'It scares me': B.C. health-care workers seeing signs of flesh-eating drug

Caring for Downtown Eastside residents struggling with wounds aggravated by the toxic drug supply and poor sanitation is already hard enough, but some Vancouver health-care workers are worried the "flesh-eating drug" is already showing signs in the neighbourhood.

Right now Kilala Lelum, an urban indigenous health co-op, is the only organization operating a low-barrier medical unit in the East Hastings area out of a specially-equipped van, loaded with medical supplies from the overdose antidote Naloxone to a plethora of wound care supplies. https://kilalalelum.ca/

They’re used to patients avoiding the healthcare system and poorly caring for worsening flesh wounds that can turn chronic, but now they’re starting to see signs of people using xylazine, an animal tranquilizer creeping into B.C.’s toxic drug supply and showing signs of its characteristic skin wounds: serious, deep, and worse the longer someone uses drugs tainted with the "tranq dope," as it’s often called.

"I do have some clients who've clearly been into possibly this tranq dope and it scares me, for numerous reasons,” said Kilala Lelum nurse practitioner, Drew Kostyniuk. "A lot of people disconnected, a lot of people have unmet health needs."

While xylazine has been detected in the toxic drug supply since 2018, the BC Centre for Substance Use issued a bulletin earlier this year warning that they’re increasingly detecting it as a cutting agent in drug samples. The BCCDC warns health-care professionals that Naloxone doesn’t work on the drug, lengthy blackouts and comas have been reported and that they should “consider the presence of xylazine if wounds are slow to heal.”

WARNINGS FROM THE U.S.

In the United States, xylazine has been referred to as the "zombie drug" for its effects on users, but the most alarming characteristic has been its impact on the body. 

The animal tranquilizer has been mixed with other drugs, like fentanyl, amplifying their effects but the vasoconstrictor also shrinks blood vessels, leading to horrific wounds.

Infections can worsen, rotting flesh and leading to amputations.

Currently, approximately two per cent of illicit drugs sampled in B.C. contain xylazine and Vancouver Coastal Health says they’re considering whether to add testing strips for the substance to their drug-checking program.

On Friday, the BCCCDC’s Harm Reduction Services published a warning that light blue pills, imprinted with an M and 30 on either side, were being "sold as oxycodone" in the DTES and had positive for fentanyl and xylazine.

LIMITED ACCESS TO WOUND CARE

Kostyniuk and other sources in the Downtown Eastside cite long waits, stigma, and poor experiences with the medical system as the reason for some people’s avoidance of hospital or clinical care for their wounds. 

When asked why there are no longer roving street nurses to deal with such issues, Vancouver Coastal Health sent an email statement about their outreach teams which they said “work to bring health care directly to (residents)" and "include various roles such as nurses, social workers, outreach workers, peer support specialists and cultural liaison workers, among others.”

While wound care is available in overdose prevention sites, the Kilela Lelum van can’t handle the needs of the community with the resources they have, and the province’s paramedics’ union says they could easily step in to expand the low-acuity unit they have serving the area.

“We're already doing that in a lot of situations and it’s something we could be doing more of,” said Troy Clifford, president of the Ambulance Paramedics of B.C., pointing to their good relationship with Downtown Eastside residents.

“They trust paramedics, we're there to help and maybe they don't need to be in the back of an ambulance or in an emergency department and that will free up some of the backlogs there.”

The idea of providing care before wounds and other issues escalate is heavily endorsed by the B.C. Green Party, with one of their deputy leaders championing both the economics and ethics of upstream, proactive health care. 

“It's the epitome of the health crisis that we have, where we're not providing early care to people, and people suffer complications, people end up in the hospital,” said Dr. Sanjiv Gandhi, former head of cardiothoracic surgery at BC Children’s Hospital. “We would save so much in terms of the health of the population and the economic ramifications are tremendous.” 

With the latest toxic drug statistics published earlier in the day, Gandhi noted that while the focus is on the number of deaths, many of those who survived an overdose or long-time addiction and living with chronic wounds are “suffering on a daily basis, they're the forgotten ones.”