Many people living on the streets in Philadelphia’s Kensington neighborhood — the largest open-air drug market on the East Coast — are in full-blown addiction, openly snorting, smoking, or injecting illicit drugs, hunched over crates or on stoops. Syringes litter sidewalks, and the stench of urine fouls the air.

[This story also ran on U.S. News & World Report and is reprinted with permission from KHN.]

The neighborhood’s afflictions date to the early 1970s, when industry left and the drug trade took hold. With each new wave of drugs, the situation grows grimmer. Now, with the arrival of xylazine, a veterinary tranquilizer, new complications are burdening an already overtaxed system.

“It’s all hands on deck,” said Dave Malloy, a longtime Philadelphia social worker who does mobile outreach in Kensington and around the city.

Dealers are using xylazine, which is uncontrolled by the federal government and cheap, to cut fentanyl, a synthetic opioid up to 50 times stronger than heroin. The street name for xylazine is “tranq,” and fentanyl cut with xylazine is “tranq dope.” Mixed with the narcotic, xylazine amplifies and extends the high of fentanyl or heroin.

But it also has dire health effects: It leaves users with unhealing necrotic ulcers, because xylazine restricts blood flow through skin tissue. Also, since xylazine is a sedative rather than a narcotic, overdoses of tranq dope do not respond as well to the usual antidote — naloxone — which reverses the effects of only the latter.

Xylazine has been spreading across the country for at least a decade, according to the Drug Enforcement Administration, starting in the Northeast and then moving south and west. Plus, it has proven to be easy for offshore bad actors to manufacture, sell, and ship in large quantities, eventually getting it into the U.S., where it often circulates by express delivery.

First detected in Philadelphia in 2006, xylazine was found in 90% of street opioid samples in the city by 2021. That year, 44% of all unintentional fentanyl-related overdose deaths involved xylazine, city statistics show. Since testing procedures during postmortems vary widely from state to state, no comprehensive data for xylazine-positive overdose deaths nationally exists, according to the DEA.

Here in Kensington, the results are on display. Emaciated users walk the streets with necrotic wounds on their legs, arms, and hands, sometimes reaching the bone.

Efforts to treat these ulcers are complicated by the narrowing of blood vessels that xylazine causes as well as dehydration and the unhygienic living conditions that many users experience while living homeless, said Silvana Mazzella, associate executive officer of the public health nonprofit Prevention Point Philadelphia, a group that provides services known as harm reduction.

Stephanie Klipp, a nurse who does wound care and is active in harm reduction efforts in Kensington, said she has seen people “literally living with what’s left of their limbs — with what obviously should be amputated.”

Fatal overdoses are rising because of xylazine’s resistance to naloxone. When breathing is suppressed by a sedative, the treatment is CPR and transfer to a hospital to be put on a ventilator. “We have to keep people alive long enough to treat them, and that looks different every day here,” Klipp said.

If a patient reaches the hospital, the focus becomes managing acute withdrawal from tranq dope, which is dicey. Little to no research exists on how xylazine acts in humans.

Melanie Beddis lived with her addiction on and off the streets in Kensington for about five years. She remembers the cycle of detoxing from heroin cold turkey. It was awful, but usually, after about three days of aches, chills, and vomiting, she could “hold down food and possibly sleep.” Tranq dope upped that ante, said Beddis, now director of programs for Savage Sisters Recovery, which offers housing, outreach, and harm reduction in Kensington.

She recalled that when she tried to kick this mix in jail, she couldn’t eat or sleep for about three weeks.

There is no clear formula for what works to aid detoxing from opiates mixed with xylazine.

“We do need a recipe that’s effective,” said Dr. Jeanmarie Perrone, founding director of the Penn Medicine Center for Addiction Medicine and Policy.

Perrone said she treats opioid withdrawal first, and then, if a patient is still uncomfortable, she often uses clonidine, a blood pressure medication that also lessens anxiety. Other doctors have tried gabapentin, an anticonvulsant medication sometimes used for anxiety.

Methadone, a medication for opioid use disorder, which blunts the effects of opioids and can be used for pain management, seems to help people in tranq dope withdrawal, too.

In the hospital, after stabilizing a patient, caring for xylazine wounds may take priority. This can range from cleaning, or debridement, to antibiotic treatment — sometimes intravenously for periods as long as weeks — to amputation.

Philadelphia recently announced it is launching mobile wound care as part of its spending plan for opioid settlement funds, hopeful that this will help the xylazine problem.

The best wound care that specialists on the street can do is clean and bandage ulcers, provide supplies, advise people not to inject into wounds, and recommend treatment in medical settings, said Klipp. But many people are lost in the cycle of addiction and don’t follow through.

While heroin has a six- to eight-hour window before the user needs another hit, tranq dope wanes in just three or four, Malloy estimated. “It’s the main driver why people don’t get the proper medical care,” he said. “They can’t sit long enough in the ER.”

Also, while the resulting ulcers are typically severely painful, doctors are reluctant to give users strong pain meds. “A lot of docs see that as med-seeking rather than what people are going through,” Beddis said.

In the meantime, Jerry Daley, executive director of the local chapter of a grant program run by the Office of National Drug Control Policy, said health officials and law enforcement need to start cracking down on the xylazine supply chain and driving home the message that rogue companies that make xylazine are “literally profiting off of people’s life and limb.”

The post As Opioids Mixed With Animal Tranquilizers Arrive in Kensington, So Do Alarming Health Challenges appeared first on Medika Life.

Twitch is a platform that provides content creators the opportunity to livestream video games, cooking, political commentary, travel, or anything else that the creator chooses, so long as it falls within the platform’s terms and conditions.

Twitch enters into an agreement with each of its partnered content creators, allowing them to monetize their channels and splitting the revenue received from subscribers who pay up to $24.99 per month to support their favorite streamers. This arrangement has been lucrative for Twitch, and content creators with large followings can make well into the high six figures annually, with the very top echelon pushing into seven figures in earnings. Many leverage their fame and reach into other lucrative opportunities for sponsorships or content creation on other platforms.

Cracking the Façade to Find an Ugly Reality

One of those enormously successful streamers is a 28-year-old named Kaitlyn Siragusa, better known by her Twitch handle, Amouranth. She’s one of several young women who have attracted vitriol and blowback from some corners of the internet and media for leveraging their appearance, sexuality, and charm as part of their online personality to make a living. Whether you agree with her persona and presentation or not, you can’t argue with her success. Siragusa pulls in a reported seven figures per month, Twitch being her primary platform.

But the reality is much darker.

Beyond the standard harassment that any woman in the public eye, particularly in the historically male-dominated world of gaming and streaming – sadly experiences, Ms. Siragusa revealed on a live stream on October 16^th that she’s not actually single, as she’s represented in the past. In fact, she’s married to her trafficker.

She’s alleged she’s a victim of labor trafficking, her husband forcing her to stream and create content – some of it risqué – against her will. Live on stream she showed text messages from her husband in which he threatens her with financial abuse and her pets with physical harm if she doesn’t comply and keep up the facade. She claimed he’s taken control of her finances and bank accounts and has physically broken the door to the room in which she streams so she can’t lock him out.

“I’m basically living in a fancy prison,” she said.

The recording of the stream has since been deleted.

Toxicity, Misogyny, and Liability

Fellow prominent Twitch streamers broadcast their support for Ms. Siragusa across their own social channels, but a vocal contingent of her community and other streamers, some with enormous reach, had a different perspective.

The issue, they said, wasn’t that she had been forced to entertain them against her will. The issue was that she pretended to be single when she wasn’t and because they’d been duped, they deserved refunds for all the money they’d spent supporting her.

Twitch is no stranger to controversy, but this time feels different. The company has banked millions of dollars from its partnership with Amouranth, but it seems clear that those profits were the direct result of exploitation and forced labor. Does Twitch, or any organization for that matter, have an obligation to the people from whose efforts the company profits?

I’m not an attorney, but it seems unlikely that there’s any legal exposure for Twitch or Amazon in this case. Siragusa is an independent contractor and thus has none of the myriad worker protections that those with employee status enjoy. Further, there’s been no indication that she told anyone at the company about her situation before she came forward publicly on her stream. The moral argument is more crucial in this case.

Twitch boasts up to 8 million unique streams every month. More than 31 million people visit the site or use the app every day. They employ more than 1800 people globally. It a dominant player in the streaming space.

What do you do as an industry leader when such an ugly situation comes to light on your platform and the response from certain corners of your customer base and creator community isn’t sympathy or support, but anger, misogyny, and victim-blaming? This is a question that cuts to the core of the kind of company Twitch wants to be, who they want to serve, and who they want to partner with as a business.

What Comes Next?

The easiest thing that Twitch, and by extension Amazon, could do would be to ignore the situation entirely, to put the onus on Ms. Siragusa to manage the crisis on her own. That’s not how a responsible organization behaves, but it wouldn’t be entirely unexpected.

Though there may not be a legal obligation for Twitch to investigate whether this is an isolated incident, could a conscientious organization really fail to do so? Can a company live with itself, and what price will it pay in the court of public opinion, if it does nothing or stays silent when entangled in something as ugly as this that its directly profited from?

If you’re a woman who works at Twitch, or who streams on the platform, how would you feel about an organization that’s historically done relatively little to stem harassment and toxicity and is now silent after this revelation by one of their partners? I might find myself questioning how many other prominent young women on the platform are being forced to work against their will.

I would argue that the time is now for some introspection, and an evaluation of how the platform incentivizes content creators and protects potentially vulnerable individuals. Children as young as 13 can stream on the platform, after all. Is there more that Twitch could be doing? Almost certainly.

These are uncomfortable questions that should concern an organization if they’re being asked by employees or business partners, and even if the microscope of public scrutiny hasn’t found Twitch or Amazon yet, it’s only a matter of time should other content creators on the platform come forward, inspired by Ms. Siragusa’s bravery.

You can’t be dedicated to responsible business practices only when it’s convenient. It requires getting your hands dirty when things get complex and messy, taking ownership, and showing leadership. You don’t need to have all the answers, but people know the difference between right and wrong. Make sure they know that your company does too.

Neither Twitch nor its parent company, Amazon, have to this point issued a statement on the matter.

Ms. Siragusa published a recent video announcing that her husband is “getting help” and that she has regained access to all her finances and accounts and is “seeking legal and emotional counsel.”

The post Amouranth, Twitch, Amazon, and the Unraveling of Compassion and Common Sense appeared first on Medika Life.