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In Philadelphia, harm reduction experts help communities fight xylazine addiction


For several years, xylazine has been wreaking havoc among drug users in Philadelphia, particularly in the part of the city known as Kensington. On the street, it's known as tranq. It's a legal drug for veterinary use as a sedative. But when humans inject it, usually mixed with opioids, it can be devastating. Now, with xylazine linked to a stunning increase in overdose deaths across the nation, the Biden administration has taken an unusual step - designating the substance as an emerging threat. Over the next 90 days, the government plans to roll out a national plan to better understand, identify and combat it. That's work Sarah Laurel has already been doing for the last four years. She is the founder and executive director of Savage Sisters, a housing and harm reduction nonprofit in South Philadelphia. We caught her in the middle of another very busy day. Thanks for taking the time, Sarah.

SARAH LAUREL: Thanks for having me.

LIMBONG: All right. Sarah, I want to start with your own story because not only do you run Savage Sisters, but you know the community of the people you serve really intimately and their struggles, right?

LAUREL: I do. I am in recovery from homelessness as well as substance disorder in Kensington.

LIMBONG: Can you tell us a little bit about what makes, you know, fentanyl, which is already dangerous, even more so when xylazine is added to the mix?

LAUREL: Xylazine is a game changer for people who use substances. When it first was noticed in the Philadelphia drug supply, we started to see a slower response when we were reversing overdoses, and then we began seeing wounds on individuals who are using tranq dope. And as the past four years have gone on, we saw a very large increase. It became the predominant supply with fentanyl becoming the adulterant to it. And we are now left with individuals that have open gaping ulcers, infections, some necrotic tissue, and that leads to amputation.

LIMBONG: When we air conversations like this, I think listeners who don't have relevant experience sometimes tell us they don't understand why some people experiencing addiction would seek something so dangerous. I'm curious, what would you say to help them understand?

LAUREL: Nobody asked for this. When you are a person who is purchasing drugs from the criminal drug market, you get what you get, and you don't get upset. I don't think that anybody knew that it would have this catastrophic effect. However, once we found out what was in the supply, it was too late because individuals were already chemically dependent on it.

LIMBONG: So how do you help someone who is overdosing or withdrawing from xylazine?

LAUREL: Typically, if you're just combating an opioid overdose, that individual responds rather quickly when administered naloxone. However, because of the heavy sedative in the drug supply, those individuals are not responsive. They are not beginning to breathe on their own. And so we now carry oxygen and have been for a few years. We are the only organization that carries it streetside and reverses overdoses with naloxone and oxygen. But I will say it is very effective.

As far as the withdrawal protocols, I'm not a medical professional. The individuals that are going into inpatient are being treated only for opioid withdrawal, which is a small part of what they are coming off of. So we need to address the xylazine withdrawal. Xylazine is an alpha-2 agonist, and it hits the GABA receptors, so it is similar to a benzo withdrawal.

LIMBONG: What do you make of this move from the Biden administration? Are there other specific practical recommendations you'd make to the White House about how to fight back against tranq?

LAUREL: Well, I don't - their response is to say it's a problem. I haven't seen action yet. So my call to action is we need updated withdrawal protocols. We need updated overdose reversal protocols. We need safe supply. We need to stop focusing on one substance because no matter what happens, if we announce that we're hyper-focused on one substance, the criminal drug market will step in and will find a new adulterant that could be potentially more lethal. And we will have to figure that out in a few years as well. We're four years deep in this. My city is devastated by these consequences and so are my friends. And we need resources, streetside, immediately.

LIMBONG: Can you tell us about someone you've helped or are helping recently?

LAUREL: We help people every single day. We have the store front. Individuals come in for showers and wound care. Sometimes that looks like just wrapping those wounds and giving them supplies to take with them. A large number of the individuals that our wound care team treats, they need hospitalization. They need IV antibiotics. Some will eventually need an amputation. So what we are doing is the best that we can. However, the need is much greater. We had a success story yesterday. An individual walked in and was ready to go to treatment, and he got picked up and he left. The large majority of people that we see come in, they get harm reduction supplies, wound care, showers, and then they go back about their business.

LIMBONG: Is there anything else you want people to know, either about the drug or the people who use it?

LAUREL: Please don't call it a zombie drug. It is not a zombie drug. My friends are not zombies. They are people who use substances and who are victims of the criminal drug market and the adulteration of the supply. And I am asking that we see some action around the response so that our friends can get the help that they need.

LIMBONG: Sarah Laurel, founder and executive director of Savage Sisters in Philadelphia. Sarah, thank you so much.

LAUREL: Yup. Transcript provided by NPR, Copyright NPR.

Sarah Handel
[Copyright 2024 NPR]
Andrew Limbong is a reporter for NPR's Arts Desk, where he does pieces on anything remotely related to arts or culture, from streamers looking for mental health on Twitch to Britney Spears' fight over her conservatorship. He's also covered the near collapse of the live music industry during the coronavirus pandemic. He's the host of NPR's Book of the Day podcast and a frequent host on Life Kit.