Canada

'We want to keep people alive': Outreach workers call for tools to combat toxic new street drugs

How health workers are fighting the overdose crisis when the drugs are changing, and with the 'zombie' drug tranq that causes horrible flesh wounds showing up on the streets.

How health workers are fighting the overdose crisis when the drugs are changing

How a flesh-rotting ‘zombie drug’ is complicating the overdose crisis

5 months ago
Duration 9:30
Warning: Video contains distressing images | A menacing new additive is turning up in fentanyl and threatening to make Canada’s overdose crisis worse. CBC’s Ellen Mauro breaks down the risks of xylazine, better known as tranq.

Walking through the Glengarry non-profit housing complex in Windsor, Ont., harm reduction outreach co-ordinator Lacie Krzemien is exhausted. 

The recent news that Windsor's only safe consumption site, Safepoint, will pause operations at the end of December has left her despondent. 

"I'm upset, because it's taking away another resource. It means more of my clients are at a higher risk of death,'' said Krzemien, who distributes safe supplies for people using drugs with Pozitive Pathways Community Services.

She says the announcement comes at a time when the drug supply has become increasingly toxic. The arrival of drugs such as "tranq," fentanyl mixed with xylazine, an animal tranquillizer that's resistant to naloxone, is making the overdose crisis even more complicated. 

Tranq has also become infamous for causing users to develop seeping wounds. 

Earlier this year, Health Canada released a report that said tranq was spreading rapidly across Canada. In 2022, 75 per cent of the drug samples tested that contained xylazine were from Ontario. According to Ontario's coroner, xylazine has been detected in 184 drug toxicity deaths since 2020. 

At least two of those were in Windsor.

Two women sit at a picnic table and talk while a man looks on in the background.
Lacie Krzemien, left, does outreach in Windsor, Ont., speaking to people about the changing drug supply and how it complicates overdoses. (Mia Sheldon/CBC)

"I'm sure that it's a lot worse than what we're seeing, you know, in the statistics right now," said Krzemien. 

She used Safepoint as a resource for clients with tranq wounds and testing the drug supply. It's one of the few places in Windsor that offers fentanyl drug testing. But that won't be the case come January.

CBC News spoke with Windsor Mayor Drew Dilkens before Safepoint announced it would be pausing operations. The Mayor, who said he spends the majority of time working on the city's mental health and addiction problem, was opposed to the site. 

"We want to find, and have the money spent, in a way that's actually going to make a material difference. And that is with mental health and addiction support, and helping people get the treatment that they need to become productive members of society again."

CBC News asked the Ontario Ministry of Health about the current review and how it impacts drug testing and safety. In an email, they replied that the review will determine the next steps and that, "CTS [Consumption and Treatment Services] sites are expected to build trust in the communities where they are located through consultation and ongoing engagement."

Krzemien says the decision to pause Safepoint's operations erodes that trust.

"We want to keep people alive," said Krzemien. "We want to keep them breathing."

'It's just getting worse'

Xylazine is just one of the many dangerous additives being found in the illicit drug supply. Benzodiazepines, which are depressants, have been present in up to 60 per cent of the fentanyl supply, according to the Toronto Drug Checking Service.

There are also stronger synthetic opioids, like carfentanil, which are even more deadly than fentanyl. 

In October, Health Canada announced an extra $21 million in funding to try and get ahead of a worsening overdose crisis. But when the drug supply — specifically synthetic opioids — keeps changing, so do the tactics needed to catch up.

The Toronto Drug Checking Service is one of the recipients of Health Canada's new funding. The service, which uses a lab in St. Michael's Hospital, tests street drug samples to identify exactly what's in them.

"It's important for people to know what it is that they're using, just so that they can make safer choices," said the lead for the Toronto Drug Checking Service, Karen McDonald.

"When we're using any type of pharmaceutical or when we're drinking alcohol or eating any type of food … we have, like, an ingredients list or we know exactly what is in those products."

A person in a white lab coat and protective gloves uses a handheld machine to take a sample of material from a small glass dish.
The Toronto Drug Checking Service is an anonymous public health service that analyzes street drugs to see what is in them. (Mia Sheldon/CBC)

Both tranquillizers like xylazine and depressants like benzodiazepines (benzos) are highly sedative and are especially dangerous when people are unaware they're consuming them.

Nicknamed the "zombie drug" for the blackout states it can cause, xylazine is normally used to sedate cattle or horses and is not approved for human consumption. As a central nervous system depressant, it dangerously suppresses vital signs like heart rate and blood pressure.

"What that means is the drug supply is getting stronger," said McDonald, noting that the amount of xylazine found in Toronto samples in the last two years has ranged from six per cent to 20 per cent. 

"It's just getting worse and worse and worse — more contaminated, less predictable." 

A graph.
B.C., Alberta and Ontario made up 97 per cent of identified xylazine substances in Canada last year, according to Health Canada's drug analysis service. (Statistics Canada)

A deadly threat

Tranq has not only been detected across Canada but in 48 of 50 U.S. states, and is especially acute in places like Philadelphia, where it is estimated up to 90 per cent of the opioid supply has xylazine in it. 

The situation is so bad that U.S. President Joe Biden has called the xylazine-fentanyl mix a deadly threat.

"The thing is, you don't know you're doing it," said Ryan Green, who has been homeless in Philadelphia for more than a year. He's used fentanyl before, but when he got to the city's Kensington neighbourhood, it was different.

A young man in a hoodie pulls aside a bandage on is forearm to show a large wound.
Ryan Green, 36, shows CBC the 'tranq sores' on his body. The wounds are caused by using drugs cut with xylazine. (Mia Sheldon/CBC)

"It just knocks you out," Green told CBC. "You end up unconscious to the point where people just drop."

Those who consume tranq also develop wounds and infections. Some people can have dozens of sores on their body. 

"I've been out here a year, and I thought this was the extent of my tranq sores," Green said, pointing out some of the lesions on his body. "I guess the way it works is it just kind of goes through your body and it picks a soft spot of flesh. And that's where it comes out."

Green was having his wounds treated at a mobile medical clinic operated by the city and a neighbourhood hospital. It started operating in May 2022 because of the dramatic number of tranq wounds in the area.  

Michelle Murphy-Rozanski, the nurse practitioner at the clinic, has seen all kinds of wounds, some "going down to the bone, the muscle, the cartilage." She said some patients have been permanently disfigured or faced amputation. 

"It used to be [people who use drugs] would lose their house, they would lose their job, they would lose their kids, they would lose their spouse. Now, they're losing body parts, arms, legs, fingers, parts of their neck. They're still unable to quit."

A woman wearing protective gloves works at a counter preparing medical supplies.
Nurse practitioner Michelle Murphy-Rozanski treats people in a Philadelphia neighbourhood who have physical wounds caused by using tranq. 'It used to be [people who use drugs] would lose their house, they would lose their job, they would lose their kids, they would lose their spouse. Now, they're losing body parts, arms, legs, fingers, parts of their neck.' (Mia Sheldon/CBC)

Xylazine in Canada

There isn't much research on how xylazine affects humans, including its addictive nature or withdrawal. Recent papers in the United States have called for more research and understanding of xylazine's effects. 

"[There's] a lot of fear," said Krzemien. "There's a lot of uncertainty."

The RCMP has been aware of xylazine in Canada's drug supply since 2012, but since xylazine is a veterinary drug and not technically a narcotic, enforcement is difficult. 

The RCMP told CBC News it could be used as a cutting agent with synthetic opioids like fentanyl and trafficked at street level.

It's not known why xylazine is being added. There is speculation that it prolongs the high of fentanyl or that adding it increases weight to the drug supply, making production cheaper.

Michael Brennan, executive director of Windsor's Pozitive Pathways Community Services, says that you can see a bad batch of drugs travel from Toronto to Windsor by tracking the overdoses. 

"You'll see an alert come out of Hamilton. Then it'll show up [in Windsor] a couple of weeks later," said Brennan.

Regional health authorities and law enforcement agencies across Canada have issued alerts about xylazine being found in the community. 

Brandon Bailey, who has been an active drug user in Windsor but is currently clean, says the unpredictability of the drug supply scares him.

A man in a t-shirt and shorts sits on a park bench speaking to a woman who has her back to the camera.
Brandon Bailey tells CBC News that it’s not just people who are homeless or on the street who are hurt by a more toxic drug supply. It’s anyone who uses. (Mia Sheldon/CBC)

"In a way, that has helped me … keep away from stuff now, because I don't know what's in it. But also, there are times where I've relapsed," Bailey said, noting there is little drug testing in Windsor.

"[Everyone is] susceptible to this. It's not just people who are living in poverty or people who are homeless. It's happening to everybody."


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