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The Rise of Xylazine: A Q&A with Savage Sisters Founder Sarah Laurel

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Xylazine, also known as “tranq” or “tranq dope,” is a powerful animal tranquilizer that has infiltrated the illicit drug market in recent years — notably since the start of the Covid-19 pandemic. Today, it’s a dominant substance found in up to 91% of the dope supply in Philadelphia. Xylazine is increasingly showing up in other parts of the nation as well.

The sedative makes overdoses harder to reverse, and it causes painful wounds so severe, they can result in amputation. Xylazine is often used to bulk up fentanyl — a highly potent synthetic opioid that has led to record numbers of fatal overdoses. Many people using street substances don’t realize they’re consuming xylazine, and many don’t receive the wound care they need before it’s too late to prevent severe damage. 

The team at Savage Sisters Recovery knows this all too well. They’ve been on the frontlines of the xylazine crisis since it first took hold in Kensington, PA. Keep reading for a Q&A on the rise of xylazine with founder and executive director, Sarah Laurel.

Savage Sisters and the Xylazine Crisis: A Q&A with Sarah Laurel

Sarah Laurel calls on her own experiences with substance use and being unhoused in Kensington to connect with — and care for — those still struggling. In addition to boots-on-the-ground outreach initiatives, her activism throughout PA aims to educate and raise awareness around harm reduction, public health resources, and stigma. We’re so grateful to Sarah for talking to us about the rise of xylazine and how her Philadelphia-based nonprofit helps those affected in Kensington and beyond.

Sarah Laurel presents a workshop on xylazine at Gaudenzia’s 28th Annual Women and Children’s conference in Nov 2022

Could You Please Describe Savage Sisters Recovery and the Work You Do?

We are a 501(C)(3) nonprofit that provides trauma-informed recovery housing, outreach, advocacy, education, and harm reduction services in the Pennsylvania region. Savage Sisters operates nine health management houses and a drop-in center in Kensington that serves as our outreach hub. We also do overdose reversal trainings, a lot of street outreach and cleanup initiatives with our volunteers, and wound care. Our team relies on lived experience, which makes us uniquely qualified to serve and interact with our friends in the Kensington community.

Savage Sisters team members at their Kensington-based drop-in location.

What Are the Challenges of Testing & Treating for Xylazine Use?

There aren’t enough case studies on it yet, and treatment providers just aren’t testing for it. The testing can be expensive, and it takes longer to get results, but regular toxicology screens don’t detect xylazine. Some of the effects mirror opioid use, so most treatment centers are treating cases where xylazine is involved like opioid cases. People aren’t getting medical care because they’re terrified of the withdrawal they’ll have to go through. Opioid reversal treatments like Narcan also aren’t as effective with xylazine, which is a sedative, not an opioid. Since no one’s been testing for it, people don’t realize how prevalent xylazine is. We work in Kensington, and the Philadelphia Department of Health was able to do a drug checking program alongside NPS Discovery, which is a lab in the region that tests drug samples.

Over the last three years, we got as many samples as we could to them from all different corners. We’ve had samples sent there from all over the state, so we know it’s not isolated to Philadelphia. I have a lot of people that I interact with who use drugs in Kensington, but will give us samples from Allentown, PA. We’ve gotten testing done on samples from Pittsburg, Ohio, Baltimore, New Jersey, New York, and Pennsylvania. 

In samples we sent in from January 2022, we found 23-25 parts of xylazine to every 1-2 parts of fentanyl. By the second quarter of 2022, we were finding 52 parts of xylazine. The testing showed us the dope supply in Philly is essentially xylazine laced with fentanyl, there’s barely any heroin in it.

Savage Sisters contact cards include an important call to action for treatment providers.

Why is Xylazine so Prevalent Today?

If you think back to the start of the pandemic, when they shut all the borders down and everyone was quarantined, we saw everyone hyper-focusing on heroin and then fentanyl, but that whole time, we saw the rise in the Philly dope supply of xylazine. Back in 2020, you could buy it in a bulk bag on Amazon. It was not difficult to access.

Every time we hyperfocus on one substance, the drug market comes out with a more lethal, potent substance that means less jail time for those selling, and a deeper high for those using. The consequences of this change in drugs can be very intense. It’s so important to pay attention to what’s happening on our streets and address trends like xylazine quickly. We’ve been stomping up and down to bring attention to this for years.

Is it Any Harder to Get Xylazine Now?

The DEA did step in and make it harder to buy xylazine, but that’s only been over the last 12-16 months. Xylazine has been dominating the dope supply for about four years now, and no one’s been testing for it or really controlling it. This is a new thing, for humans to turn around and consume something like this. It’s slightly harder to get xylazine now, but it’s still not as difficult as smuggling heroin across the border, unfortunately.

Can You Talk About the Wounds You See from Xylazine Use?

People who inject xylazine will get bruises or wounds that initially look like bruising from injecting heroin or other substances. But those bruises harden over time and the flesh turns necrotic and falls off. Doctors are still trying to understand why it causes these wounds. There’s just not a lot of answers right now. Savage Sisters does a lot of street outreach, and we have nurses who come out with us and help clean and treat wounds whenever they can. We try to get people into medical care if they’re willing.  

With some of the wounds we see, we don’t even realize at first that it’s someone’s skin we’re looking at because of the coloring and how hard it is. The wounds get so bad, you can see tendon or straight down to the bone. Some people keep injecting in these areas because they’re so scared of causing new wounds in other areas. When the wounds don’t get treated, people get infected and can end up with maggots, or it gets so bad the limb has to be amputated. We have a wound care station at our drop-in center in Kensington where people can come and get care, but we try to treat the wounds we see on the street whenever we can as well.

Do People Realize They’re Consuming Xylazine?

People will often ask me, “Why do people do it?” I’m a person in recovery. When someone goes to the dope man, they don’t ask, “Hey, what did you put in this?” They’re not going to tell you what’s in it. You get what you get. They infiltrated the drug supply with xylazine, and now everybody is addicted to it. That’s what they want because that’s what they’re addicted to. You don’t really think about it. And a lot of the time, you just don’t really know what you’re getting. That’s how they control the drug market and everyone that’s caught in that cycle.

How Strong Are the Effects of Xylazine?

For large animals, xylazine will completely knock them out for 15-30 mins, and then there’s one to four hours of lethargy and grogginess. When you imagine the size of cow or a horse, and then imagine the size of a 100lb woman injecting that substance, it’s doing what it’s supposed to do. It’s putting them to sleep. It’s making people black out for hours at a time, which is really dangerous.

How Do You Approach Conducting Overdose Reversals?

First, we’re always mindful of entering someone’s space. If someone doesn’t need Narcan, they’ll usually let you know right away. When they do, depending on the substances they’re injecting — we really don’t always know what people are getting in Kensington — they can appear rigid, they could be flailing about, or they could be immobile on the ground.

We always approach people respectfully, introduce ourselves, let them know that we are going to administer Narcan. Most people used to come back quickly. They’d be quite responsive. Nowadays, because of xylazine, they’re not responding as quickly. You may need to Narcan a person several times to reverse an overdose and then stay with them or help them get medical care. You may also need to do rescue breathing for a significant amount of time, so we train people on how to do this and we’ll take oxygen out with us as well.

When someone wakes up from an overdose, I don’t want to get too close to their personal space. I realize this person is coming back from death. If they say, “Get away from me,” you get away from them. If they plan on using again right away, we ask if we can sit with them while they use and monitor in case they overdose again. Creating a safe, nonjudgmental space and offering autonomy is huge. That’s how harm reduction saves lives and gives people more chances to get into treatment.  

Savage Sisters conducts regular clean-up efforts with volunteers in the Kensington area, safely disposing of used needles and other paraphernalia.

How Do You Stay Motivated in This Line of Work?

At the end of the day, it’s none of my business, the effect that I have. My entire life, for a very long time, was completely centered in Kensington and controlled by drugs and alcohol. With what I do now, it is literally the same, it’s just a different perspective. It’s really something, to recover from that and go back now and dominate those streets with radical love. My squad and I do that every day. These are our streets, and you can’t keep us from here. You can’t keep us from our people.

Learn more about the xylazine crisis in Philadelphia, Savage Sisters Recovery and their work, and medical strategies for managing xylazine withdrawal from Gaudenzia’s chief medical officer, Dr. Phillip Moore, in this Philadelphia Inquirer piece on xylazine.

If you or someone you love needs help with substance use and co-occurring disorders, please call our 24-hour Treatment and Referral HelpLine at 833.976.HELP (4357) or email [email protected] today.

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