The city of Philadelphia has been struggling for several years with a new substance with devastating effects: xylazine. Nicknamed “zombie drug,” it plunges people who consume it into a prolonged state of unconsciousness, in addition to creating strong dependence and irreversible physical damage. The duty went there to document the social impact of this drug which is starting to make its way into the country. Second of five texts.
Michael Collins clenches his jaw and groans in pain as he takes off his old yellow sock, the dirty fabric sticking to the wounds. His foot is huge, white and warm, revealing a severe infection. “Am I going to lose my foot? » he asks in a terrified voice.
Like several other patients attending the Penn’s Rock mobile clinic, which operates in the Kensington neighborhood of Philadelphia, Michael, 35, waited until he was no longer able to walk before going for a consultation. “I’ve been telling him to go to the hospital for days,” explains his wife, Nikki, 28. It’s always the same thing, he says: “I want to ‘get better’” [une expression locale qui signifie consommer pour éviter le malaise du manque]. Then he falls asleep, and when he wakes up, he is still in a state of withdrawal. »
In the minibus which has been transformed into a clinic, the smell of wounds and necrotic flesh caused by the consumption of “tranq” – or “zombie drug” – is obvious. The nurses explain to Michael that there is no longer a minute to lose. “You need to go to the hospital to start intravenous antibiotic treatment,” recommends Jennifer Mignon in a serious tone. It’s going to be hell if you don’t start treatment now. Infections kill people every day. »
A team is ready to transport him to the hospital, but Michael persists, despite the pain and the fear of losing his foot. “I don’t want to go to this shitty hospital,” he tells his wife while the nurse searches for a new pair of clean socks to cover his now disinfected and bandaged foot.
Michael refuses to leave his wife alone in the street, even though she assures him that she will join him at the hospital later. Above all, he is afraid of the inevitable withdrawal that he will have to undergo in the hospital.
Many of them, like Michael, avoid the hospital, notes nurse Tanisha Veney. “They are stigmatized in health services,” she explains. If you know in advance that you’re going to be treated like you’re trash, and not like a whole person, you won’t want to go there. That’s why so many people come to our mobile clinic, it’s because we treat them with respect. »
After a discussion with members of the team, Michael and his wife decide to go to therapy to stop using. There, we will take care of their wounds. “We are going to leave all of this,” he explains, resolute, making a broad hand gesture to indicate the neighborhood ravaged by drugs. If we stay here, we’ll die. »
But the young couple doesn’t want to leave just yet. “Tomorrow,” Michael repeats. The team arranges to meet him at the mobile clinic the next morning. Until then, Michael and Nikki plan to commit petty thefts to eat and “get better” one last time. “You have to do what you have to do to support your consumption,” confides Michael without false modesty.
Consume to control pain
The fate that awaits Michael is far from unique. Since xylazine hit the streets of Kensington, Monika VanSant, an addiction treatment doctor at Girard Behavioral Wellness Center and Penn’s Rock Mobile Clinic, has seen many of her patients have their arms amputated. , which one leg. She keeps a whole batch of wheelchairs in her clinic.
“Xylazine causes blood vessels to contract,” she explains. It stops blood flow and kills skin cells. There are therefore no more white cells to fight against the infection. The bacteria eat the necrotic tissue, causing an abscess, and tunnel all around it, causing the wound to open up like a pocket of pus. »
If the wounds are not treated, they will sometimes spread over the entire front of the leg or the entire arm. It is not uncommon for ligaments and even bones to be exposed. “The bigger the wound, the more intense the pain, and therefore the more these people will consume to control the pain. And the vicious cycle gets worse because they don’t want to go to the hospital. They are mortally afraid of the hospital, because they cannot tolerate the withdrawal symptoms. »
In the emergency room, doctors may give pharmaceutical opioids to addicted patients to keep them comfortable, but the doses these people consume on the street are so high that doctors cannot keep up. , she explains.
“Bags on the street typically contain two milligrams of fentanyl and xylazine. However, in intensive care units, micrograms are used for sedation. It’s a hundred times less. And street drug users take them several times a day, often more than one bag at a time. Some will inject up to five bags at a time. »
Missed appointment
The next morning, at an intersection where three agencies are doing fieldwork, staff from the mobile wound clinic wait for Michael and Nikki. In vain. The young couple never introduced themselves.
A disappointing situation for sure, but not unusual for the team. “Once they leave the clinic, it’s hard. It’s in their hands. You have to try to catch them when they are there,” explains Nakomo Finnel, director of operations at the Penn’s Rock mobile clinic.
But he doesn’t give up. He saw others. He is convinced that they will come back, at one point or another. And when they do, he will continue to encourage them to seek help to stop using, until they are ready.
Until then, he hopes they will stay alive. “There are so many people dying,” laments Nakomo. I’m walking down the street and I see someone unconscious who can’t be brought back to life. It happens all the time. And I hate it when it’s a face I know. »
This report was financed thanks to the Transat-International Journalism Fund.The duty.