In a van parked outside a church in Baltimore's Carrollton Ridge neighborhood, Gerald A. Hill Sr. is preparing wound care kits for people addicted to opioids.
Baltimore's harm reduction vans have long been a place for people to exchange used needles for clean needles. In recent months, more people have been coming to Baltimore's two mobile harm intervention vans in need of serious wound care due to a drug called xylazine. Among users, it is commonly referred to as Tranq.
Used for decades by veterinarians to tranquilize large animals, xylazine is being used by drug dealers to amp up the effects of fentanyl and other opioids. In humans, the drug causes deep flesh wounds that sometimes bore down to the bone.
"People who use the drug, [their] blood circulation is poor a lot of times," Hill said. "When they come to our van at times, you can smell their wounds. It's really a horrible smell."
The Centers for Disease Control and Prevention found that xylazine was involved in 11% of opioid overdoses in the Northeast from 2019 to 2022. The Biden administration has designated the drug as an emerging threat.
Clean needles and now wound care supplies
The wound care kits Hill passes out on Baltimore's harm reduction vans include first-aid supplies like medical tape, gauze and disinfectant. Hill said the vehicles can easily see 70 people in a day. Some come in with arms ballooned two or three times their size due to infection or with sores that fester and turn black. Not all the wounds are caused by xylazine, but the drug is increasing the number of people needing care, Hill said.
Hill is trying to inform people about Xylazine as he hands out kits and exchanges needles. One man, who wanted to remain anonymous due to his drug use, said he'd never heard of the drug, but recognized the symptoms and wondered if his recent sores were caused by Xylazine.
Another woman, who preferred not to be named for the same reason, said she had plenty of experience with the drug.
"It literally just ate the front layer of skin on my leg. It just killed the skin," she said.
The open sores can be prohibitive to people getting help for addiction as well. Many rehab centers won't admit people when they have large wounds.
"Xylazine has increased the complexity of treating wounds," said Yianni Varonia, a spokesperson for Baltimore's health department. "Most rehabilitation facilities are not equipped to address severe Xylazine wounds, and therefore direct individuals with severe wounds to hospital emergency rooms for immediate care."
"Pouring gasoline on the fire"
Xylazine is insidious in other ways as well. It causes many of the dangerous symptoms of opioids like slowed breathing and heart rate.
"You're basically pouring gasoline on the fire by putting these two drugs [xylazine and opioids] together in your system at the same time," said Keith Humphreys, a professor of behavioral sciences at Stanford University.
Naloxone, an opioid overdose reversal drug, does not counteract xylazine, increasing the risk of accidental overdose.
Xylazine found in 48 states
The Drug Enforcement Administration says it has found xylazine in opioids in 48 of 50 states.
The drug is much more prominent in Maryland. The CDC found that 80% of opioids tested at eight needle exchange sites in the state had xylazine mixed in.
Meanwhile, the prevalence of the drug continues to grow as it's being detected more frequently in western states.
In addition to harm reduction vans, Baltimore provides more extensive care to people suffering from wounds at its SPOT vans. The vehicles are literally mobile clinics fit with two exam rooms, an area to conduct blood tests and a waiting room. The SPOT vans are staffed with nurse practitioners who can draw blood, conduct tests, prescribe medication and provide some primary care.
Tiffany has been using opioids since she was a teenager. We are only using her first name to protect her privacy. She's now in her 30s and is full of sores from Xylazine.
Nurses on the SPOT van are cleaning her injuries and giving her bandages to take home to ensure her sores don't get infected.
"It turned black," Tiffany said, describing one of her wounds. "They want me to go to the hospital because I got more on the back of the leg. I got a big one right here. I got one right here. Right there."
Tiffany points out sores about the size of a quarter or larger on her arms, legs and stomach. She has one on her shin that is so bad she can't take the bandage off to show the nurse.
SPOT van nurse Molly Rice said she's seeing more of these cases.
"We are seeing more and more of these just like pretty aggressive wounds that seem to be from xylazine," she said. "With any wound or really with any of our patients, unfortunately, a lot of them are on the street, they're living in abandoned buildings. The risk just of infection, just on a day-to-day basis, is so much higher."
Baltimore is trying to increase awareness about the dangers of Tranq as it sees more and more evidence of the drug making its way into the illegal supply.
"We are increasing the number of wound care supplies we are providing," said Rania Muhammad, the assistant director for community risk reduction services at the Baltimore Health Department.
The city is buying newly available xylazine test strips and continuing to hand out fliers.
"Xylazine seems to have spread quite quickly around the nation relative to some other drugs," Humphreys said.
He added since the whole country is feeling the effects, it will likely reverberate to Washington where the White House or Congress may take more action. The Biden administration has a plan to stem the drug. Congress is also considering a bill that would control the substance, but it hasn't taken any action on the legislation since it was introduced.
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