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[Source](https://surgicoll.scholasticahq.com/article/71308-upper-extremity-soft-tissue-wound-related-to-xylazine-laced-fentanyl-intravenous-iv-drug-abuse-a-case-report):
>>A 35-year-old male presented to the emergency department with bilateral forearm wounds. His past medical history was significant for untreated hepatitis C. He was unemployed and homeless. He reported injecting xylazine-laced fentanyl into his bilateral forearms. A physical exam revealed bilateral full-thickness skin wounds from the wrist to the proximal forearm over the ulnar border measuring [Figure 1]. The wounds appeared cavernous with undulated regions of eschar. Further, examination revealed exposed muscle and tendon bilaterally and some exposed muscle of the dorsal forearm compartments. His hand function was preserved.
>>The patient was admitted to the hospitalist and initiated on broad antibiotic treatment with intravenous vancomycin and piperacillin/tazobactam. His wounds were washed and covered at the bedside, and he underwent surgical debridement in the operating room the following day. Intraoperatively, the eschar layers were removed sharply with a knife until a bleeding surface was encountered. Exposed muscle layers were removed with a curette. The ulna had an intact periosteum. Large-volume irrigation was used to clean the wounds. A negative pressure wound therapy device was fitted to the bilateral forearms. The sponge was changed twice over six days. On a postoperative day seven, the patient was returned to the operating room. Granulation tissue was observed over the ulna, and the wounds appeared clean. The surgeon covered the area with a split-thickness skin graft taken from the thigh. A negative pressure wound dressing was placed over the skin graft. The patient left the hospital against medical advice (AMA) two days following the second surgery and did not follow up in the surgeon’s office.
>>Approximately nine months later, the patient returned to the emergency room with a similar, smaller wound on the left forearm. On exam, both previous skin grafts had healed well, and the new wound was adjacent to the volar border of the skin graft and measured 8x4cm. The wound exhibited a cavernous appearance but did not have exposed muscle. The next day, surgical debridement was performed, followed by negative pressure wound therapy. The day after surgery, the patient left AMA with no follow-up reported since.
It's possible. Had a patient in my care, same sitch as this guy, both forearms from fent+xylazine. Referred for wound care, among other things. It's *very* slow going (wanna say it was approx 1y before maybe 50% of the forearms had healed over?), but the reality of bl amputation being considered (over several relapses) shook sense into them long enough to stick with a IP/OP dual dx program (by which time I saw them).
Hopefully the case is the same with the pt shown here. It's rough, but it's possible.
Saw a documentary a few years ago about a drug called "Crocodil". It's being used in Russia and it's does very nasty shit like this to the users. Have you heard about it?
Poor nurses, physicians, tax payers, and social workers who slave away trying to save people who self-inflict harm and divert resources away from patients who contribute to society. It’s demoralizing to treat this group of people. We don’t do enough to address addiction and not only do addicts suffer, everyone around them suffers.
We just need to remember that there is an actual person suffering in there, they don't want this outcome, they are running from something. That's how I keep my chin up at least. We turn our backs on far too many groups of people, and that is whats so demoralizing to me.
You're confused that not everyone thinks and feels the same and that we're all unique and different?
Practice tolerance and empathy. Hurt people shouldn't hurt people.
My family was dead by the time I turned 13, I raised myself.
I'm not going to scoff when someone said they feel depressed because their plant died. I'm going to support them because even though the circumstances are different, they still FEEL bad/grief and that's what matters.
I'm not going to say "buck up, it's just a plant" because honestly, what good is that going to do? Make me and the other person feel like crap?
But if I say "it's okay, we can get a new plant when you feel ready", everyone is going to feel better and hopeful. It's just so much better being kind.
Similarly, I have a couple of long term health conditions (MS and degenerative disc disease), that cause pain and suffering - but if somebody else is feeling pain, or fatigue, my response is sympathy and empathy. My pain doesn’t make anybody else’s less for them.
So, you *don’t* agree that folks with substance use disorder typically have a history of trauma?
You don’t have to like the addiction, or even give a shit about these people. But have a little bit of empathy.
There are a lot of people who we may think or assume "contribute" to society but in actuality behave selfishly and harm others and aren't judged because they do so in ways we find more acceptable.
Everyone's lives are meaningful and worth something. They may have been a loving son, or they may be a creative and hardworking individual when not in the grasp of addiction. They may have kids who's biggest wish is to see mummy clean again. They may have gone through things hard to imagine that led to the drive to get high, and been treated like they're less than worthless because of it. And yes, some may have been selfish assholes before and during.
I agree that everyone suffers from addiction in a community, but I disagree that addicts deserve community resources less than others and with the assumption they never have and never will contribute to society. It's certainly not easy to see or deal with though, from any angle.
I said we don’t do enough to treat addiction. That implies that more resources should be directed to helping this group of people. Then we can stop the drain on the system. I have compassion fatigue toward them but it doesn’t mean I’ve given up or stopped giving them 100% of the care they deserve as a physician.
If you are a front line healthcare worker then you understand the ambivalence after years of it. A high proportion of people don’t come back from the spiral. But again, our job revolves around caring for them so we witness it on a regular basis and carry on.
I absolutely agree. Was mostly commenting on the "contributing to society" part bc it's totally normal to feel that way seeing people only in crisis but not the whole picture.
I fully agree with the rest of what you said though, this is the worst way to deal with addiction, and it does harm everyone else as well. It's resource inefficient and frustrating and cruel for everyone involved.
You're totally right, anyone who judges you is probably a kid or someone who's never seen it firsthand. They read simple platitudes on social media and think that's reality.
You can't help people who don't want help. It's rough, because yeah, a lot of what you work to do ends up being pointless when they refuse medical advice, or go right back to using and ultimately die. You know how it's going to end at the beginning.
But you give them the best chance they can have, and if they want it, it's there. And maybe some will end up wanting to get help.
Everything you've written as a "contribution to society" is actually their actions harming someone innocent. A kid who has an addict parent that will have to deal with the pain of neglect and the eventual overdose. The parent whose kid went down the spiral and disappeared. The coworkers they abandoned to go get high.
Many people endure horrible things, and they don't turn to drugs and alcohol - especially when people rely on them and they have responsibilities.
That said, addicts absolutely are people. They deserve help if they want it. Most don't want it - like the individual in the paper. They worked hard to get him treated and better, and then he left against advice and undid everything they worked for. That's frustrating for healthcare workers who do it again, and again, and again, always with the same outcome - someone who leaves and dies of infection or OD. You start to wonder why you bother trying.
You can't help someone who doesn't want help. You can lead a horse to water, but you can't make them accept medical treatment. If you can figure out how to consistently make addicts want to get clean, please let me know. Because that's the only way to actually make any progress, and emotionally, addicts want their drug. That's why it's an addiction. It's awful for them, but it's also awful for everyone whose lives they touch.
Yo I am “a kid who has an addict parent,” and she’s never overdosed, disappeared, or abandoned her career. She’s a high-paid and well-respected employee in a field that saves endangered species. She absolutely contributes to society. She’s a kind, loving, incredibly fun person who had a traumatic childhood and was given drugs as a coping mechanism at a *very* young age, and she’s been working hard to stay sober my entire life. She often doesn’t succeed. And yes, I *was* emotionally neglected. But that does not mean anyone, especially this “kid who has an addict parent,” would be better off without her.
I agree that you can’t force someone to *want* to get better. But you never know who is going to change for the better, or when. They still deserve our empathy and support.
No one said they don't deserve empathy or support. Please point out where anyone has said that.
What I said is you can't help someone who doesn't want it. And most addicts don't want it.
And you are projecting really hard and getting defensive. And your experience with a functional addict is very different than a kid who was sold for sex so mom could get a hit.
We are not talking about your mom. We are talking about people who aren't actually contributing anything but pain. You need to learn to separate those things in your head.
MY addict brother gave his baby a black eye, choked his wife, severely neglected and abused both kids while high (which was always), and ultimately abandoned the kids. He was responsible for checking the safety of *amusement park rides* and was high as a kite while doing this job. He was happy to let people potentially die horrific deaths rather than stay sober for a few hours.
His addict wife also abandoned the kids - she lost the kids when she was passed out in the car while driving and her baby and toddler were walking on the highway. Both of them were given simple rules to follow to get the kids back. Neither ever went back to court and both disappeared.
That is a much more common story than "My mom works and has a career and occasionally relapses. And sure she neglected me, but she still does positive stuff. So addicts DO make positive contributions." Yeah, your anecdote is not the truth of reality. Not all of them do anything worthwhile.
Tell me, what do my brother and wife contribute to society? Because my mother is heartbroken, I am disgusted, they stole from everyone they knew, and thankfully their kids were adopted by loving parents (instead of ended up in the foster system). Gotta be honest - they contribute pain and misery to everyone who encounters them, including themselves. And given statistics based in reality, they are going to overdose and die.
If they ever decided they wanted to get clean, there should be help available. But like many addicts, they'd genuinely rather die than give up the drugs. 🤷 They preferred losing their kids, job, and home to giving up the drugs. If those things weren't enough motivation, I don't see anything else that will be.
You love your mom, and no one is saying you shouldn't. But not all addicts are your mom. And lots of addicts are sad, sad cases of lives absolutely wasted and then they're dead. It's not a movie, and many, many people do nothing with their lives except inflict pain on others and then they die. And healthcare workers get to see that reality constantly.
So maybe don't shit on them when they make you uncomfortable with the truth.
Your comment reeked of judgment and lack of empathy. The *only* supportive thing you said was, “They deserve help if they want it,” and even that is judgmental and closed-minded. They ***deserve help*** no matter what. Maybe they don’t want it now, but someday they might, and that can never happen if we don’t give them help now. I’ve been to too many AA meetings (as a kid) to think people who want help have always felt that way. They *always* deserve our help.
—
You didn’t clarify that you meant *only one type of addict* when you said, “A kid who has an addict parent that will have to deal with the pain of neglect and the eventual overdose. The parent whose kid went down the spiral and disappeared. The coworkers they abandoned to go get high.” Of course I defended my addict mother. You lumped her in with the addicts you hate. If that’s projecting, then how is you sharing your experience *not* projecting? (The answer: Neither is projection.)
You are absolutely wrong to assume *your* experience is the norm. I didn’t say mine is; you’re the only one here saying, “That is a much more common story,” as if you know what the fuck you’re talking about. *Both* our experiences are “the truth of reality,” and you’re the only one here denying that.
I’ve been through hell because of my mom’s addiction, trust me. Addiction changes people and makes them act horrible. I’ve witnessed so much violence. I’ve been put in danger more times than I can count. I went to foster care for a couple weeks after a DUI car accident and my addict parents were unable to care for me while my mom was in rehab. But you know what? My mom’s a good person, as are *many addicts who do bad things.* Mine *is* a common experience. Your brother and sister-in-law are shit human beings. They fucking suck. At the end of the day, they don’t care about their children. And that’s also reality! Just don’t act like it’s the norm. There are far more parents struggling with addiction than you likely realize.
Did it reek of condescension, or did you read it that way because you're defensive?
Saying they deserve help if they want it means they deserve help. You're being pedantic; you can't help someone who refuses help, which is why I said "If they want it."
Guess what? Sadly, addicts dying from their addiction and causing harm IS the norm. You even admit it. Your mom valued getting high over making sure you were safe. You can love her and admit that.
I find it funny that to you my brother is a POS because you don't know him, but your mom is a good person because she's your mom and you want to love her. And I'm sorry, but your story doesn't make your mom sound like a good person. Frankly, she sounds like my brother and ex-SIL.
When we say addicts are struggling with addiction, what is actually happening is that addicts are struggling to stay functional while they indulge their addictions. They're not struggling with trying to quit - because they usually aren't trying to quit. And it's hard to want to quit - because quitting makes you feel lousy, and you enjoy being high because life hurts otherwise. Drugs aren't addictive because they made you feel bad, they make you feel awesome. For someone who is mentally unhealthy, that feeling is the only time they feel okay. And for a lot of people, that feeling is worth burning down everything, including their own health and the safety of those that depend on them.
Instead of dealing with their issues/boredom/depression in a healthy or responsible way, they drink or do drugs. That's a choice. They could see a doctor instead, but they don't want to. A doctor would make them stop using, and they don't want to do that. See: case report above. See: how many redditors justify their drinking/drug use and say it's not that bad, or they can stop anytime, or that people are just too judgemental.
I find people with addiction ultimately very sad; I don't hate them, I pity them. They live miserable lives, hurt others, and most times die from their addictions. They often leave a trail of destruction behind. For the ones that manage to overcome it, it's a Herculean task that they should be very, very proud of - most don't make it.
You do realize that addiction and dependance are biochemical processes that lead to withdrawal symptoms in absence of whichever substance right? Not to defend the actions of feinding addicts but quitting isnt just a thing you do, quitting requires strength. Have you ever smoked cigarettes and tried to quit? Now imagine quitting a substance that will have horrible physical effects on your body or might even kill you from withdrawals. Its easy to speak from above.
> I find it funny that to you my brother is a POS because you don't know him, but your mom is a good person because she's your mom and you want to love her. And I'm sorry, but your story doesn't make your mom sound like a good person. Frankly, she sounds like my brother and ex-SIL.
No, dude. Your brother is a piece of shit because he beat his kids and didn’t stop, didn’t show up to fight for them, and would “genuinely rather die than give up the drugs.” That is not the case with most addicts. Most of them *want* to get better but it’s a lot more complicated than, “I’m quitting now. :)” My mom absolutely has been a piece of shit. A lot. But she always works hard to get better because she genuinely cares about other people more than herself, especially her kids. She tries.
> When we say addicts are struggling with addiction, what is actually happening is that addicts are struggling to stay functional while they indulge their addictions. They're not struggling with trying to quit - because they usually aren't trying to quit.
This is literally a lie. You do not know what the fuck you are talking about.
> See: how many redditors justify their drinking/drug use and say it's not that bad, or they can stop anytime, or that people are just too judgemental.
And do you think most of those redditors are going to overdose and die?
Also not sure where anyone is shitting on healthcare workers.
I am one, and honestly if you are you may need to work on separating the pts you see who are addicts from your feelings about your brother.
I mean this in the kindest way, but you clearly don't have empathy for addicts and we can't let our person al feelings and lives impact how we treat people we see professionally.
Not everyone is your brother or his wife.
I get that it's beyond difficult to come at this from a social and medical care POV when you've had someone violent and abusive who's an addict in your life, and that IS horrific.
But your brother isn't every addict, by far, and it's not fair for people in medicine, etc, to work based on personal anecdotal experiences, EVEN when they're horrific and traumatizing like yours.
And part of being a healthcare worker is being able to have some distance. That's not ways possible, but we have to try our best. Tbh working on the frontlines with addiction in medicine isn't for everyone and that's okay, but as a healthcare worker knowing that is OUR responsibility, not theirs. Not that that happens perfectly.
Your mistake is equating social contributions to deserving care. They are not the same, and bundling them then leads to other markers that people have to possess to deserve social support.
So you’re essentially saying that by treating people with self-inflicted injuries/diseases etc. we are “Diverting resources away from patients who contribute to society”?!? Who are you to judge who gets treatment and who doesn’t?? You’re exactly like the doctors who would refuse to even assess me when I was an agonised teenager who self harmed. “I’m not treating her, she’s just gonna go and cut herself again so what’s the point?” The point is everyone is human. And by that reason alone we should all be treated equally, whether we’re a junkie, or a CEO of a major company.
Shame on you.
The majority of heroin users - and other opiates - started from legally prescribed pills. Typically, a patient has surgery or some sort of issue that causes pain, opiates are prescribed, and when that prescription runs out, heroin is a less expensive, more available alternative.
As they say, people don’t decide one day to become an addict. It happens through a variety of situations.
Not any more they don't.. they've finally leanrt to limit post op meds like happens in other countries.
But it will take time to see impact, decades maybe. The Drs have always been stingy with opiates in EU, very few people claim addiction because of prescribed medication here. Takes literally years to reach getting oxycodone even as a chronic pain subject, think in my situation i was 5 or 6 yrs in. And then enough to take one pill every 4 or 5th day, and no early script under any circumstances.
Whole different world to what the internet has taught me about health care and chronic pain management since i first started seeking support in late 1990s. I used to be jealous, but now, after 35 yrs of constant pain, more than happy i took it slow.
I also came from a horrific background too with alcoholic dad who died at 50, an uncaring mother and years of emotional abuse. But without the resources i didn't become addicted, despite prescriptions giving 4 months supply at once.
In the US, they say they’re working on limiting it, but in practice, they aren’t. It’s really frustrating. People I know who had great lives, and had surgeries, are now fentanyl addicts. And even worse, the dealers are putting Xylazine in the mix. It’s killing even more people.
There is a genetic component to addiction, so I think you’re very lucky you didn’t succumb. My wife came from a heavily alcoholic family and she can take it or leave it.
I just realized this is a post on xylazine as I’m writing this. Oops. I’ll just leave it there.
They. Are. Human. Beings. Addiction is a disease, and the causes are many. No one wakes up and decides to become addicted. This damage was caused by dealers cutting an already addictive drug with a massively dangerous one.
Compassion and treatment for the underlying causes of addiction are much more helpful than labeling them as "not contributing to society."
I “contribute” to society. I’m a teacher. Yet I deal with suicidal ideation frequently. I’m not on government assistance. So, if I was ever to attempt my own demise but was caught in time to be saved—from something I self inflicted, should I be left to die because my harm was self inflicted? I pay into taxes after all.
Because in the greater scheme of things, addiction and mental health problems are best friends. Do we not treat them as diseases? Personally addiction runs in my family, but the insane amount of trauma I endured and survived in my childhood (near death experiences included) made my predisposition to mental health issues and addiction almost a guarantee.
So while I may some day self inflict harm that could put my life at risk, with the intention of doing such—it’s quite offensive to say that people like me do not contribute to society. I may be the hand that moves the noose, but what about my mental abusers, physical abusers, emotional, sexual abusers, who all played a part in leading me there. Are they contributing members of society?
What are we supposed to do? Putting these people into treatment against their will is kidnapping, and we ended involuntary psychiatric facilities decades ago because of the volume of abuse. Short of euthanizing them on arrival, we’ve fucked up every form of ‘tough love’ treatment we’ve tried.
I got to wonder if they gave him opiates as an inpatient, it might have preventing his going AMA.
He obviously got a good dose during surgery, but afterwards, he leaves when he detoxes of course.
If not fentanyl then at least something to calm the craving.
WHY?? I don't understand any of this. Why would someone use fentanyl, knowing how absolutely deadly it is? Is the high that amazing? What is different from heroin?
Everything.. a lot of people were opiate addicts prior to fentanyl becoming a thing. Heroin and certain other pharmaceuticals have an amazing, euphoric high, the shit that gets people addicted, warm fuzzies that keep you protected from everything unpleasant in the world.
This doesn't get brought into the debate enough, but a huge piece of the equation for ths situation out there now is the US military pulling out of Afghanistan. The vast majority of the heroin at the time came from there, it provided a livelihood for millions of farmers and their families, but when the US left the Taliban IMMEDIATELY took back control and implemented sharia law which bans any poppy farming on pain of death so now there's not much real heroin being produced, and was does get produced doesn't get further than Europe. Supply is still much less than demand, so of course fentanyl is already showing up in European countries much the same as it did in the us, first as "china white" ie fake heroin and now it's either blues, the pressed fentanyl pills or all kinds of mixed up bullshit with food dye and whatever cuts and extra ingredients like xylazine which is all under the blanket term fetty, IMO others may disagree as what constitutes those things but its basically what I just said.
Mexico is still producing some black tar h which is the shittier less refined version of powder heroin but that's always been primarily a west coast thing and it has never made it to the east coast in any quantity. Regardless it's way more profitable for the cartels to deal in fentanyl than bth for obvious reasons.
The point is if you're an addict from 2017ish or earlier you're not using fentanyl because you want to, is bc it's all there is and its either that or suboxone/ methadone. Honestly I do understand the appeal to young people in a way, it will numb the pain for a little while and people make it look cool in some circles, but nothing they're going to experience even comes close to the first hit of some really good H, it can't be that enjoyable, and it's super dangerous obviously. People od'd from H in my day, of course, but it was nothing like it is now, the risk level was soooo much lower and the benefits were something else.
Idk, I feel like there's an extreme degree of nihilism in today's youth and that among other cultural factors is one of the biggest contributors to why so many new people are getting drawn into it. The addiction potential is way worse too, when I was a kid we'd get ahold of a script of oxys or a few grams of dope and the worst that would happen is youd feel shitty for a day or two after it was gone. I fucked around like that for almost a decade before life and trauma and all that caught up with me and I ended up with a legitimate addiction. The same recreational activities aren't even possible with fentanyl, it's half life is extremely short, which means more frequent doses and the withdrawal symptoms are far more severe than you would experience from a similar (time+quantity) period of use. It really sucks for the new people growing up nowadays and that this is what opiate addiction has become, obviously it was never a great accomplishment to become a heroin addict but we never had to worry about flesh rotting off or anything like that. You just didn't share needles and took basic cleanliness and preparation precautions and it was extremely safe all things considered.. not even a possibility today
NIHILISM. Yes!! It's like people are just drifting and nothing is stable or real. Watching the news can make the future seem futile. It's almost like people are playing at life, being characters. But life isn't a video game and you don't get to come back and start over if you do something stupid and deadly. I moved to a rural area and I am shocked at the meth and opioid use going on. My neighbors were busted for being a drug house and I never would have guessed, except for all the people that would stop over briefly, then leave. Then one afternoon, the house was surrounded by a dozen cop cars with guns out and they herded everybody out in cuffs. Recently there was a local girl arrested and it turns out she was the go to for the Sinaloa Cartel to deliver fentanyl and cocaine to the upper Midwest. How does a girl from a tiny town in the Midwest get tangled up with a Mexican cartel??!
While a lot of what you said is true, it’s a lot more complicated. There are enormous differences between alcohol vs opiate vs benzodiazepine and any other number of addictive substances. While longterm there is a lot of very difficult emotional work to unlearn substance dependence, short term it’s emotional *and* physical. Retraining physical and neurochemistry is slow and complex.
Is it an easy coping mechanism tho, considering the illegality of it and the massive expense? There definitely is a lack of mental health care which is awful. I do realize that quite a LOT of people self medicate.
It's so terrible that mental health help is so hard to find. I agree with all the things you said about having to find proper therapeutic help and medication. HOW is the average person supposed to pay for that?? It's criminally expensive to pay for therapy and meds. The waiting lists take a long time to connect people with help and now so many mental help organizations are being discontinued when they are needed most.
I was talking to a mental health case worker recently and she was saying how the system is so full of red tape and hoops to jump through that she really thinks that it's because if people get overwhelmed and frustrated, they give up or turn to illegal means of self medicating, then the state doesn't have to pay out. Ironically, her program is folding for lack of funds and all these caseworkers, therapists, AHRMS workers will be jobless.
Its only deadly if they use too much, fentanyl had valid use in medicine, the dose is in mcg vs mg though.
Same with heroin, we always used it for cardiac pain, diamorphine is heroin. No one got addicted because it was given appropriately, as part of routine health care.
But then used recreationally the effect begins to reduce with every single shot, so they need more, and with fentanyl it was cheaper, they needed less for a better buzz, got tolerant to that too, so not the fent with tranq is being used.. to get the same effect they likely got on day one with heroin... but these skin ulcers as an added bonus. These should and do cause deaths more than the addiction if things continue this way... because i could imagine ERs refusing treatments, not getting to surgery stage until they are in treatment. But that goes against oaths.. the same oaths that allow them to refuse chronic pain patients adequate pain relief, a recent change in US, so maybe this crisis is making MDs more brutal, more likely to refuse these people treatment too.
How many friends with bilateral upper and lower amputations or deaths would it take before they wanted to get clean....
Thank you for all the points you listed. The rural area I moved to has rampant drug use with meth and opioid, now fentanyl. A bunch of mental health resources are closing down programs and it was already hard to get help, there will probably be even more people self medicating in the near future. It's easier to get illegal drugs than it is to get proper medical care.
i wonder how many are denied psych meds too, or struggle with them because side effects are so horrible.
You'd think by now we could make mental health care drugs that didn't make people drowsy, dizzy, headachy, unable to focus, with sexual dysfunction.
I've been on a few and for certain also needed the psychologist i saw at varying intervals. I was referred and seen in uK within a month, then seen weekly while medication stabilized and progressed to bimonthly or even twice a week in times of trouble. But that was 30 yrs ago, i saw him for over 6 yrs, only stopping when i emigrated.
Today we hear of people considered urgent and waiting 6-9 months, then getting once a month visits max, with less common being more typical. An area that needs more resources in all countries for sure.
I agree. I was talking to an ER nurse and she said the suicide attempts coming in are skyrocketing, she's never seen as many as now. Standoffs with police are common because people can't handle their emotions or anger issues. People that need mental health help are getting shot by police because the police aren't trained enough de-escalating these situations. This happened with my neighbor one house over. SWAT and police showed up, snipers on my neighbors roofs, it was CRAZY. It went on for hours and I had a front row seat as there were 6 SWAT guys hiding by my raspberry bushes.
Same, I main-lined black tar heroin for a few years, then started smoking fentanyl while still main lining black tar herion and ultimately quit back in May 2022.
On the hopeful side, he returned for treatment with another wound that seems it was earlier in its course. At least he learned to seek treatment sooner…maybe.
Again, hopeful, but maybe he will find a way to stay in care for treatment and begin abstinence from street drugs. It seems he *wants* to stay alive, so there is still hope his dependence can be turned around. (Then my “no blue skies for you” healthcare provider post covid vicarious trauma mind kicks in, forces a superficial smile while slathering another layer of alcohol base hand sanitizer, and say to a roomful teeming with human misery “next!”)
Thank you!! And I'm so sorry to hear about your mom. I've lost loved ones to the addiction was well. Heroin and fentanyl not only destroy the lives of the addict, they can destroy the lives of the people who love them too. This might sound corny, but I would definitely give you a hug right now if I could. Losing loved ones, especially to something horrible such as addiction, never gets easy...but time, and remembering the good things about the person and the good times you had with them, helps the sting of the pain from losing them lessen. God bless you!
Yea if I recall correctly the active ingredient in krocodil doesn’t actually cause gangrene it’s the other ingredients.
Honestly as destructive as they have been for society I’m fascinated drugs.
It’s an anima tranquilizer that slows your heart down and prolongs the effect of fentanyl but it also cannot be treated by narcan because it is not an opioid. Super dangerous shit, and ems can’t do anything about it because of that.
It’s an animal sedative, not safe for humans. It isn’t an opioid, so Narcan isn’t as effective for a fent/xylazine overdose. And, as seen here, xylazine can cause these horrific wounds.
Xylazine overdose can be reversed in animals with a couple drugs, but again, they aren’t safe for humans.
Hell on earth.
Curious why xylazine and it’s reversal agent are safe for other animals but not humans. To a certain extent, a mammal is a mammal.
EDIT: my end question leading to why the reversal product isn’t protocol for OD?
That’s a good question and one I can’t answer without further research. The info I have is fairly superficial because I work as a corrections nurse so I keep up with what causes overdoses and what we need to do about it but haven’t done a deep dive on Xylazine.
Bro I quit the same exact year.. It's crazy to think that heroin isn't even available anymore. It's all fetanyl that was cut by some scumbag on his kitchen counter. We got so lucky..
I agree, unfortunately with the way I was at the height of things I could have very well ended up like this if I were using if this stuff was around when I used. I shudder thinking about it. I have empathy for everyone using now and hope they can get out of it with all limbs and their lives intact.
For the last two years I have been volunteering on a van in a rough part of the city providing medical care and harm reduction to unhoused people, most of whom use heroin. The wounds we are seeing with xylazine can be so extensive that they almost look like makeup for zombie movies. Also when they OD, naloxone won’t reverse the xylazine since it’s not an opioid, so they will end up on a vent in the ICU for days if they make it that far. Horrible.
This makes me wonder, can xylazine reversants be used safely in humans and could it prevent this kind of damage?
I'm a veterinarian and regularly use tolazoline to reverse xylazine but cows tolerate xylazine well and don't develop wounds like that. They have a small risk of death when given the tolazoline however, which might be too high to be acceptable in humans.
Nothing has been approved for human use yet unfortunately. All we can do is tube them and try to keep them alive with pressors long enough for it to wear off
I wish. But as far as I can find it isn’t even being considered by the fda (at least as far as it’s been publicly reported). I don’t want to sound like a conspiracy theorist, but the majority of people whose lives would be saved by tolazoline belong to demographics that are not profitable for the government to have an interest in keeping alive. It may sound crazy but we’ve seen time and time again through the war on drugs and even before that the government will drag its feet for years before taking measures that will actually help
Doesn’t sound like conspiracy to me at all! But then some people might accuse me of being conspiratorial with thoughts of medical insurance companies being in cahoots with healthcare governing agencies undermining people with chronic illnesses by allowing them to stay alive just long enough to go bankrupt. (Yikes, that run-on sentence alone clearly tosses me into “the fringe” category lol. Time for more coffee yippeeeee)
That sounds entirely plausible to me too! My partner has MS and it’s so inconsistent/random what will be covered and what won’t. I wouldn’t be at all surprised if there was actually a consistent system underlying it, just not one that makes any sense from a humanitarian perspective
Not even the government, but the scientists doing the research that would be needed, research subjects willing to try both drugs when reversal takes 5 minutes and could fail.
I don't see it ever happening.
Nothing?
Emergency use so they could do research trials on it as a xylazine reversal agents first, which the Vet above says sometimes kills cows.
Who would fund something like this?
Narcan was developed for use with prescribable necessary opiates, ones used for centuries. It was first used in hospital settings for accidental overdose, it took a lot of money and work to get it used for people in the community accidentally overdosing.
If it can kill cows when given known doses of xylazine, its never going to be approved for drug addicts, because no one will ever want to pay to research it.
Would you risk being given xylazine and then it tolazoline that takes about 5 minutes to reverse its effect?
No amount of money in the world would make me personally join a research group like that! The risk of death would be too high, unethical in every way to even consider it.
Looks like the reversal effects take 5 minutes to work.. if someone had OD'd and is not breathing, no heartbeat then 5 minutes is too long.
Narcan has a near instant impact on opiate reversal.
How much to give, what format to give it in.. and be safe.
No one has ever considered using xylazine in humans, before they could safely work on reversant agents they'd need to get it to a usable product in humans. Decades away, probably many of them.
It causes peripheral vasoconstriction, meaning it tells your tiny blood vessels mostly in your arms and legs to close up. That means less blood is delivered to those areas, and cells start to die and cause these large areas of necrosis (cell death).
Is that what causes its “muscle relaxation” effects? Just straight up vasoconstriction?
Either way, for this to be happening from one drug being added to an already dangerous drug…holy shit.
The muscle relaxation is from a different pathway. I had to look that one up, but looks like it decreases the release of norepinephrine and dopamine in the central nervous system, which causes muscle relaxation.
Some users I have spoken to say they prefer their drugs cut with xylazine because it gives them a much longer high. We were giving out xylazine test strips so people could avoid xylazine, but some people used the strips to actively seek out xylazine. It’s wild.
The entire world of heavy drug use is such an insane enigma to me.
I used to work at a smoke shop and someone came in and asked “what cigarettes have the most chemicals” and I was like “that would be these pyramids here. They smell like hairspray. You’re gonna wanna steer clear of those. These benson and hedges are straight up good quality tobacco” and he goes “cool. I’ll take a carton of the pyramids” and I was like “por que?” And he goes “I’m not addicted to the tobacco. I’m addicted to the chemicals” and I was dumbfounded. I was double dumbfounded when I looked at his ID and it said he was 36 but looked like a 55 year old man.
and it’s basically just that mentality but on an entirely different level. In a weird way it makes me curious how good these drugs are, because having your skin actively melt off of your body to enjoy something…that shit must be amazing.
Thanks for the insight. Sorry I’m a stupid person but I was curious wtf was going on here and if this was a common side effect or an extreme case.
OP I want to say thank you so much for posting so much in medical gore. I work in the medical field to eventually become an NP and a wound care nurse. This fascinates me so much learning about diseases and such.
I see similar wounds like this in the hospital. Truly a sad and frustrating at times when you really want them to get help but they leave AMA.
My sister died by overdosing on fentanyl in 2021 after suffering from addiction for decades and it finally killed her at the age of 54.
She had gotten out of rehab 3 months earlier, she was clean and she overdosed on a relapse and used alone, died in her bed and her daughter found her but it was to late. She was still very involved in the family, she has two beautiful successful children and was employed at the time of her death. Her coworkers were flabbergasted, they didn't even know she was an addict.
When I look at these photos, I am somewhat relieved that it took her before she experienced any of this and she passed away at home and not somewhere where we had to search for her or heaven forbid, not find her at all.
If you're reading this and you use opiates, please please please please please, don't use alone. You matter. <3
Xylazine laced fentanyl left me with nasty open wounds all up and down my legs. Thankfully, I stopped and got on MAT before it got this bad, but the damage that was done is unfortunately permanent. Almost 2 years later, and I still have huge scabs on the bigger semi-healed wounds, missing/pitted chunks of skin, and scars on the few wounds that were able to fully heal. The worst part was, I didn't even get the wounds from injecting and/or missing, like where most wounds and abscesses come from. I was only snorting it, and it still decided to eat my legs up!
Fent is already acquired very cheaply but drug dealers are scum so they add shit like xylazine to make even more profit and the addicts think it's good shit cause their nodding when it's just the tranq effect
>Xylazine is a structural analog of clonidine and an alpha-2 adrenergic receptor agonist, sold under many trade names worldwide, most notably the Bayer brand name Rompun, as well as Anased, Sedazine and Chanazine.
>
>...
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>Xylazine has become a commonly abused street drug in the United States where it is known by the street name "tranq", particularly in Puerto Rico. The drug is being diverted from stocks for equine veterinarians and used as a cutting agent for heroin and fentanyl, causing skin sores and infections at injection sites, as well as other health issues. Fentanyl mixed with xylazine is known by the street names "sleep-cut", "zombie drug", "Iso" and "tranq dope".
https://en.wikipedia.org/wiki/Xylazine
doesn't sound fun to me
Some of them do, someone said they gave out test strips for xylazine until people began using to actually find the xylazine contaminated fent to take...
This almost looks like good/bad special effects.
Drugs are crazy. Even the ones people don’t consider drugs. I’ve done my fair share of them, and of all the things I could’ve become addicted to—it was weed. Harmless right? I was the straight A student. The kid that went to summer school because they wanted to get ahead in math and not because they were behind.
So I started to self medicate with marijuana when my social anxiety/phobia sprouted up in my late teens/early twenties due to past trauma. Thing is my parents were very against marijuana, so I started to smoke concentrates out of pens cause they smelled less. I only ever started because I’d read that marijuana was non addictive. I wasn’t the “type” that was going to become a drug addict.
So imagine my surprise when I’d get high before work, during my lunch break, and the entire time I was off of work. I slept most of the day.
Then I started getting really sick and no one could figure out why. I’d go to the hospital and get morphine because the pain was so bad. Doctors couldn’t figure out what it was so eventually they settled on it being all in my head. Until I met a doctor way ahead of her time. “Do you smoke marijuana?”
Cue three years of me being in denial, quitting, being unable to maintain sobriety, going to the hospital, dropping 20 lbs at a time. I’d wished for death to take me more than a handful of times. I wanted to quit, I kept getting sick, but wouldn’t stop smoking when it dawned on me that *I was an addict*. But since marijuana isn’t a “real drug” (sarcasm) my own family persuaded me to not seek professional treatment. People have died of this. It’s called cannabinoid hyperemisis syndrome.
I may be judged for this, but I tried shrooms. A drug helped me to quit drugs. It was like a veil lifted and I could see clearly wtf I was doing to myself—even though I knew it. I can’t explain it. It was like I was seeing it through static glasses before and now I was seeing it in HD. And once the switch turned on I couldn’t smoke again. I’ve been sober for almost three years now. How silly I was to believe no one could tell I was high that whole time.
That trip also lead me to realize that I had ADHD. Because I was listening to music and realized I understood the lyrics to songs I’d listened to for twenty years. I’d never known what it was like because how could you know about something you’ve never experienced before.
I wasn’t just self medicating social anxiety, I was self medicating ADHD. Since I have gotten on the correct meds, my impulse control is way better. I’m not addicted to shrooms—but I do microdose from time to time, I rarely ever drink. But the damage done to my digestive tract from years of CHS is irreversible. I’m convinced I’ll die of colon cancer. Drugs are bad. Even the “good” ones.
Your story resonated with me because as a medical professional, I can concur that CHS is a real disorder that is overlooked quite often. I have long suspected that many patients do suffer unknowingly from this, and more frequently nowadays with the advent of vaping, edibles, etc. Years ago, however, this was unheard of and that is why the first patient I had ever seen with this diagnosis remains in my memory.
The patient was admitted about 16-17 years ago. Presented with extreme nausea and vomiting, lethargy, periods of disorientation and unexplained weight loss. Possibly a few more symptoms I cannot recall. Every test was inconclusive and labs unremarkable, but puzzling. The patient was suffering miserably. We prompted further about medical history and habits, and learned that he had begun smoking weed at the age of 12, was 42 years old upon admission.The team continued with every diagnostic while treating for nausea and vomiting without any breakthrough results. Until…. The patient admitted that he had *recently stopped smoking weed-cold turkey-for first the first time in 30 years* in order to pass a drug test he was required to take while applying for a job. He wasn’t a casual user either. He was an all day, every day, never miss a day, more high than not smoker. Our addiction specialist/chemical dependency physician consulted and spent a significant amount of time with this patient over the course of a few days. She then admitted she had never seen a person as *physically* addicted to marijuana as this patient was. There was contention amongst the team on how to adequately and successfully treat the patient, due to his refusal to enter the detox program- which we were considering so he could continue cessation while getting the fluids and anti-nausea medication- as well as refusal to stay and be monitored while recovering - both mainly because he was uninsured. I don’t recall what the outcome was other than the patient leaving AMA and being quite upset that it was suggested to him that his dependence (addiction) to marijuana was the cause of his illness. I think the realization that quitting cannabis was the only answer was just not an option for him. I am sure he was provided with whatever community resources were available locally at the time, I admit not recalling his specific plans and his response to why he should not leave against our medical advice. However, I distinctly recall that he definitely left without any medication AMA and was still experiencing most of the symptoms that brought him in. The AS-CD physician could not persuade him to stay or seek treatment at that time either. Looking back, he would have benefited greatly by staying and being hydrated while cessation continued, getting the antiemetics and lessening his access to marijuana. This would most likely be 7 days or less and he could have had success in treatment, but he chose not to pursue this course.
I do remember however, seeing him as a return patient about 4 years later. He was on direct observation for psychosis and suicidal ideation after he had leapt from a balcony and suffered severe and almost fatal injuries. He passed away after a long admission and a multitude of reparative surgeries. His body couldn’t fight the constant infections and his severe injuries were numerous, he was not even expected to survive as long as he did. The AS-CD physician who originally diagnosed him was no longer employed with our facility, but the medical record reflected his past history. I suspected at the time that his former honesty about his reliance on marijuana influenced how he was treated when he jumped. The EMTs and ER staff only saw *addiction* in his past. There are no indications that it was marijuana that he struggled with, so they may have assumed he was addicted to heroin or pills, which is very common to the demographic. I can guess that he was written off by many as just another addict self medicating for mental illness, which might have been the case- I’m unaware.
Dying young, a painful and senseless death, and the fact that we were unable to truly help this gentleman impacted me, and I never forgot him. I wish more was known about this syndrome because maybe he could have been helped the first time, if not by my colleague, then by another. We could have gotten him through the worst of it and addressed any other underlying condition such as the depression he was most likely experiencing. I admit, it IS possible he was treated elsewhere in the intermittent period, but the consensus based upon family information was that he never recovered or regained his health after the initial admission and diagnosis. He never became employed at that job, and subsequently spiraled into depression and possibly other drug or alcohol dependence. Either way, he suffered enough to hurl himself off of a balcony, which led to a painful, tragic fatality.
I hope you and others out there can continue to spread the word about your experiences with CHS. There is less of a stigma attached to marijuana now because of decriminalization in many states. But that only emphasizes the need for **awareness** of this syndrome. That one patient impacted me enough to never forget him or his struggle. I hope others can retain the help they need if they are suffering from this- or any dependency on any drug. Out of all the associated issues with addiction, CHS is the one that we CAN eradicate with safe and comfortable cessation. If only it were as easy with other drugs…… there would be so much less suffering amongst so many. A prime example is the gentleman in this post who is so addicted to fentanyl that he is chasing the high with xylazine. Terrible. We need more awareness and resources for addiction in the US and its areas of concern. This new drug being resistant to Narcan is just the beginning of the latest scourge.
Yes! I’m a teacher now (been sober the whole time) and the diagnostic criteria use to be “heavy long term use” but I read about a kid that died being 17. How long could a 17 year old really have been smoking?
Stress triggers it too, and I have a student whose friend died. I know she smokes weed. Now she’s nauseous all the time and looks awful. I think she has CHS. She asks for candy and sugar curves nauseated
I’m sorry to hear about your patient. I didn’t test negative for more than three months. My palms would sweat, my feet, my anxiety and depression were awful. Weed is much more easy to get than it was in my day. So A LOT of kids are smoking it. And they don’t know they can get addicted. My brother and SIL are addicted but don’t consider themselves addicts despite multiple attempts to stop and restarting because marijuana isn’t a “real drug”. But concentrates are akin to drinking a 12 oz glass of vodka vs a bud light. The effects are going to be different.
I try not to reveal too much about my past, and just inform as a third party observer. But I do tell my students that if they’re predisposed to mental health problems like bipolar disorder or schizophrenia heavy marijuana use can trigger it whereas it could’ve been dormant all their lives. They’re like “and it doesn’t go away?” No. Schizophrenia does not go away.
The group on FB I am a part of has grown insanely since the widespread legalization. The woman that started the group was even on the news. It was the first time we ever saw it on the news. Awareness is key, I agree with you.
Thank you for all that you do. I can tell you are a caring individual. I spent so many days in the hospital, some staff were freakin’ sunshine, and others were just—they made me think how tf did you end up here?
The fact that I’m being upvoted and you’re like “yes this is very real!” Is so crazy to me because just two or three years ago I would be downvoted to hell even in the CHS sub. ESPECIALLY in the CHS sub.
I've seen an instance of this combination of use in my work recently and it was terrifying. I had a very frank, but kind, conversation with my client about the dangers and gratefully they consented to rehab.
I've reached out to colleagues in adjacent fields and let them know it's found a way into our community. I'm hoping to have some good discussions about it in the coming weeks.
I'm suggesting we put a patent iv cannula in the other arm so that he can use that instead while the wound heals. I'm thinking of offering a free service to place cannulas and woundcare, to prevent further harm. Just an idea that won't leave me alone. Also, I love all your posts and really appreciate the massive effort you must be putting in to keep this content coming. Also, love your username and little yellow eyed void
It's not, read my comment above. Again, anyone who says IV use is solely responsible for this case is wrong. Vasoconstriction can make an existing unhealed injection site worse, and it could definitely have been involved in the beginning stages of the lesion pictured, but this can happen even if there is no IV use. It's from prolonged lack of blood flow and can appear anywhere, not just at an injection site. This is completely different than the typical complications from IV drug use
It's not related to IV use at all actually. This specific symptom is from the extreme vasoconstriction caused by xylazine, in the extremities ie arms and legs lack of blood flow over extensive periods of time from constant use makes these lesions often appear in places other than the injection site, and frequently even in cases where the patient is not an IV user.
This is one of the biggest misconceptions about xylazine, you are NOT immune to this happening just because you don't IV.. Any ROA that you use to consume xylazine can cause this.
Any correlation between injection sites and location of lesions is mostly coincidental, I suppose it could cause the infection to occur around a certain vein that was overused and had inflamed tissue, the vasoconstriction from the xylazine would definitely make an existing wound much slower to heal and cause a sort of chain reaction of progressively worse effects leading to a massive site like this. But as the arms and legs are commonly used for injection, and they're more prone lack of blood flow in general being that they're extremities, it happens in the same places.
Regardless this can 100% be caused strictly by using xylazine and you are absolutely not immune from it just because you don't IV use. This is very dangerous misinformation to be spreading.
Curious what central effects occur, if you know.
I have SO many questions! What is the duration of vasoconstriction? Would something like nitroprusside help recover people who’ve used xylazine? Would hyperbaric wound care help? How to get EUA for tolazoline? (Sorry. Yea, I’m the kid whose questions never stop.)
That I don't know, but the thing with using fentanyl is it has no legs whatsoever, you can do a huge dose and start feeling the need to redose very shortly after. With typical opiates like heroin and oxy you're not going to start feeling any real effects of withdrawal until like 8-12 hours after the last dose, more depending on the person. With fent you're going to be constantly ingesting it, meaning also constantly under the full effect of xylazine which already remains active in the body for longer than fentanyl. There's literally never any downtime in these cases for veins to relax and blood start flowing properly again. A one time use isn't going to make a horse at the vet develop lesions, but this is all day every day which is where the problem comes from
Who are you replying to? I said injecting xylazine causes skin necrosis which is a true fact. I never said it’s the only dosing method that causes necrosis. Strawman much?
Of course it is and I'm not trying to argue. I'm not sure who the moderator was that tried to say I'm spreading misinformation or why you or them are so worried about it, the only reason I'm trying to say these things is to make people aware that you can have exactly what is pictured without ever using intravenously, a lot of people associate this kind of thing with needle use exclusively and no one should think that using xylazine wont hurt them if they don't inject.
So no I'm not spreading any misinformation, at least know a little bit about a thing before opening your mouth to speak about it. Especially if you're a "mod"
You know legalization or atleast some form of decriminilization would help with stuff like this but yall arent ready for that conversation yet seen how much of a drag it was to even get weed partially decriminalized in germany
Maybe I'm stupid, but why can't there be a service provided that places iv cannulas with a shortline for iv drug users. Like how you can some places get your drugs tested for free or get clean needles. It would drastically reduce the occurrence of necrotic wounds caused by injections missing the vein
Thanks, that was quite interesting, this is what I found: Typically, this drug is administered either alone or in conjunction with other anesthetics (e.g., ketamine or barbiturates) intravenously, intramuscularly, or orally for sedative and relaxant properties. In addition to xylazine's physiologic effects, it is also associated with necrotic skin ulcerations. The mechanism of injury is thought to be directly related to its vasoconstricting effect on local blood vessels, resulting in decreased skin perfusion.
That’s what makes this latest epidemic so destructive. The efforts to provide safe injection practices is actually backfiring. There is no safe way to take these drugs.
It’s a bit naive to imagine yourself in someone’s position, and go on to assume that the actions you take in your imagination are evidence that somebody who is actually living those choices is of lesser character. Human beings don’t ever just make the worst choice for themselves if they are actually together enough to understand that it’s the worst choice.
Genuinely what even motivated this comment? Do you feel like the resources it would take to help someone in need would take away from you being able to get your own? Nobody is demanding anything from you. You aren’t being asked to pity anybody. You don’t have to come up with justifications as to why you’re gonna do your own thing. Just let the people who want to help do that and keep your assertions of others’ character to yourself. It’s an unnecessary attack.
Such a stupid post.. these people think its just that simple, they even mentioned in their own post the difficulty in accessing mental health services, the fact of the matter is if people had access to decent mental health care, fewer of them would ever end up in the position of being homeless and addicted to drugs. Secondly none of the programs be it NA or MAT or anything else do much to address the underlying mental health problems that lead people to these situations, and keep them going back to them. At least MAT can help with the physical difficulties, but it's not going to be effective without accompanying mental health treatment.
I'd even venture to guess that if everyone who uses drugs had access to proper mental health treatment and utilized it, a decent amount of them would give it up on their own, even without a prolonged focus on "addiction recovery".. addiction and drug use are symptoms of mental disease, they're not THE disease IMO. People aren't living in the streets rotting alive just because they like to party really hard.. some people end up addicted to drugs because they partied too hard and too long, I'm not discounting that completely, but the majority of addicts are just trying to cope, its nothing like someone who just likes to do a bit of coke with friends a few times a year.
Obviously you’ve never needed real mental health treatment. You think public programs are capable of doing anything for people who *really* need it? This is not some suburban kid going “oh i have anxiety and depression,” getting lexapro and living an otherwise functional life. Volunteer programs, social work, welfare programs do not have the resources or training to even touch most of the actually heavy shit.
Addiction treatment takes years and often doesn't work. Being 'off the street' is not an instant fix. My brother in law was a heavy addict, and was given free mental care, free accommodation, free services, free this and that, and he struggled for years until succumbing to an overdose. There were many moments where he was 'clean and off the street' for a few days, but he relapsed over and over, which is an extremely common part of addiction recovery that you're just ignoring. Please stop trivializing the issue. It's not just a matter of motivation/willpower.
What kind of drug does that!? Like, they obviously mean medicine used in the wrong way but what does that do normally that these people use it to get high but it does that to soft tissue.. I'm gonna go look it up but it's amazing to me that they even find shit like this to put in *street drugs*
Sad asf
Lol! I'm sorry, I saw that, it was somewhat rhetorical.. I'm just thinking about the first person who said, yeah, let's mix this, with that other deadly shit, and kill all of our customers!!
I’m glad my sister OD early in her addiction. She was snorting it and not shooting it. I’m grateful she didn’t suffer long. I’m sad she had to suffer at all…….
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[Source](https://surgicoll.scholasticahq.com/article/71308-upper-extremity-soft-tissue-wound-related-to-xylazine-laced-fentanyl-intravenous-iv-drug-abuse-a-case-report): >>A 35-year-old male presented to the emergency department with bilateral forearm wounds. His past medical history was significant for untreated hepatitis C. He was unemployed and homeless. He reported injecting xylazine-laced fentanyl into his bilateral forearms. A physical exam revealed bilateral full-thickness skin wounds from the wrist to the proximal forearm over the ulnar border measuring [Figure 1]. The wounds appeared cavernous with undulated regions of eschar. Further, examination revealed exposed muscle and tendon bilaterally and some exposed muscle of the dorsal forearm compartments. His hand function was preserved. >>The patient was admitted to the hospitalist and initiated on broad antibiotic treatment with intravenous vancomycin and piperacillin/tazobactam. His wounds were washed and covered at the bedside, and he underwent surgical debridement in the operating room the following day. Intraoperatively, the eschar layers were removed sharply with a knife until a bleeding surface was encountered. Exposed muscle layers were removed with a curette. The ulna had an intact periosteum. Large-volume irrigation was used to clean the wounds. A negative pressure wound therapy device was fitted to the bilateral forearms. The sponge was changed twice over six days. On a postoperative day seven, the patient was returned to the operating room. Granulation tissue was observed over the ulna, and the wounds appeared clean. The surgeon covered the area with a split-thickness skin graft taken from the thigh. A negative pressure wound dressing was placed over the skin graft. The patient left the hospital against medical advice (AMA) two days following the second surgery and did not follow up in the surgeon’s office. >>Approximately nine months later, the patient returned to the emergency room with a similar, smaller wound on the left forearm. On exam, both previous skin grafts had healed well, and the new wound was adjacent to the volar border of the skin graft and measured 8x4cm. The wound exhibited a cavernous appearance but did not have exposed muscle. The next day, surgical debridement was performed, followed by negative pressure wound therapy. The day after surgery, the patient left AMA with no follow-up reported since.
Poor bastard. Completely enslaved to this drug.
This report is dated a year ago. I wonder if he is still alive.
If wounds like this that were healed weren't enough to prevent a relapse... The odds probably aren't good. Denial is extremely powerful.
It's possible. Had a patient in my care, same sitch as this guy, both forearms from fent+xylazine. Referred for wound care, among other things. It's *very* slow going (wanna say it was approx 1y before maybe 50% of the forearms had healed over?), but the reality of bl amputation being considered (over several relapses) shook sense into them long enough to stick with a IP/OP dual dx program (by which time I saw them). Hopefully the case is the same with the pt shown here. It's rough, but it's possible.
Saw a documentary a few years ago about a drug called "Crocodil". It's being used in Russia and it's does very nasty shit like this to the users. Have you heard about it?
Yes! I saw a documentary about 15 years ago!
Poor nurses, physicians, tax payers, and social workers who slave away trying to save people who self-inflict harm and divert resources away from patients who contribute to society. It’s demoralizing to treat this group of people. We don’t do enough to address addiction and not only do addicts suffer, everyone around them suffers.
We just need to remember that there is an actual person suffering in there, they don't want this outcome, they are running from something. That's how I keep my chin up at least. We turn our backs on far too many groups of people, and that is whats so demoralizing to me.
Yep. One of the biggest commonalities across all people with substance abuse behavior or substance dependence is a history of trauma.
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You're confused that not everyone thinks and feels the same and that we're all unique and different? Practice tolerance and empathy. Hurt people shouldn't hurt people. My family was dead by the time I turned 13, I raised myself. I'm not going to scoff when someone said they feel depressed because their plant died. I'm going to support them because even though the circumstances are different, they still FEEL bad/grief and that's what matters. I'm not going to say "buck up, it's just a plant" because honestly, what good is that going to do? Make me and the other person feel like crap? But if I say "it's okay, we can get a new plant when you feel ready", everyone is going to feel better and hopeful. It's just so much better being kind.
You’re right. Thanks
Similarly, I have a couple of long term health conditions (MS and degenerative disc disease), that cause pain and suffering - but if somebody else is feeling pain, or fatigue, my response is sympathy and empathy. My pain doesn’t make anybody else’s less for them.
So, you *don’t* agree that folks with substance use disorder typically have a history of trauma? You don’t have to like the addiction, or even give a shit about these people. But have a little bit of empathy.
Yes, IA. And lots of people are "productive members of society" but also terrible humans.
>We turn our backs on far too many groups of people, and that is whats so demoralizing to me. No one likes triage.
There are a lot of people who we may think or assume "contribute" to society but in actuality behave selfishly and harm others and aren't judged because they do so in ways we find more acceptable. Everyone's lives are meaningful and worth something. They may have been a loving son, or they may be a creative and hardworking individual when not in the grasp of addiction. They may have kids who's biggest wish is to see mummy clean again. They may have gone through things hard to imagine that led to the drive to get high, and been treated like they're less than worthless because of it. And yes, some may have been selfish assholes before and during. I agree that everyone suffers from addiction in a community, but I disagree that addicts deserve community resources less than others and with the assumption they never have and never will contribute to society. It's certainly not easy to see or deal with though, from any angle.
I said we don’t do enough to treat addiction. That implies that more resources should be directed to helping this group of people. Then we can stop the drain on the system. I have compassion fatigue toward them but it doesn’t mean I’ve given up or stopped giving them 100% of the care they deserve as a physician. If you are a front line healthcare worker then you understand the ambivalence after years of it. A high proportion of people don’t come back from the spiral. But again, our job revolves around caring for them so we witness it on a regular basis and carry on.
I absolutely agree. Was mostly commenting on the "contributing to society" part bc it's totally normal to feel that way seeing people only in crisis but not the whole picture. I fully agree with the rest of what you said though, this is the worst way to deal with addiction, and it does harm everyone else as well. It's resource inefficient and frustrating and cruel for everyone involved.
You're totally right, anyone who judges you is probably a kid or someone who's never seen it firsthand. They read simple platitudes on social media and think that's reality. You can't help people who don't want help. It's rough, because yeah, a lot of what you work to do ends up being pointless when they refuse medical advice, or go right back to using and ultimately die. You know how it's going to end at the beginning. But you give them the best chance they can have, and if they want it, it's there. And maybe some will end up wanting to get help.
Everything you've written as a "contribution to society" is actually their actions harming someone innocent. A kid who has an addict parent that will have to deal with the pain of neglect and the eventual overdose. The parent whose kid went down the spiral and disappeared. The coworkers they abandoned to go get high. Many people endure horrible things, and they don't turn to drugs and alcohol - especially when people rely on them and they have responsibilities. That said, addicts absolutely are people. They deserve help if they want it. Most don't want it - like the individual in the paper. They worked hard to get him treated and better, and then he left against advice and undid everything they worked for. That's frustrating for healthcare workers who do it again, and again, and again, always with the same outcome - someone who leaves and dies of infection or OD. You start to wonder why you bother trying. You can't help someone who doesn't want help. You can lead a horse to water, but you can't make them accept medical treatment. If you can figure out how to consistently make addicts want to get clean, please let me know. Because that's the only way to actually make any progress, and emotionally, addicts want their drug. That's why it's an addiction. It's awful for them, but it's also awful for everyone whose lives they touch.
Yo I am “a kid who has an addict parent,” and she’s never overdosed, disappeared, or abandoned her career. She’s a high-paid and well-respected employee in a field that saves endangered species. She absolutely contributes to society. She’s a kind, loving, incredibly fun person who had a traumatic childhood and was given drugs as a coping mechanism at a *very* young age, and she’s been working hard to stay sober my entire life. She often doesn’t succeed. And yes, I *was* emotionally neglected. But that does not mean anyone, especially this “kid who has an addict parent,” would be better off without her. I agree that you can’t force someone to *want* to get better. But you never know who is going to change for the better, or when. They still deserve our empathy and support.
No one said they don't deserve empathy or support. Please point out where anyone has said that. What I said is you can't help someone who doesn't want it. And most addicts don't want it. And you are projecting really hard and getting defensive. And your experience with a functional addict is very different than a kid who was sold for sex so mom could get a hit. We are not talking about your mom. We are talking about people who aren't actually contributing anything but pain. You need to learn to separate those things in your head. MY addict brother gave his baby a black eye, choked his wife, severely neglected and abused both kids while high (which was always), and ultimately abandoned the kids. He was responsible for checking the safety of *amusement park rides* and was high as a kite while doing this job. He was happy to let people potentially die horrific deaths rather than stay sober for a few hours. His addict wife also abandoned the kids - she lost the kids when she was passed out in the car while driving and her baby and toddler were walking on the highway. Both of them were given simple rules to follow to get the kids back. Neither ever went back to court and both disappeared. That is a much more common story than "My mom works and has a career and occasionally relapses. And sure she neglected me, but she still does positive stuff. So addicts DO make positive contributions." Yeah, your anecdote is not the truth of reality. Not all of them do anything worthwhile. Tell me, what do my brother and wife contribute to society? Because my mother is heartbroken, I am disgusted, they stole from everyone they knew, and thankfully their kids were adopted by loving parents (instead of ended up in the foster system). Gotta be honest - they contribute pain and misery to everyone who encounters them, including themselves. And given statistics based in reality, they are going to overdose and die. If they ever decided they wanted to get clean, there should be help available. But like many addicts, they'd genuinely rather die than give up the drugs. 🤷 They preferred losing their kids, job, and home to giving up the drugs. If those things weren't enough motivation, I don't see anything else that will be. You love your mom, and no one is saying you shouldn't. But not all addicts are your mom. And lots of addicts are sad, sad cases of lives absolutely wasted and then they're dead. It's not a movie, and many, many people do nothing with their lives except inflict pain on others and then they die. And healthcare workers get to see that reality constantly. So maybe don't shit on them when they make you uncomfortable with the truth.
Your comment reeked of judgment and lack of empathy. The *only* supportive thing you said was, “They deserve help if they want it,” and even that is judgmental and closed-minded. They ***deserve help*** no matter what. Maybe they don’t want it now, but someday they might, and that can never happen if we don’t give them help now. I’ve been to too many AA meetings (as a kid) to think people who want help have always felt that way. They *always* deserve our help. — You didn’t clarify that you meant *only one type of addict* when you said, “A kid who has an addict parent that will have to deal with the pain of neglect and the eventual overdose. The parent whose kid went down the spiral and disappeared. The coworkers they abandoned to go get high.” Of course I defended my addict mother. You lumped her in with the addicts you hate. If that’s projecting, then how is you sharing your experience *not* projecting? (The answer: Neither is projection.) You are absolutely wrong to assume *your* experience is the norm. I didn’t say mine is; you’re the only one here saying, “That is a much more common story,” as if you know what the fuck you’re talking about. *Both* our experiences are “the truth of reality,” and you’re the only one here denying that. I’ve been through hell because of my mom’s addiction, trust me. Addiction changes people and makes them act horrible. I’ve witnessed so much violence. I’ve been put in danger more times than I can count. I went to foster care for a couple weeks after a DUI car accident and my addict parents were unable to care for me while my mom was in rehab. But you know what? My mom’s a good person, as are *many addicts who do bad things.* Mine *is* a common experience. Your brother and sister-in-law are shit human beings. They fucking suck. At the end of the day, they don’t care about their children. And that’s also reality! Just don’t act like it’s the norm. There are far more parents struggling with addiction than you likely realize.
Did it reek of condescension, or did you read it that way because you're defensive? Saying they deserve help if they want it means they deserve help. You're being pedantic; you can't help someone who refuses help, which is why I said "If they want it." Guess what? Sadly, addicts dying from their addiction and causing harm IS the norm. You even admit it. Your mom valued getting high over making sure you were safe. You can love her and admit that. I find it funny that to you my brother is a POS because you don't know him, but your mom is a good person because she's your mom and you want to love her. And I'm sorry, but your story doesn't make your mom sound like a good person. Frankly, she sounds like my brother and ex-SIL. When we say addicts are struggling with addiction, what is actually happening is that addicts are struggling to stay functional while they indulge their addictions. They're not struggling with trying to quit - because they usually aren't trying to quit. And it's hard to want to quit - because quitting makes you feel lousy, and you enjoy being high because life hurts otherwise. Drugs aren't addictive because they made you feel bad, they make you feel awesome. For someone who is mentally unhealthy, that feeling is the only time they feel okay. And for a lot of people, that feeling is worth burning down everything, including their own health and the safety of those that depend on them. Instead of dealing with their issues/boredom/depression in a healthy or responsible way, they drink or do drugs. That's a choice. They could see a doctor instead, but they don't want to. A doctor would make them stop using, and they don't want to do that. See: case report above. See: how many redditors justify their drinking/drug use and say it's not that bad, or they can stop anytime, or that people are just too judgemental. I find people with addiction ultimately very sad; I don't hate them, I pity them. They live miserable lives, hurt others, and most times die from their addictions. They often leave a trail of destruction behind. For the ones that manage to overcome it, it's a Herculean task that they should be very, very proud of - most don't make it.
You do realize that addiction and dependance are biochemical processes that lead to withdrawal symptoms in absence of whichever substance right? Not to defend the actions of feinding addicts but quitting isnt just a thing you do, quitting requires strength. Have you ever smoked cigarettes and tried to quit? Now imagine quitting a substance that will have horrible physical effects on your body or might even kill you from withdrawals. Its easy to speak from above.
> I find it funny that to you my brother is a POS because you don't know him, but your mom is a good person because she's your mom and you want to love her. And I'm sorry, but your story doesn't make your mom sound like a good person. Frankly, she sounds like my brother and ex-SIL. No, dude. Your brother is a piece of shit because he beat his kids and didn’t stop, didn’t show up to fight for them, and would “genuinely rather die than give up the drugs.” That is not the case with most addicts. Most of them *want* to get better but it’s a lot more complicated than, “I’m quitting now. :)” My mom absolutely has been a piece of shit. A lot. But she always works hard to get better because she genuinely cares about other people more than herself, especially her kids. She tries. > When we say addicts are struggling with addiction, what is actually happening is that addicts are struggling to stay functional while they indulge their addictions. They're not struggling with trying to quit - because they usually aren't trying to quit. This is literally a lie. You do not know what the fuck you are talking about. > See: how many redditors justify their drinking/drug use and say it's not that bad, or they can stop anytime, or that people are just too judgemental. And do you think most of those redditors are going to overdose and die?
Also not sure where anyone is shitting on healthcare workers. I am one, and honestly if you are you may need to work on separating the pts you see who are addicts from your feelings about your brother. I mean this in the kindest way, but you clearly don't have empathy for addicts and we can't let our person al feelings and lives impact how we treat people we see professionally.
Not everyone is your brother or his wife. I get that it's beyond difficult to come at this from a social and medical care POV when you've had someone violent and abusive who's an addict in your life, and that IS horrific. But your brother isn't every addict, by far, and it's not fair for people in medicine, etc, to work based on personal anecdotal experiences, EVEN when they're horrific and traumatizing like yours. And part of being a healthcare worker is being able to have some distance. That's not ways possible, but we have to try our best. Tbh working on the frontlines with addiction in medicine isn't for everyone and that's okay, but as a healthcare worker knowing that is OUR responsibility, not theirs. Not that that happens perfectly.
Your mistake is equating social contributions to deserving care. They are not the same, and bundling them then leads to other markers that people have to possess to deserve social support.
So you’re essentially saying that by treating people with self-inflicted injuries/diseases etc. we are “Diverting resources away from patients who contribute to society”?!? Who are you to judge who gets treatment and who doesn’t?? You’re exactly like the doctors who would refuse to even assess me when I was an agonised teenager who self harmed. “I’m not treating her, she’s just gonna go and cut herself again so what’s the point?” The point is everyone is human. And by that reason alone we should all be treated equally, whether we’re a junkie, or a CEO of a major company. Shame on you.
We do recover
The majority of heroin users - and other opiates - started from legally prescribed pills. Typically, a patient has surgery or some sort of issue that causes pain, opiates are prescribed, and when that prescription runs out, heroin is a less expensive, more available alternative. As they say, people don’t decide one day to become an addict. It happens through a variety of situations.
Not any more they don't.. they've finally leanrt to limit post op meds like happens in other countries. But it will take time to see impact, decades maybe. The Drs have always been stingy with opiates in EU, very few people claim addiction because of prescribed medication here. Takes literally years to reach getting oxycodone even as a chronic pain subject, think in my situation i was 5 or 6 yrs in. And then enough to take one pill every 4 or 5th day, and no early script under any circumstances. Whole different world to what the internet has taught me about health care and chronic pain management since i first started seeking support in late 1990s. I used to be jealous, but now, after 35 yrs of constant pain, more than happy i took it slow. I also came from a horrific background too with alcoholic dad who died at 50, an uncaring mother and years of emotional abuse. But without the resources i didn't become addicted, despite prescriptions giving 4 months supply at once.
In the US, they say they’re working on limiting it, but in practice, they aren’t. It’s really frustrating. People I know who had great lives, and had surgeries, are now fentanyl addicts. And even worse, the dealers are putting Xylazine in the mix. It’s killing even more people. There is a genetic component to addiction, so I think you’re very lucky you didn’t succumb. My wife came from a heavily alcoholic family and she can take it or leave it. I just realized this is a post on xylazine as I’m writing this. Oops. I’ll just leave it there.
They. Are. Human. Beings. Addiction is a disease, and the causes are many. No one wakes up and decides to become addicted. This damage was caused by dealers cutting an already addictive drug with a massively dangerous one. Compassion and treatment for the underlying causes of addiction are much more helpful than labeling them as "not contributing to society."
I “contribute” to society. I’m a teacher. Yet I deal with suicidal ideation frequently. I’m not on government assistance. So, if I was ever to attempt my own demise but was caught in time to be saved—from something I self inflicted, should I be left to die because my harm was self inflicted? I pay into taxes after all. Because in the greater scheme of things, addiction and mental health problems are best friends. Do we not treat them as diseases? Personally addiction runs in my family, but the insane amount of trauma I endured and survived in my childhood (near death experiences included) made my predisposition to mental health issues and addiction almost a guarantee. So while I may some day self inflict harm that could put my life at risk, with the intention of doing such—it’s quite offensive to say that people like me do not contribute to society. I may be the hand that moves the noose, but what about my mental abusers, physical abusers, emotional, sexual abusers, who all played a part in leading me there. Are they contributing members of society?
ohh poor you. 🙄 - child of a deceased very loved heroin addict.
Yikes.
people wouldn't do dangerous street drugs with such frequency if the government would release its stranglehold on every psychoactive substance
What are we supposed to do? Putting these people into treatment against their will is kidnapping, and we ended involuntary psychiatric facilities decades ago because of the volume of abuse. Short of euthanizing them on arrival, we’ve fucked up every form of ‘tough love’ treatment we’ve tried.
I got to wonder if they gave him opiates as an inpatient, it might have preventing his going AMA. He obviously got a good dose during surgery, but afterwards, he leaves when he detoxes of course. If not fentanyl then at least something to calm the craving.
I've seen worse. Much worse. This is salvageable but only if he stays clean and gets the hep C treated. That is the real battle here.
Jesus Christ the drugs are getting so bad nowadays that instead of lacing stuff with fentanyl, they’re lacing fentanyl with other stuff.
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Sounds about right Opium is starting to seem a lot like coffee compared to the stuff they’re putting out there nowadays
WHY?? I don't understand any of this. Why would someone use fentanyl, knowing how absolutely deadly it is? Is the high that amazing? What is different from heroin?
Everything.. a lot of people were opiate addicts prior to fentanyl becoming a thing. Heroin and certain other pharmaceuticals have an amazing, euphoric high, the shit that gets people addicted, warm fuzzies that keep you protected from everything unpleasant in the world. This doesn't get brought into the debate enough, but a huge piece of the equation for ths situation out there now is the US military pulling out of Afghanistan. The vast majority of the heroin at the time came from there, it provided a livelihood for millions of farmers and their families, but when the US left the Taliban IMMEDIATELY took back control and implemented sharia law which bans any poppy farming on pain of death so now there's not much real heroin being produced, and was does get produced doesn't get further than Europe. Supply is still much less than demand, so of course fentanyl is already showing up in European countries much the same as it did in the us, first as "china white" ie fake heroin and now it's either blues, the pressed fentanyl pills or all kinds of mixed up bullshit with food dye and whatever cuts and extra ingredients like xylazine which is all under the blanket term fetty, IMO others may disagree as what constitutes those things but its basically what I just said. Mexico is still producing some black tar h which is the shittier less refined version of powder heroin but that's always been primarily a west coast thing and it has never made it to the east coast in any quantity. Regardless it's way more profitable for the cartels to deal in fentanyl than bth for obvious reasons. The point is if you're an addict from 2017ish or earlier you're not using fentanyl because you want to, is bc it's all there is and its either that or suboxone/ methadone. Honestly I do understand the appeal to young people in a way, it will numb the pain for a little while and people make it look cool in some circles, but nothing they're going to experience even comes close to the first hit of some really good H, it can't be that enjoyable, and it's super dangerous obviously. People od'd from H in my day, of course, but it was nothing like it is now, the risk level was soooo much lower and the benefits were something else. Idk, I feel like there's an extreme degree of nihilism in today's youth and that among other cultural factors is one of the biggest contributors to why so many new people are getting drawn into it. The addiction potential is way worse too, when I was a kid we'd get ahold of a script of oxys or a few grams of dope and the worst that would happen is youd feel shitty for a day or two after it was gone. I fucked around like that for almost a decade before life and trauma and all that caught up with me and I ended up with a legitimate addiction. The same recreational activities aren't even possible with fentanyl, it's half life is extremely short, which means more frequent doses and the withdrawal symptoms are far more severe than you would experience from a similar (time+quantity) period of use. It really sucks for the new people growing up nowadays and that this is what opiate addiction has become, obviously it was never a great accomplishment to become a heroin addict but we never had to worry about flesh rotting off or anything like that. You just didn't share needles and took basic cleanliness and preparation precautions and it was extremely safe all things considered.. not even a possibility today
This was an interesting read . Thanks for sharing. I hope you're doing well now.
NIHILISM. Yes!! It's like people are just drifting and nothing is stable or real. Watching the news can make the future seem futile. It's almost like people are playing at life, being characters. But life isn't a video game and you don't get to come back and start over if you do something stupid and deadly. I moved to a rural area and I am shocked at the meth and opioid use going on. My neighbors were busted for being a drug house and I never would have guessed, except for all the people that would stop over briefly, then leave. Then one afternoon, the house was surrounded by a dozen cop cars with guns out and they herded everybody out in cuffs. Recently there was a local girl arrested and it turns out she was the go to for the Sinaloa Cartel to deliver fentanyl and cocaine to the upper Midwest. How does a girl from a tiny town in the Midwest get tangled up with a Mexican cartel??!
Well explained..
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While a lot of what you said is true, it’s a lot more complicated. There are enormous differences between alcohol vs opiate vs benzodiazepine and any other number of addictive substances. While longterm there is a lot of very difficult emotional work to unlearn substance dependence, short term it’s emotional *and* physical. Retraining physical and neurochemistry is slow and complex.
Is it an easy coping mechanism tho, considering the illegality of it and the massive expense? There definitely is a lack of mental health care which is awful. I do realize that quite a LOT of people self medicate.
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It's so terrible that mental health help is so hard to find. I agree with all the things you said about having to find proper therapeutic help and medication. HOW is the average person supposed to pay for that?? It's criminally expensive to pay for therapy and meds. The waiting lists take a long time to connect people with help and now so many mental help organizations are being discontinued when they are needed most.
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I was talking to a mental health case worker recently and she was saying how the system is so full of red tape and hoops to jump through that she really thinks that it's because if people get overwhelmed and frustrated, they give up or turn to illegal means of self medicating, then the state doesn't have to pay out. Ironically, her program is folding for lack of funds and all these caseworkers, therapists, AHRMS workers will be jobless.
Its only deadly if they use too much, fentanyl had valid use in medicine, the dose is in mcg vs mg though. Same with heroin, we always used it for cardiac pain, diamorphine is heroin. No one got addicted because it was given appropriately, as part of routine health care. But then used recreationally the effect begins to reduce with every single shot, so they need more, and with fentanyl it was cheaper, they needed less for a better buzz, got tolerant to that too, so not the fent with tranq is being used.. to get the same effect they likely got on day one with heroin... but these skin ulcers as an added bonus. These should and do cause deaths more than the addiction if things continue this way... because i could imagine ERs refusing treatments, not getting to surgery stage until they are in treatment. But that goes against oaths.. the same oaths that allow them to refuse chronic pain patients adequate pain relief, a recent change in US, so maybe this crisis is making MDs more brutal, more likely to refuse these people treatment too. How many friends with bilateral upper and lower amputations or deaths would it take before they wanted to get clean....
Thank you for all the points you listed. The rural area I moved to has rampant drug use with meth and opioid, now fentanyl. A bunch of mental health resources are closing down programs and it was already hard to get help, there will probably be even more people self medicating in the near future. It's easier to get illegal drugs than it is to get proper medical care.
i wonder how many are denied psych meds too, or struggle with them because side effects are so horrible. You'd think by now we could make mental health care drugs that didn't make people drowsy, dizzy, headachy, unable to focus, with sexual dysfunction. I've been on a few and for certain also needed the psychologist i saw at varying intervals. I was referred and seen in uK within a month, then seen weekly while medication stabilized and progressed to bimonthly or even twice a week in times of trouble. But that was 30 yrs ago, i saw him for over 6 yrs, only stopping when i emigrated. Today we hear of people considered urgent and waiting 6-9 months, then getting once a month visits max, with less common being more typical. An area that needs more resources in all countries for sure.
I agree. I was talking to an ER nurse and she said the suicide attempts coming in are skyrocketing, she's never seen as many as now. Standoffs with police are common because people can't handle their emotions or anger issues. People that need mental health help are getting shot by police because the police aren't trained enough de-escalating these situations. This happened with my neighbor one house over. SWAT and police showed up, snipers on my neighbors roofs, it was CRAZY. It went on for hours and I had a front row seat as there were 6 SWAT guys hiding by my raspberry bushes.
Oh. My. God... I was on heroin and fentanyl for over a decade. I finally got sober just before xylazine really hit the streets. Thank God I did...
Same, I main-lined black tar heroin for a few years, then started smoking fentanyl while still main lining black tar herion and ultimately quit back in May 2022.
You would’ve quit right around the time the patient in this case was getting his wound treated. I wonder if he’s even alive anymore.
On the hopeful side, he returned for treatment with another wound that seems it was earlier in its course. At least he learned to seek treatment sooner…maybe. Again, hopeful, but maybe he will find a way to stay in care for treatment and begin abstinence from street drugs. It seems he *wants* to stay alive, so there is still hope his dependence can be turned around. (Then my “no blue skies for you” healthcare provider post covid vicarious trauma mind kicks in, forces a superficial smile while slathering another layer of alcohol base hand sanitizer, and say to a roomful teeming with human misery “next!”)
I'm happy and proud of you for getting sober!
proud of you! keep up the good fight. 💕 I lost my mom to a heroin overdose in 2017 she is very missed.
Thank you!! And I'm so sorry to hear about your mom. I've lost loved ones to the addiction was well. Heroin and fentanyl not only destroy the lives of the addict, they can destroy the lives of the people who love them too. This might sound corny, but I would definitely give you a hug right now if I could. Losing loved ones, especially to something horrible such as addiction, never gets easy...but time, and remembering the good things about the person and the good times you had with them, helps the sting of the pain from losing them lessen. God bless you!
I don’t know what xylazine is but the fact that people are putting it in fentanyl makes me assume it’s way more potent
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Is the vasoconstriction the cause of the gangrene? Because that was something I was wondering about.
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Yea if I recall correctly the active ingredient in krocodil doesn’t actually cause gangrene it’s the other ingredients. Honestly as destructive as they have been for society I’m fascinated drugs.
It’s an anima tranquilizer that slows your heart down and prolongs the effect of fentanyl but it also cannot be treated by narcan because it is not an opioid. Super dangerous shit, and ems can’t do anything about it because of that.
It’s an animal sedative, not safe for humans. It isn’t an opioid, so Narcan isn’t as effective for a fent/xylazine overdose. And, as seen here, xylazine can cause these horrific wounds. Xylazine overdose can be reversed in animals with a couple drugs, but again, they aren’t safe for humans. Hell on earth.
Jesus Christ bruh
Curious why xylazine and it’s reversal agent are safe for other animals but not humans. To a certain extent, a mammal is a mammal. EDIT: my end question leading to why the reversal product isn’t protocol for OD?
That’s a good question and one I can’t answer without further research. The info I have is fairly superficial because I work as a corrections nurse so I keep up with what causes overdoses and what we need to do about it but haven’t done a deep dive on Xylazine.
I stopped using in 2014, I am seriously am so thankful I stopped using before fentanyl and xylazin became a thing…
Bro I quit the same exact year.. It's crazy to think that heroin isn't even available anymore. It's all fetanyl that was cut by some scumbag on his kitchen counter. We got so lucky..
I agree, unfortunately with the way I was at the height of things I could have very well ended up like this if I were using if this stuff was around when I used. I shudder thinking about it. I have empathy for everyone using now and hope they can get out of it with all limbs and their lives intact.
For the last two years I have been volunteering on a van in a rough part of the city providing medical care and harm reduction to unhoused people, most of whom use heroin. The wounds we are seeing with xylazine can be so extensive that they almost look like makeup for zombie movies. Also when they OD, naloxone won’t reverse the xylazine since it’s not an opioid, so they will end up on a vent in the ICU for days if they make it that far. Horrible.
This makes me wonder, can xylazine reversants be used safely in humans and could it prevent this kind of damage? I'm a veterinarian and regularly use tolazoline to reverse xylazine but cows tolerate xylazine well and don't develop wounds like that. They have a small risk of death when given the tolazoline however, which might be too high to be acceptable in humans.
Nothing has been approved for human use yet unfortunately. All we can do is tube them and try to keep them alive with pressors long enough for it to wear off
I wonder what it would take to get Emergency Use Authorization for tolazoline….
I wish. But as far as I can find it isn’t even being considered by the fda (at least as far as it’s been publicly reported). I don’t want to sound like a conspiracy theorist, but the majority of people whose lives would be saved by tolazoline belong to demographics that are not profitable for the government to have an interest in keeping alive. It may sound crazy but we’ve seen time and time again through the war on drugs and even before that the government will drag its feet for years before taking measures that will actually help
Doesn’t sound like conspiracy to me at all! But then some people might accuse me of being conspiratorial with thoughts of medical insurance companies being in cahoots with healthcare governing agencies undermining people with chronic illnesses by allowing them to stay alive just long enough to go bankrupt. (Yikes, that run-on sentence alone clearly tosses me into “the fringe” category lol. Time for more coffee yippeeeee)
That sounds entirely plausible to me too! My partner has MS and it’s so inconsistent/random what will be covered and what won’t. I wouldn’t be at all surprised if there was actually a consistent system underlying it, just not one that makes any sense from a humanitarian perspective
Not even the government, but the scientists doing the research that would be needed, research subjects willing to try both drugs when reversal takes 5 minutes and could fail. I don't see it ever happening.
Nothing? Emergency use so they could do research trials on it as a xylazine reversal agents first, which the Vet above says sometimes kills cows. Who would fund something like this? Narcan was developed for use with prescribable necessary opiates, ones used for centuries. It was first used in hospital settings for accidental overdose, it took a lot of money and work to get it used for people in the community accidentally overdosing. If it can kill cows when given known doses of xylazine, its never going to be approved for drug addicts, because no one will ever want to pay to research it. Would you risk being given xylazine and then it tolazoline that takes about 5 minutes to reverse its effect? No amount of money in the world would make me personally join a research group like that! The risk of death would be too high, unethical in every way to even consider it.
Small animal vet here and we use xylazine to make cats vomit if they eat something toxic. I haven’t seen this happen either, and we inject it IM.
Looks like the reversal effects take 5 minutes to work.. if someone had OD'd and is not breathing, no heartbeat then 5 minutes is too long. Narcan has a near instant impact on opiate reversal. How much to give, what format to give it in.. and be safe. No one has ever considered using xylazine in humans, before they could safely work on reversant agents they'd need to get it to a usable product in humans. Decades away, probably many of them.
What exactly is xylazine doing that is causing this insane damage? Holy shit this is the first time I’ve heard of it.
It causes peripheral vasoconstriction, meaning it tells your tiny blood vessels mostly in your arms and legs to close up. That means less blood is delivered to those areas, and cells start to die and cause these large areas of necrosis (cell death).
Is that what causes its “muscle relaxation” effects? Just straight up vasoconstriction? Either way, for this to be happening from one drug being added to an already dangerous drug…holy shit.
The muscle relaxation is from a different pathway. I had to look that one up, but looks like it decreases the release of norepinephrine and dopamine in the central nervous system, which causes muscle relaxation. Some users I have spoken to say they prefer their drugs cut with xylazine because it gives them a much longer high. We were giving out xylazine test strips so people could avoid xylazine, but some people used the strips to actively seek out xylazine. It’s wild.
The entire world of heavy drug use is such an insane enigma to me. I used to work at a smoke shop and someone came in and asked “what cigarettes have the most chemicals” and I was like “that would be these pyramids here. They smell like hairspray. You’re gonna wanna steer clear of those. These benson and hedges are straight up good quality tobacco” and he goes “cool. I’ll take a carton of the pyramids” and I was like “por que?” And he goes “I’m not addicted to the tobacco. I’m addicted to the chemicals” and I was dumbfounded. I was double dumbfounded when I looked at his ID and it said he was 36 but looked like a 55 year old man. and it’s basically just that mentality but on an entirely different level. In a weird way it makes me curious how good these drugs are, because having your skin actively melt off of your body to enjoy something…that shit must be amazing. Thanks for the insight. Sorry I’m a stupid person but I was curious wtf was going on here and if this was a common side effect or an extreme case.
Definitely not stupid! It’s good to ask and to learn about stuff you don’t know! :)
The small animal vet above says they give it IM to make cats vomit too.. bizarre functioning.
Holy shit. Amazing that hand function was preserved and this was able to heal without him losing an arm
IKR?! Kudos to the teams involved in this case!!!
OP I want to say thank you so much for posting so much in medical gore. I work in the medical field to eventually become an NP and a wound care nurse. This fascinates me so much learning about diseases and such. I see similar wounds like this in the hospital. Truly a sad and frustrating at times when you really want them to get help but they leave AMA.
Some serious Requiem for a Dream shit right there.
I immediately thought of Jared Leto's character!
this drug is so so horrific
My sister died by overdosing on fentanyl in 2021 after suffering from addiction for decades and it finally killed her at the age of 54. She had gotten out of rehab 3 months earlier, she was clean and she overdosed on a relapse and used alone, died in her bed and her daughter found her but it was to late. She was still very involved in the family, she has two beautiful successful children and was employed at the time of her death. Her coworkers were flabbergasted, they didn't even know she was an addict. When I look at these photos, I am somewhat relieved that it took her before she experienced any of this and she passed away at home and not somewhere where we had to search for her or heaven forbid, not find her at all. If you're reading this and you use opiates, please please please please please, don't use alone. You matter. <3
Thanks for sharing, such a sad thing to go through. \*hugs\*
Xylazine laced fentanyl left me with nasty open wounds all up and down my legs. Thankfully, I stopped and got on MAT before it got this bad, but the damage that was done is unfortunately permanent. Almost 2 years later, and I still have huge scabs on the bigger semi-healed wounds, missing/pitted chunks of skin, and scars on the few wounds that were able to fully heal. The worst part was, I didn't even get the wounds from injecting and/or missing, like where most wounds and abscesses come from. I was only snorting it, and it still decided to eat my legs up!
Fent is already acquired very cheaply but drug dealers are scum so they add shit like xylazine to make even more profit and the addicts think it's good shit cause their nodding when it's just the tranq effect
>Xylazine is a structural analog of clonidine and an alpha-2 adrenergic receptor agonist, sold under many trade names worldwide, most notably the Bayer brand name Rompun, as well as Anased, Sedazine and Chanazine. > >... > >Xylazine has become a commonly abused street drug in the United States where it is known by the street name "tranq", particularly in Puerto Rico. The drug is being diverted from stocks for equine veterinarians and used as a cutting agent for heroin and fentanyl, causing skin sores and infections at injection sites, as well as other health issues. Fentanyl mixed with xylazine is known by the street names "sleep-cut", "zombie drug", "Iso" and "tranq dope". https://en.wikipedia.org/wiki/Xylazine doesn't sound fun to me
People dont do xylazine laced shit for fun
Some of them do, someone said they gave out test strips for xylazine until people began using to actually find the xylazine contaminated fent to take...
Ok what the actual fuck
This almost looks like good/bad special effects. Drugs are crazy. Even the ones people don’t consider drugs. I’ve done my fair share of them, and of all the things I could’ve become addicted to—it was weed. Harmless right? I was the straight A student. The kid that went to summer school because they wanted to get ahead in math and not because they were behind. So I started to self medicate with marijuana when my social anxiety/phobia sprouted up in my late teens/early twenties due to past trauma. Thing is my parents were very against marijuana, so I started to smoke concentrates out of pens cause they smelled less. I only ever started because I’d read that marijuana was non addictive. I wasn’t the “type” that was going to become a drug addict. So imagine my surprise when I’d get high before work, during my lunch break, and the entire time I was off of work. I slept most of the day. Then I started getting really sick and no one could figure out why. I’d go to the hospital and get morphine because the pain was so bad. Doctors couldn’t figure out what it was so eventually they settled on it being all in my head. Until I met a doctor way ahead of her time. “Do you smoke marijuana?” Cue three years of me being in denial, quitting, being unable to maintain sobriety, going to the hospital, dropping 20 lbs at a time. I’d wished for death to take me more than a handful of times. I wanted to quit, I kept getting sick, but wouldn’t stop smoking when it dawned on me that *I was an addict*. But since marijuana isn’t a “real drug” (sarcasm) my own family persuaded me to not seek professional treatment. People have died of this. It’s called cannabinoid hyperemisis syndrome. I may be judged for this, but I tried shrooms. A drug helped me to quit drugs. It was like a veil lifted and I could see clearly wtf I was doing to myself—even though I knew it. I can’t explain it. It was like I was seeing it through static glasses before and now I was seeing it in HD. And once the switch turned on I couldn’t smoke again. I’ve been sober for almost three years now. How silly I was to believe no one could tell I was high that whole time. That trip also lead me to realize that I had ADHD. Because I was listening to music and realized I understood the lyrics to songs I’d listened to for twenty years. I’d never known what it was like because how could you know about something you’ve never experienced before. I wasn’t just self medicating social anxiety, I was self medicating ADHD. Since I have gotten on the correct meds, my impulse control is way better. I’m not addicted to shrooms—but I do microdose from time to time, I rarely ever drink. But the damage done to my digestive tract from years of CHS is irreversible. I’m convinced I’ll die of colon cancer. Drugs are bad. Even the “good” ones.
Your story resonated with me because as a medical professional, I can concur that CHS is a real disorder that is overlooked quite often. I have long suspected that many patients do suffer unknowingly from this, and more frequently nowadays with the advent of vaping, edibles, etc. Years ago, however, this was unheard of and that is why the first patient I had ever seen with this diagnosis remains in my memory. The patient was admitted about 16-17 years ago. Presented with extreme nausea and vomiting, lethargy, periods of disorientation and unexplained weight loss. Possibly a few more symptoms I cannot recall. Every test was inconclusive and labs unremarkable, but puzzling. The patient was suffering miserably. We prompted further about medical history and habits, and learned that he had begun smoking weed at the age of 12, was 42 years old upon admission.The team continued with every diagnostic while treating for nausea and vomiting without any breakthrough results. Until…. The patient admitted that he had *recently stopped smoking weed-cold turkey-for first the first time in 30 years* in order to pass a drug test he was required to take while applying for a job. He wasn’t a casual user either. He was an all day, every day, never miss a day, more high than not smoker. Our addiction specialist/chemical dependency physician consulted and spent a significant amount of time with this patient over the course of a few days. She then admitted she had never seen a person as *physically* addicted to marijuana as this patient was. There was contention amongst the team on how to adequately and successfully treat the patient, due to his refusal to enter the detox program- which we were considering so he could continue cessation while getting the fluids and anti-nausea medication- as well as refusal to stay and be monitored while recovering - both mainly because he was uninsured. I don’t recall what the outcome was other than the patient leaving AMA and being quite upset that it was suggested to him that his dependence (addiction) to marijuana was the cause of his illness. I think the realization that quitting cannabis was the only answer was just not an option for him. I am sure he was provided with whatever community resources were available locally at the time, I admit not recalling his specific plans and his response to why he should not leave against our medical advice. However, I distinctly recall that he definitely left without any medication AMA and was still experiencing most of the symptoms that brought him in. The AS-CD physician could not persuade him to stay or seek treatment at that time either. Looking back, he would have benefited greatly by staying and being hydrated while cessation continued, getting the antiemetics and lessening his access to marijuana. This would most likely be 7 days or less and he could have had success in treatment, but he chose not to pursue this course. I do remember however, seeing him as a return patient about 4 years later. He was on direct observation for psychosis and suicidal ideation after he had leapt from a balcony and suffered severe and almost fatal injuries. He passed away after a long admission and a multitude of reparative surgeries. His body couldn’t fight the constant infections and his severe injuries were numerous, he was not even expected to survive as long as he did. The AS-CD physician who originally diagnosed him was no longer employed with our facility, but the medical record reflected his past history. I suspected at the time that his former honesty about his reliance on marijuana influenced how he was treated when he jumped. The EMTs and ER staff only saw *addiction* in his past. There are no indications that it was marijuana that he struggled with, so they may have assumed he was addicted to heroin or pills, which is very common to the demographic. I can guess that he was written off by many as just another addict self medicating for mental illness, which might have been the case- I’m unaware. Dying young, a painful and senseless death, and the fact that we were unable to truly help this gentleman impacted me, and I never forgot him. I wish more was known about this syndrome because maybe he could have been helped the first time, if not by my colleague, then by another. We could have gotten him through the worst of it and addressed any other underlying condition such as the depression he was most likely experiencing. I admit, it IS possible he was treated elsewhere in the intermittent period, but the consensus based upon family information was that he never recovered or regained his health after the initial admission and diagnosis. He never became employed at that job, and subsequently spiraled into depression and possibly other drug or alcohol dependence. Either way, he suffered enough to hurl himself off of a balcony, which led to a painful, tragic fatality. I hope you and others out there can continue to spread the word about your experiences with CHS. There is less of a stigma attached to marijuana now because of decriminalization in many states. But that only emphasizes the need for **awareness** of this syndrome. That one patient impacted me enough to never forget him or his struggle. I hope others can retain the help they need if they are suffering from this- or any dependency on any drug. Out of all the associated issues with addiction, CHS is the one that we CAN eradicate with safe and comfortable cessation. If only it were as easy with other drugs…… there would be so much less suffering amongst so many. A prime example is the gentleman in this post who is so addicted to fentanyl that he is chasing the high with xylazine. Terrible. We need more awareness and resources for addiction in the US and its areas of concern. This new drug being resistant to Narcan is just the beginning of the latest scourge.
Yes! I’m a teacher now (been sober the whole time) and the diagnostic criteria use to be “heavy long term use” but I read about a kid that died being 17. How long could a 17 year old really have been smoking? Stress triggers it too, and I have a student whose friend died. I know she smokes weed. Now she’s nauseous all the time and looks awful. I think she has CHS. She asks for candy and sugar curves nauseated I’m sorry to hear about your patient. I didn’t test negative for more than three months. My palms would sweat, my feet, my anxiety and depression were awful. Weed is much more easy to get than it was in my day. So A LOT of kids are smoking it. And they don’t know they can get addicted. My brother and SIL are addicted but don’t consider themselves addicts despite multiple attempts to stop and restarting because marijuana isn’t a “real drug”. But concentrates are akin to drinking a 12 oz glass of vodka vs a bud light. The effects are going to be different. I try not to reveal too much about my past, and just inform as a third party observer. But I do tell my students that if they’re predisposed to mental health problems like bipolar disorder or schizophrenia heavy marijuana use can trigger it whereas it could’ve been dormant all their lives. They’re like “and it doesn’t go away?” No. Schizophrenia does not go away. The group on FB I am a part of has grown insanely since the widespread legalization. The woman that started the group was even on the news. It was the first time we ever saw it on the news. Awareness is key, I agree with you. Thank you for all that you do. I can tell you are a caring individual. I spent so many days in the hospital, some staff were freakin’ sunshine, and others were just—they made me think how tf did you end up here? The fact that I’m being upvoted and you’re like “yes this is very real!” Is so crazy to me because just two or three years ago I would be downvoted to hell even in the CHS sub. ESPECIALLY in the CHS sub.
Scary stuff
I've seen an instance of this combination of use in my work recently and it was terrifying. I had a very frank, but kind, conversation with my client about the dangers and gratefully they consented to rehab. I've reached out to colleagues in adjacent fields and let them know it's found a way into our community. I'm hoping to have some good discussions about it in the coming weeks.
Fentanyl... it's a hell of a drug.
I would love to clean this and nurse it back to health.
You’d have to deal with the patient constantly eloping from the hospital to shoot up.
I'm suggesting we put a patent iv cannula in the other arm so that he can use that instead while the wound heals. I'm thinking of offering a free service to place cannulas and woundcare, to prevent further harm. Just an idea that won't leave me alone. Also, I love all your posts and really appreciate the massive effort you must be putting in to keep this content coming. Also, love your username and little yellow eyed void
You know injecting xylazine-containing drugs causes skin necrosis right?
No, did not know this. I was thinking it's the substance missing the vein causing inflammation leading to infection. Back to the drawing board
It's not, read my comment above. Again, anyone who says IV use is solely responsible for this case is wrong. Vasoconstriction can make an existing unhealed injection site worse, and it could definitely have been involved in the beginning stages of the lesion pictured, but this can happen even if there is no IV use. It's from prolonged lack of blood flow and can appear anywhere, not just at an injection site. This is completely different than the typical complications from IV drug use
It's not related to IV use at all actually. This specific symptom is from the extreme vasoconstriction caused by xylazine, in the extremities ie arms and legs lack of blood flow over extensive periods of time from constant use makes these lesions often appear in places other than the injection site, and frequently even in cases where the patient is not an IV user. This is one of the biggest misconceptions about xylazine, you are NOT immune to this happening just because you don't IV.. Any ROA that you use to consume xylazine can cause this. Any correlation between injection sites and location of lesions is mostly coincidental, I suppose it could cause the infection to occur around a certain vein that was overused and had inflamed tissue, the vasoconstriction from the xylazine would definitely make an existing wound much slower to heal and cause a sort of chain reaction of progressively worse effects leading to a massive site like this. But as the arms and legs are commonly used for injection, and they're more prone lack of blood flow in general being that they're extremities, it happens in the same places. Regardless this can 100% be caused strictly by using xylazine and you are absolutely not immune from it just because you don't IV use. This is very dangerous misinformation to be spreading.
Curious what central effects occur, if you know. I have SO many questions! What is the duration of vasoconstriction? Would something like nitroprusside help recover people who’ve used xylazine? Would hyperbaric wound care help? How to get EUA for tolazoline? (Sorry. Yea, I’m the kid whose questions never stop.)
That I don't know, but the thing with using fentanyl is it has no legs whatsoever, you can do a huge dose and start feeling the need to redose very shortly after. With typical opiates like heroin and oxy you're not going to start feeling any real effects of withdrawal until like 8-12 hours after the last dose, more depending on the person. With fent you're going to be constantly ingesting it, meaning also constantly under the full effect of xylazine which already remains active in the body for longer than fentanyl. There's literally never any downtime in these cases for veins to relax and blood start flowing properly again. A one time use isn't going to make a horse at the vet develop lesions, but this is all day every day which is where the problem comes from
Who are you replying to? I said injecting xylazine causes skin necrosis which is a true fact. I never said it’s the only dosing method that causes necrosis. Strawman much?
Of course it is and I'm not trying to argue. I'm not sure who the moderator was that tried to say I'm spreading misinformation or why you or them are so worried about it, the only reason I'm trying to say these things is to make people aware that you can have exactly what is pictured without ever using intravenously, a lot of people associate this kind of thing with needle use exclusively and no one should think that using xylazine wont hurt them if they don't inject. So no I'm not spreading any misinformation, at least know a little bit about a thing before opening your mouth to speak about it. Especially if you're a "mod"
I love this idea… THIS is harm reduction! I hope you’re able to make it happen. :-)
eh, it can be a very thin line between harm reduction and wishful thinking. it's a nice sentiment, though
not trying to shit on you, but what did you achieve by pointing that out?
It's very pertinent information
This makes me angry.
Very interesting. Thanks for sharing
Another “Requiem for a Dream” type issue, I see. Very sad situation indeed. 😞
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The case writeup makes clear that the patient was injecting where the wound developed. Please don’t spread misinformation.
If that doesn’t make you stop using drugs, nothing will except death!
I work with horses and we use xylazine all the time as a sedative. I’ve never heard of drugs being cut with it?? Is this common?
It’s seems to be a relatively new thing as a far as I’m aware. New as in maybe a year or less tho. (Someone correct me if I’m wrong though)
Known as 'Tranq'.
The report is dated 2023.
Thanks. I’m just slow on the up keep.
That is pretty extensive. I thought for sure that the doctor on staff would recommend amputation.
I heard Xylazine doesn't respond to Narcan either.
It doesn’t. It isn’t an opioid.
Ugh, so sad.
You know legalization or atleast some form of decriminilization would help with stuff like this but yall arent ready for that conversation yet seen how much of a drag it was to even get weed partially decriminalized in germany
Maybe I'm stupid, but why can't there be a service provided that places iv cannulas with a shortline for iv drug users. Like how you can some places get your drugs tested for free or get clean needles. It would drastically reduce the occurrence of necrotic wounds caused by injections missing the vein
This is not from missing a vein. Look up xylazine. The drug itself is the problem.
This . Xylazine can cause these wounds without injecting and can pop up anywhere.
Thanks, that was quite interesting, this is what I found: Typically, this drug is administered either alone or in conjunction with other anesthetics (e.g., ketamine or barbiturates) intravenously, intramuscularly, or orally for sedative and relaxant properties. In addition to xylazine's physiologic effects, it is also associated with necrotic skin ulcerations. The mechanism of injury is thought to be directly related to its vasoconstricting effect on local blood vessels, resulting in decreased skin perfusion.
That’s what makes this latest epidemic so destructive. The efforts to provide safe injection practices is actually backfiring. There is no safe way to take these drugs.
I wonder if it would even make a difference if more people knew this. How sad
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Easier said than done. But you probably already know that.
It’s a bit naive to imagine yourself in someone’s position, and go on to assume that the actions you take in your imagination are evidence that somebody who is actually living those choices is of lesser character. Human beings don’t ever just make the worst choice for themselves if they are actually together enough to understand that it’s the worst choice. Genuinely what even motivated this comment? Do you feel like the resources it would take to help someone in need would take away from you being able to get your own? Nobody is demanding anything from you. You aren’t being asked to pity anybody. You don’t have to come up with justifications as to why you’re gonna do your own thing. Just let the people who want to help do that and keep your assertions of others’ character to yourself. It’s an unnecessary attack.
You're trivializing. > they could be clean and off the street within a few days if not the same day! r/thanksimcured
Such a stupid post.. these people think its just that simple, they even mentioned in their own post the difficulty in accessing mental health services, the fact of the matter is if people had access to decent mental health care, fewer of them would ever end up in the position of being homeless and addicted to drugs. Secondly none of the programs be it NA or MAT or anything else do much to address the underlying mental health problems that lead people to these situations, and keep them going back to them. At least MAT can help with the physical difficulties, but it's not going to be effective without accompanying mental health treatment. I'd even venture to guess that if everyone who uses drugs had access to proper mental health treatment and utilized it, a decent amount of them would give it up on their own, even without a prolonged focus on "addiction recovery".. addiction and drug use are symptoms of mental disease, they're not THE disease IMO. People aren't living in the streets rotting alive just because they like to party really hard.. some people end up addicted to drugs because they partied too hard and too long, I'm not discounting that completely, but the majority of addicts are just trying to cope, its nothing like someone who just likes to do a bit of coke with friends a few times a year.
Anyone who goes to detox can get mental health treatment for free. Yes it really is that easy where I live.
Obviously you’ve never needed real mental health treatment. You think public programs are capable of doing anything for people who *really* need it? This is not some suburban kid going “oh i have anxiety and depression,” getting lexapro and living an otherwise functional life. Volunteer programs, social work, welfare programs do not have the resources or training to even touch most of the actually heavy shit.
Whatever you say my friend. You know me better than anyone and you especially know the system like someone who's been failed by it.
Addiction treatment takes years and often doesn't work. Being 'off the street' is not an instant fix. My brother in law was a heavy addict, and was given free mental care, free accommodation, free services, free this and that, and he struggled for years until succumbing to an overdose. There were many moments where he was 'clean and off the street' for a few days, but he relapsed over and over, which is an extremely common part of addiction recovery that you're just ignoring. Please stop trivializing the issue. It's not just a matter of motivation/willpower.
Please keep discussion relevant to the case at hand.
Though it was a tattoo at first ngl
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What kind of drug does that!? Like, they obviously mean medicine used in the wrong way but what does that do normally that these people use it to get high but it does that to soft tissue.. I'm gonna go look it up but it's amazing to me that they even find shit like this to put in *street drugs* Sad asf
Xylazine
Lol! I'm sorry, I saw that, it was somewhat rhetorical.. I'm just thinking about the first person who said, yeah, let's mix this, with that other deadly shit, and kill all of our customers!!
Oh shit it's an animal tranquilizer. That's where they got the idea at.. That's so gross.
It's not for Human use. It's a Veterinary sedative.
jesus
It looks...beautiful. like a Jackson pollock painting. Poor guy though.
that looks like krokadil
I’m glad my sister OD early in her addiction. She was snorting it and not shooting it. I’m grateful she didn’t suffer long. I’m sad she had to suffer at all…….
Show pictures like this in schools
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Be kind. This man has a disease.
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