Drug additives leave more users with permanent scars

Dr. Timothy Allen, an addiction physician in Milwaukee County, Wis., regularly sees patients with small, round wounds dotting their calves. The lesions form because the drug the patients are addicted to constricts their blood vessels, restricting blood flow and destroying tissue. Xylazine, a horse tranquilizer known as “tranq,” is infiltrating the street drug supply across the country. During the past few years, Allen said most of his patients tested positive for fentanyl, but now about 80 percent are also recovering from xylazine. The tranquilizer’s high lasts for several hours and users experience achiness and fatigue. Allen told me that users don’t like the drug and often try to avoid the tranquilizer. But it’s powerful and cheap, so dealers often mix it into fentanyl and other substances.

Most of the wounds heal within a few weeks of being off the drug, Allen said, but sometimes the damage is irreparable. He once had to amputate a couple of a patient’s toes. “People who are older tend to fare far worse versus people who are younger,” said Allen. “The period of time that you’re exposed determines how much tissue damage you get.”

About 3,500 fewer Americans died from drug overdoses last year than in 2022 after a year-over-year rise in deaths that lasted more than a decade. While the decline may just be a slight variation and not a significant drop, communities across the country are celebrating what may be a sliver of hope. But even as fatal overdoses dipped, the illicit drug supply is becoming more destructive. Today’s powerful form of methamphetamine, known as crystal meth, often triggers psychosis and schizophrenia-like symptoms, while xylazine can physically maim its users.

The Drug Enforcement Administration first noted that dealers were mixing xylazine into other drugs in Puerto Rico in the early 2000s. Eventually, some islanders began abusing the tranquilizer on its own, though it is legally used only in veterinary settings and is not approved for humans. Around 2021, law enforcement noticed a significant spike in the number of xylazine-positive overdose deaths in the northeastern United States.

The agency reported that about 25 percent of fentanyl powder seized in 2022 contained xylazine. In 2023, authorities found the tranquilizer in 30 percent of confiscated fentanyl powder. Federal officials issued a warning about the drug in March of last year. “Xylazine is making the deadliest drug threat our country has ever faced, fentanyl, even deadlier,” said DEA Administrator Anne Milgram.

Kensington, known as Philadelphia’s “zombie neighborhood,” is at the epicenter of the xylazine surge. “People end up standing still for five or seven hours leaning against light poles, doing weird things with their arms. They’ll injure themselves,” Dr. Allen said. “It smells terrible, like gasoline.”

The city is home to a growing community of amputees, some who will never walk again.

Ground 40 is a Christian residential recovery program that serves men coming out of addiction, prison, and homelessness on a farm in Monroe, N.C. Wesley Keziah, who directs the program, said more men are showing up with xylazine in their system. “It’s not being introduced openly,” he said, noting that much like the early stages of the fentanyl epidemic, people aren’t even aware they are ingesting it.

Keziah also witnesses the long-lasting effects of crystal meth, a more potent form of methamphetamine. After the Mexican government outlawed the sale of ephedrines, the over-the-counter stimulants found in some diet pills and decongestants, meth labs in 2009 turned to a new method of cooking the drug. Today’s meth, known as P2P (phenyl-2-propanone) meth, is produced through a haphazard process using everyday toxic chemicals such as lye, cyanide, acetone, mercury, and racing fuel. Often it’s also contaminated with fentanyl.

The result is a highly concentrated potion that is even more toxic to the human brain. Users often experience severe mental symptoms similar to those of schizophrenia. Some hear voices and experience intense paranoia and hallucinations.

Sam Quinones, a former Los Angeles Times reporter and author of two books chronicling the drug addiction epidemic, said this new form of meth is inextricably linked to homelessness. “It drives people to an inability to live a life in which they are in control and an absolute inability to make sense,” Quinones said. “You could be on the street for any number of reasons. But the meth is so potent and so prevalent, that once you’re on the street and you begin using it’s mighty difficult to work your way out of homelessness.”

The detox process can take months. Keziah in North Carolina recalled one former meth addict who arrived at Ground 40 in 2021. “He was here for three weeks before we had a normal conversation with him. He believed that everybody was sent here to kill him in his sleep,” Keziah recollected. Before the former client entered the program, Keziah said he was living out of a car full of parts and pieces from electronics he had pulled apart, paranoid that someone was listening.

Eventually, the symptoms faded away after the client stopped using drugs, became a Christian, received counseling, and began building healthy lifestyle habits. “You couldn’t even tell that he’s ever had any issues with any kind of substances,” Keziah said. “It’s a radical transformation.”

Warren Yamashita, a board-certified addiction physician in Los Angeles, said that, for many meth users, the psychiatric symptoms dissipate with continued sobriety. “Patients may get misdiagnosed as having schizophrenia or bipolar disorder, whereas if they’re able to get into recovery and maintain abstinence, those psychiatric symptoms do resolve,” said Yamashita, who is also the cofounder of the Christian Medical and Dental Associations’ Addiction Medicine Section.

At the height of her addiction, Courtney Sharp injected crystal meth into her neck every day. It was the antidote to grieving the deaths of her father and brother, and the drug helped her forget the pain of giving up parental rights to her two daughters. “I really just numbed out. Nothing mattered when I used,” Sharp said. “I didn’t really care about anything.”

Sharp checked herself and her son into a women’s program with Adult and Teen Challenge of Texas, a Christ-centered residential rehab program in San Antonio, in July 2023. After Sharp came off the stimulant, she didn’t level out mentally until about a month later. “I freaked out,” she said. “I don’t remember this, but they said I tried to choke myself out. I tried to rip my clothes off. I was screaming and yelling.”

Sarah Baughman, director of development for the San Antonio program, described how staff work with former meth users as their minds and bodies readjust to reality. Besides recovering from the mental havoc, former users have to relearn how to sleep at normal times and nourish their nutrition-depleted bodies. “There’s a grace period of just becoming a normal human again,” Baughman, who is a former heroin addict, said. “But if they can get over that initial hump, there’s just so much freedom and healing on the other side.”

But some users never recover their grasp on reality. Baughman told me that, while rare, they’ve encountered clients who experience a form of long-lasting meth-induced psychosis. 

“They’re just not going to come back,” she said. “It’s just so much damage has been caused to their brain. The brain can heal, but it takes a long time.”