NORTH EAST — On a sunny afternoon in early May, a wound care team entered the woods behind a shopping center in North East in Cecil County. The team was equipped with Naloxone, bandages and a variety of medical gauges. The damp air from that morning’s rain offered sanctuary from the looming stench of garbage mounds. A beaten path, lined by used needles, led the team further into the woods.
The team of four was led by Jason Bienert, the leading wound care nurse for the addiction outreach nonprofit, Voices of Hope (VOH). Deep into the woods, the team found a homeless encampment, where they were met by a woman who directed them to her neighbor.
“He is not doing too good,” the woman said.
Following the woman, the team found a young man that the lady described as family. The man struggled to move. He was thin from lack of nutrients and held his arm as if it were no longer attached to him.
He complained of arm pains and recently discharging brown urine. His body language alone was a call for help as his puffy, dilated eyes begged for physical relief and an escape from a mental war zone.
The young man is an opioid user. He explained that he had fallen into an abnormally long, deep sleep with all of his body weight on his shoulder after the last time he injected opioids.
Bienert speculated that due to the prolonged pressure on the man’s arm and the excruciating pain the man described, he may run the risk of kidney failure due to his muscle breaking down and emitting Myoglobin – a protein produced into the blood that cannot be properly processed by kidneys and results in the discharge of dark urine.
The team went over a variety of options on how to ensure that the man’s condition doesn’t progress as Bienert stepped away to process yet another danger of the animal tranquilizer that is mixed with fentanyl and sold as heroin, leaving users with harrowing consequences. Xylazine.
Xylazine is an affordable veterinary tranquilizer that only requires a veterinary prescription to be purchased. Xylazine is not authorized by the Federal Drug Administration (FDA) for human consumption.
The packaged liquid is boiled down until a salt-like substance remains. This substance is then hand mixed without precise measurements with fentanyl and other additives and sold on the streets as “Tranq.”
“Real heroin is practically gone,” said Bienert. “All of the drugs in Cecil County are primarily fentanyl and Xylazine because a pound of fentanyl goes a lot further on the drug market than a pound of Heroin since it takes less for users to get high.”
Bienert explained fentanyl as a fast-acting, powerful substance that has the ability to render an intense “high” in users for a short period of time.
“Fentanyl is a great procedural drug in hospitals because of how powerful it is for that short period,” said Biernert. “The unfortunate part is that on the streets, just fentanyl isn’t enough because a prolonged high with just fentanyl means more fentanyl which is often deadly.”
To prolong the effect of fentanyl, dealers are adding Xylazine to provide “legs” to the high that increase the duration and provide more satisfaction to users.
Prior to Xylazine, Benzodiazepine — an organic compound used as tranquilizer and pain relief medication – was the primary drug mixed with fentanyl. Officials speculate that the transition from Benzodiazepine to Xylazine in 2020 is largely due to the accessibility of Xylazine compared to its predecessor.
“You could have a 55 gallon drum of Xylazine and not get arrested,” said Bienert.
Today, Xylazine is found in over 98 percent of Cecil County’s drug supply.
“The drug-using population that you used to see crawling around Route 40 is now sleeping the majority of the day because of Xylazine and how much the drug market has changed,” said Bienert.
When Xylazine mixed with fentanyl is consumed by humans, it decreases blood pressure, heart rate and respiration – elevating the risk of an overdose.
If a user overdoses, Xylazine is unresponsive to Naloxone- the substance used in Narcan — so ensuring that a victim’s airway is clear is imperative.
Officials say to look for respirations rather than conversations with overdose victims before, during and after Naloxone is administered and to always administer Naloxone with suspected overdoses.
“When you would use naloxone for heroin, it would reverse the fentanyl overdose and people would wake up talking to you. Xylazine is keeping people asleep,” said Bienert. “Give them Naloxone and wait to see if they are breathing — if they are not breathing or arousing after Naloxone, administer rescue breathing.”
Outside of the instant effects of Xylazine and the increased risk of an overdose, many users also experience unexplainable hole-like ulcers on their body, a symptom that introduced Bienert to Xylazine in 2019 when he worked in a hospital providing wound care.
“The first wound I saw, I knew something was different,” said Bienert. “It looked similar to wounds I was seeing in Baltimore from a drug adulterant found in cocaine in 2012 called Levamisole — it causes skin ulcers and the wounds I was seeing were very similar so I treated them the same.”
Bienert worked in the Cardiac Catheterization Laboratory at University of Maryland St. Joseph’s Medical Center in Towson, where he also provided wound care for roughly six years.
Xylazine wounds start as painful, dark, odd shaped spots that gradually bloom into deep hole-like ulcers. Bienert explained that these wounds show up anywhere on the body – not just injection sites and wounds can reach the point of amputation if untreated.
Although the wounds look complicated, Bienert said that treating them is actually simple.
“It’s not always about the newest medicine, what I learned from Hopkins Bayview is they use a lot of older medicine that is tried and true so that is what I did to deal with Xylazine wounds,” said Bienert. “The tenants of wound care are simple: moisture balance, temperature balance and keeping things clean.”
Why Xylazine consumption leads to wounds has baffled researchers, as Xylazine is considered a lab-pure substance.
Officials have identified Philadelphia as the source of Xylazine-adulterated drugs in Cecil County.
“Drugs from Philly come one type of way, drugs from other cities come another,” said Bienert.
Bienert explained that drugs from places like Baltimore City are sold in gel caps while drugs from Philadelphia are sold in Glassine packets that look like chopstick wrappers called “scrapers.”
Each “scraper” is labeled by dealers with a stamp that brands the batch of drugs to a specific dealer or block in Philadelphia. Some of the most popular stamps include brands like GLOCK, Nike, NBC and WorldStar.
“We have never found a gel cap from Baltimore in Elkton,” said Bienert. “Baltimore City is like the local hamburger place, Philadelphia is like McDonald’s — people are comfortable with the Philadelphia drug supply because it’s equivalent to a franchise business.”
VOH regularly obtains empty “scrappers” from users which are sent to the Maryland Department of Health through the Rapid Analysis of Drugs Project (RAD) to be tested.
None of the samples VOH has sent to RAD have shown traces of heroin. Every one of them have shown a presence of Xylazine and fentanyl, along with numerous additives ranging from caffeine to cattle deworming medication like Levamisole.
In response to Xylazine’s impact on Cecil County, VOH offered Bienert a position as the organization’s primary wound care nurse in late 2019 – an offer Bienert said gives him more fulfillment and purpose as a nurse.
“In a hospital system, they call you productive or non-productive based on how many people you have treated,” said Bienert. “There are no markers for value which is why I got away from hospitals because the value of care I give to just one person here is all of the difference than providing low level care to 50 people.”
With the trunk of his Mazda sedan now serving as his mobile wound care center, Bienert travels Cecil County, Harford County and even Baltimore, providing wound care to participants through friendly, conversational and informative treatment.
“I enjoy treating the whole person, not just the hole in the person,” said Bienert.
Participants in VOH’s wound care program do not need health insurance, documents or a membership to be treated for drug use related wounds. The only thing Bienert requires is that participants come to him and ask him for help.
“We do not do referrals or reach out to people, people have to come to us and from there, we will assist them as often as they need because 100 percent of drug users are human and they deserve to be treated and helped as such,” said Bienert.
As of May 2023, Bienert has treated over 500 participants with many, like Brittany Beatty, curbing Xylazine wounds and beating addiction altogether.
“Without Jason helping me and showing me how to care for my wounds, I could have lost my hands,” said Beatty. “I am grateful for him because he showed up for me and helped me while being nice and actually caring – it is not just a job to him.”
But Bienert said that the wound care services he provides is only a compliment to his caring conversations, which are the start of what he feels is the true combatant to addiction - compassion.
“We are always on the hunt for the next big public health headline, but the reality is that if we spend time working with the broken part of people, we might not have these problems,” said Bienert. “It’s broken hearts, broken homes, child abuse – all of these stories and more are present in this county and addiction is never going to be fixed unless we go after the route of addiction and care for each other.”
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