Paul Hunter’s legs are rotting. The wounds along his calves, skin and ankles are eating away at his freckled flesh. Every time he takes his socks off, the wounds rip open again.
He said his legs feel like they’re being burned or stabbed, but he’s addicted to the fentanyl that’s often laced with a veterinary tranquilizer likely causing his wounds. If he doesn’t smoke fentanyl, he experiences brutal withdrawal symptoms that can include vomiting, diarrhea, chills, muscle cramps and bone pain.
“It’s not fun at all,” he said. “I just get too sick to move things around. I can’t even tie my shoes or anything.”
So he again buys the drug that’s become the bane of his existence. And his wounds get deeper.
HOW TO HELP
Signs of an overdose include pinpoint pupils, loss of consciousness, shallow breathing, choking sounds, limpness and pale, blue or cold skin, according to the Centers for Disease Control and Prevention.
If someone is showing the signs of a possible opioid overdose involving opioids and xylazine, the Substance Abuse and Mental Health Services Administration recommends taking these steps:
- Call 911 and stay on the phone until first responders arrive.
Washington has a good Samaritan law to protect people trying to save someone from an overdose. - Give naloxone, a drug that can reverse the effects of an overdose.
Naloxone or Narcan will not cause harm if opioids are not involved in an overdose, but be aware that the effects of an overdose may continue after naloxone is given if xylazine is involved. - Give rescue breaths and chest compressions.
Rescue breaths are important for overdoses possibly involving xylazine because the sedative slows breathing. To give an adult rescue breaths, make sure the airway is clear, place one hand on the chin, tilt the head back and pinch the nose closed. Seal your mouth over the person’s mouth and give two slow breaths, watching the person’s chest rise. Follow up with one breath every 5 seconds. For chest compressions on adults, place the person on their back, press hard and fast on the center of the chest and keep your arms extended. - Monitor the person.
If the first dose of naloxone hasn’t taken effect after two to three minutes, another dose may be necessary.To learn more
The Washington State Department of Health has a detailed guide with visuals on its website.
The presence of that veterinary tranquilizer — a deadly drug called xylazine — has almost doubled in Clark County’s drug supply since November, according to Columbia River Mental Health Services.
The data suggests that at least 10 percent of the illicit fentanyl in Clark County is laced with xylazine. That’s still a small amount overall, but the prevalence of xyalzine is growing, said Dr. Kevin Fischer, chief medical officer at Columbia River Mental Health Services.
“We’re beyond it being an anomaly. … This is probably our new baseline,” Fischer said. “And history suggests that I would expect this to increase over time.”
Xylazine, also known as “tranq,” has inundated drug markets in some parts of the country, especially Philadelphia, where almost all fentanyl contains the sedative that rots human tissue.
In these areas, people with wounds like Hunter’s fill street corners and hospitals. If not cared for, the wounds can lead to sepsis and death, Fischer said. The wounds often require long, complicated hospital stays.
“As this increases and spreads, it could really start to have a significant impact on our availability of inpatient resources at our hospitals,” Fischer said.
Fischer confirmed that Hunter’s wounds are consistent with those attributed to xylazine ingestion.
Homeless outreach workers say they have noticed more people developing xylazine-related wounds, a sign of change in the drug market, Fischer said.
Xylazine is not approved for human use by the Food and Drug Administration because of its dangerous, even deadly, side effects. However, illicit xylazine is often mixed into fentanyl during production because it prolongs the effects of fentanyl, Fischer said.
“In some ways, it’s probably a competitive advantage for drug dealers to add this to their product,” Fischer said. “I don’t think we know their motivation or why it shifted — just that it happened.”
Most people are not ingesting xylazine on purpose, he said.
People yell for “Narcan” — the brand name for an overdose reversal medication called naloxone — quite often in the camp where Hunter lives, other residents said. Friends plunge the medication into the noses of those overdosing.
The problem: Naloxone only works to reverse overdoses from opioids.
Xylazine is not an opioid.
Experts say people should still use naloxone for an overdose even if they suspect xylazine might be involved because the tranquilizer is often combined with fentanyl, which does respond to naloxone. However, it may take multiple naloxone doses to revive someone.
Rescue breaths are also important if someone suspects an overdose may involve xylazine because the drug causes breathing to slow down, according to the Centers for Disease Control and Prevention.
Raising awareness
Many people living in Hunter’s camp did not know how xylazine could complicate overdoses.
Staff at Clark County Public Health are distributing an informational handout to community members and organizations that help people with substance use disorders, said Public Health spokesperson Marissa Armstrong.
Public Health also expects to begin distributing fentanyl and xylazine test strips from the Washington State Department of Health this month, Armstrong said.
For now, people in the camp where Hunter lives are coping with uncertainty.
On Wednesday, Columbia River Mobile Health, a street team that provides medical care to people living outside, treated Hunter’s wounds, which had become slightly blackened and red.
Hunter has been homeless on and off since he was 18 years old. That’s when a family member introduced him to crack, he said. He dreams of a different life where he has housing and works as a carpet layer again.
“I like the enjoyment of seeing people’s faces when they get a new carpet,” he said. “I would love to get into a nice apartment.”
