address the problem, said Health Department spokesperson James Garrow. The specialist and nurse will also set up pop-up sites people can visit to get help. The new positions aren’t directly related to the recent spike in xylazine use, he said, but the situation makes it even more urgent to get these positions filled.

“I’m really excited for our inclusion of wound care in the health department,” Garrow said. “It’s going to be a great support for our team.”

Because xylazine isn’t listed under the federal Controlled Substances Act, dealers can buy large quantities on the web. It’s relatively cheap and has opioid-like properties, making it appealing to dealers to cut with fentanyl and heroin, said DEA spokesperson Patrick Trainor.

From 2019 to 2020, Philadelphia saw a 5% increase in skin and soft tissue infections, and a more than 20% increase in bone osteomyelitis (swelling), which Health Department epidemiologist Shinefield said is likely connected to xylazine’s rise. There’s also anecdotal evidence from people working in the field that amputations may be up.

To be treated properly, xylazine wounds can require oral or intravenous antibiotics for weeks if the infection reaches the bloodstream or bone. But people are often resistant to going to the hospital because of fears of withdrawal and/or being stigmatized. Many hospitals and medical centers often don’t offer comfort medications for xylazine withdrawal, which requires benzodiazepines, creating another barrier.

Prevention Point nurses explain the options to their clients and offer cleaning, oral antibiotics, and wound care kits, said Petrillo, the  wound care nurse. But staff do not force anyone to go to the hospital.

“[Xylazine] just adds another risk for people who are already at risk for chronic conditions,” Petrillo said. She said she’s glad to hear the city is hiring a wound care specialist and nurse.

Sarah Laurel, CEO of Savage Sisters, said the South Philly recovery house operation has “kicked up” the wound care it offers, and now includes triple antibiotic ointment, wraps, and swabs in outreach kits, because of the xylazine spike. She agreed it’s “great that the health department is hiring wound care specialists.”