The Kensington neighborhood of Philadelphia - known as 'ground zero' for the city's drug epidemic - is in crisis due to widespread abuse of an animal tranquilizercalled xylazine.
Addicts are shooting up in broad daylight, hunched over in a stupor or passed out on the streets. Many have raw, gaping wounds in desperate need of medical attention.And there are needles, syringes and garbage littered across the sidewalks.
'I've never seen human beings remain in these kinds of conditions,' said Sarah Laurel, who runs outreach organization Savage Sisters.
Here, photographs obtained by Dailymail.com lay bare the shocking scale of devastation in the inner city area - described byThe Philadelphia Inquireras 'the poorest neighborhood in America's poorest big city' - which is being ravaged by the newly popular and dangerous drug.
The city's drug use and violence has run rampant under woke District Attorney Larry Krasnerwhose failure to prosecute minor crimes and bail request policies have come with an uptick in crime in the city of brotherly love.
Republicans in the Pennsylvania state Senate voted for his impeachment over what they deem a dereliction of duty. The future of the progressive prosecutor remains unclear, as the party line vote was indefinitely postponed earlier this month.
Kensington, which up until the 1950s was a bustling industrial district, is now described by The Philadelphia Inquirer as 'the poorest neighborhood in America's poorest big city'
Xylazine leaves users in a blackout stupor, making them vulnerable to violent attacks and rape
The inner city district has long been a magnet for drug users seeking their next high, but the scale of problems caused by xylazine is shocking even to locals who have become accustomed to such distressing scenes
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Ms Laurel said: 'They have open, gaping wounds, they can't walk, and they tell me, "If I go to the hospital, I'm going to get sick." They're so terrified of the detox.'
Unlike with opioids, there are no FDA-approved treatments specifically for xylazine withdrawal.
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Philip Moore, chief medical officer for the nonprofit treatment provider Gaudenzia, told the paper that weaning people off xylazine is a complicated procedure.
'We'll start treating for opioid withdrawal, and they should be getting better — but we'll see chills, sweating, restlessness, anxiety, agitation,' he said.
'They're very, very unpleasant symptoms. That's what triggers us that we're dealing with a more complicated withdrawal, that there's more xylazine in the mix.'
Kensington's streets are littered with syringes, garbage and homeless encampments, with addicts dealing and using drugs in broad daylight
Drugs are openly used and passed round. One addict (in red shirt) is seen holding a syringe in his teeth
Drug users either inject xylazine or smoke it, mixed with fentanyl and other drugs
A person is pictured passed out from the drug. Xylazine is now found in 90 per cent of all Philadelphia's heroin
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He said he had prescribed clonidine and lofexidine, both medications for high blood pressure, to get patients through withdrawal, as well as sedatives such as phenobarbitol or Valium.
Moore said there needs to be better education for medical practitioners, to enable them to deal with the withdrawal symptoms.
'The challenge is educating other physicians, nurses, nurse practitioners, and the community,' he said.
'If we don't recognize xylazine withdrawal, patients are really uncomfortable and they'll leave treatment because they don't feel like they're getting better.'
The drug was first developed in 1962 as an anesthetic for veterinary procedures, and was never cleared for human consumption. Initial trials were not completed because the drug led to respiratory depression and low blood pressure.
A man with a gaping wound on his arm sits slumped on the street. Xylazine frequently causes wounds that require amputation
A homeless man sits on a crate in the street and begs for help in Philadelphia
Drug users are pictured sprawled in the park, waiting for their next fix. The city of Philadelphia is struggling to cope with the surge in use of xylazine
A man is seen preparing his next hit. Drug use in Kensington is open and pervasive
It began being used as a substitute for heroin in the early 2000s, and was first found on the streets of Kensington in 2006 - but since the pandemic, its use has soared.
Now more than 90 percent of the heroin now found in Philadelphia contains xylazine. A June study found the drug has spread to 36 states and D.C.
The drug, also known as 'tranq', causes a blackout stupor. It also leads to skin damage so severe it resembles chemical burns, plus deep festering wounds that frequently result in amputations.
Furthermore, xylazine - which is often combined with fentanyl - means that usual treatments for opioid overdoses are not effective.
In November, the FDA issued a nationwide alert about the drug for doctors, and the following month the Office of National Drug Control Policy said it was concerned about the drug's spread.
Mayor Jim Kenney's office, which has supported an overdose prevention site in Philadelphia, said they need to do everything possible to save lives.
'As this crisis takes more lives and continues to evolve, we believe it is critical to use every available method to save lives and that an overdose prevention center would add a powerful tool to our existing harm reduction strategies,' said Sarah Peterson, a spokesman for Kenney.
'Overdose prevention centers save lives, prevent injuries and illness, reduce drug use and drug-related litter in public spaces, and increase connections to health services and treatment.'
'This is the picture of addiction... This is what happens': Mother of xylazine overdose victim describes her son's addiction
Nora Sheehan lost her son Andrew Jugler, 29, in October, 2021, after he took a deadly concoction of xylazineandfentanyl following an eight-year battle with addiction.
She said her son's addiction began after he started taking the oxycontin painkiller in 2010, but then gradually progressed to heroin and fentanyl.
In the wake of her loss, Sheehan, 56, shared a photo of her last moments with her son on social media to try and raise awareness about the devastating impact of the opioid crisis.
Nora Sheehan, 56, lost her son Andrew Jugler, 29, in October, 2021, after he took a deadly concoction of the Xylazine and fentanyl following an eight-year battle with addiction
'Holding my dead son in my arms, this is the picture of addiction... This is what happens,' caption Sheehan, from Rehoboth Beach, Delaware.
The administrative coordinator feared for her son when he joined a group living in the woods in Elkton, Maryland last summer at the height of his addiction.
Andrew Jugler, 29, died in 2021 of a xylazine overdose after an eight-year battle with addiction
She and Andrew's two sisters, Candace Jugler, 38, and Haley Jugler, 30, tried to enroll him in a rehab program but failed.
She said: 'When he moved to the woods I asked him if I could buy him a new tent or a new sleeping bag but he refused. I begged him to come home.
'While I was trying to drive Andrew to a detox center in September he opened the door while my car was going 60 miles per hour as if to throw himself out.
'I stopped the car and started screaming. I asked him in that moment where he wanted to be buried.'
The 29-year-old died on October 7 but it was two days before Ms Sheehan could identify her son's body.
Ms Sheehan said: 'I couldn't grieve until I saw him. Until then I had been holding out hope.
'They told me to prepare for the smell in the room, because his body had been outside for a while in the hot weather.
'That was the farthest thing from my mind. I wanted to hold him and hug him one last time.
'Andrew was incredibly kind and caring. He was a self-made mechanic and so loved by all of us, by his sisters and his niece and his stepdad.'
Instead of a traditional funeral service, Ms Sheehan and her family held a memorial service in his name and invited Andrew's friends, who were battling homelessness and addiction.
She added: 'I hope that sharing this image will impact addicts but mainly I hope the rest of us stop walking around blindly.
'I never thought heroin and fentanyl were as prevalent in my community as they are. It's an epidemic.'