Xylazine Hits Staten Island Hard as Politics Holds Up Help

For the past six years, Stacey Seidenfaden has helped run Staten Island’s sole drug-addiction outreach unit out of a bus. But in April, her role at Community Health Action of Staten Island changed largely to wound care provider.

More and more people were coming to the mobile medical unit with skin ulcers and wounds that would not heal. The boils and abscesses were not near where they inject their drugs, so few seemed to know where their infected wounds were coming from.

Over the past few years, Xylazine, a powerful sedative the FDA first approved for use as an animal tranquilizer in the 1970’s , has been increasingly mixed into fentanyl supply to make the synthetic opioid’s high last longer

EditSign . Not meant for human use, “tranq,” as the drug is nicknamed, often causes deadly necrotic — dying skin tissue  — wounds and makes overdoses harder to reverse with Narcan .

Seidenfaden told THE CITY she pivoted to wound care management due to a drastic uptick of Xylazine she’s witnessed in Staten Island over the past six months.

“We are trying to keep people from losing limbs,” Seidenfaden said. Xylazine wounds, which often start as a small boil or an abscess, can drastically escalate, becoming septic, and can take months to heal even when treated.

The wounds are thought to develop because Xylazine decreases blood flow to skin tissue, according to early research .

Although the largest total number of fatal overdoses involving Xylazine occur in The Bronx, Staten Island, the city’s least populous borough, had the highest rate of Xylazine-linked overdoses per capita in both 2022 and 2023, according to the most recently available data collected by the Office of the Special Narcotics Prosecutor through October 2023.

In Staten Island, 28% of all fatal drug overdoses involved Xylazine in 2023, up from 22% in 2022, according to data from the Office of the Chief Medical Examiner. By comparison, the borough with the next highest percentage was the Bronx with 26% and then Manhattan with 22%.

The borough has had the highest rate of Xylazine related overdose since the Office of the Chief Medical Examiner began testing in the latter half of 2020, when the animal tranquilizer first appeared in opioid supply. The drug’s presence across the city grew by over 800% in just one year, from 2020, when Xylazine was detected in 52 deaths, to 2021, when the drug was detected in 429 deaths.

Drug Resistance

As Xylazine has become pervasive in Staten Island drug supply, public health experts have recommended expanding educational campaigns about the drug’s dangers and tools for users to test their supplies. But these harm reduction initiatives are often met with resistance in the borough’s politically conservative neighborhoods, particularly on the South Shore.

While other boroughs have several programs to help illicit drug users — at least eight in Manhattan, five in the Bronx, five in Brooklyn, and two in Queens — Community Health Action runs Staten Island’s only syringe exchange and harm reduction outreach unit, and is the only organization providing Xylazine wound care and test kits on the street.

“There is respect for what we do, but we are largely alone here,” said CHASI’s executive director Ericker Onaga. Although other organizations incorporate some harm reduction philosophies into their outpatient programs , Community Health Action’s mobile bus unit and walk-in centers in St. George and Port Richmond are the only harm reduction service providers in the borough.

The opioid crisis has hit Staten Island hard. The borough has the second highest rate of drug overdoses in New York City behind The Bronx, according to city health data released in September. In total, 155 people died of a fatal overdose in Staten Island in 2023, according to the Staten Island Fentanyl Task Force Report .

In The Bronx, the borough with the highest overall number of drug overdoses , poster campaigns warning about the dangers of Fentanyl and Xylazine are common from advocacy groups like the Drug Policy Alliance or the National Harm Reduction Coalition, explained Steven Hernandez of St. Ann’s Corner of Harm Reduction.

St. Ann’s itself recently acquired a drug checking machine for residents of the South Bronx to test their drugs for the presence of Xylazine or other deadly substances.

“We are part of a number of initiatives, coalitions and elected officials here in the Bronx that are working together to address the issues of the moment, like new adulterants in the drug supply,” said Hernandez.

On Staten Island, although conversations around addressing the opioid crisis are common, there is often resistance in the greater community to education campaigns and harm reduction.

The Staten Island Partnership for Community Wellness, an organization facilitating borough wide health efforts, runs what they call a “guerilla poster campaign” in parks across the North Shore. The campaign warns about the dangers of Xylazine and Fentanyl, and harm reduction kits containing test kits and Narcan, made by Community Health Action, are stapled to each poster.

“People take the posters down, and we try to keep putting them back up,” said Adrienne Abbate, the group’s executive director.

Seidenfaden explained that many drug users that come to her do not realize their wounds are caused by Xylazine.

“I am trying to educate as many people as possible so they know that Xylazine is more than likely in what they are using out in the street,” she said.

On Mondays and Thursdays, the Community Health Action outreach bus parks in the conservative South Shore, ready to offer test kits, health resources and wound care. Although overdoses are prevalent in the South Shore , the area houses few addiction care facilities, and many of its residents are more resistant to outreach efforts, explained Seidenfaden.

“They prefer for addiction not to be noticeable there,” said Seidenfaden. “But the more that we show up and talk to people, slowly they start to trickle in more and more.”

Law Enforcement

District Attorney Michael McMahon, who leads the borough’s opioid task force, explained that getting the Staten Island community united to deal with the waves of addiction problems has been difficult.

“Some people only want harm reduction, some people only want law enforcement, some people want to ignore the problem completely,” he said. “But we are battling Xylazine on many fronts, with increased enforcement, expanding our treatment opportunities to get people who have addiction into treatment, and at the same time going after those few individuals who sell this stuff without any regard for human life.”

For McMahon’s office, increased enforcement through arrests and criminal investigations into drug suppliers is an essential means of combating the Xylazine influx. Last month, McMahon completed a 14 month investigation that resulted in 21 people arrested for their involvement in an alleged drug-dealing network in Stapelton.

The Staten Island Fentanyl Task Force, led by McMahon, is advocating for the state to designate Xylazine as a schedule III controlled substance in New York, which would create stronger storage requirements for veterinarians and criminalize possession.

Pennsylvania, where Xylazine started becoming pervasive in 2021 , moved to designate the drug as a schedule III controlled substance last month . And Congress introduced a bill to federally criminalize Xylazine in March of last year, but it has yet to move through the House or Senate.

Shaina Jones, 27 and living in a small town outside Philadelphia, developed a wound from Xylazine use on her wrist last year.

“Even if you are treating the wound perfectly, or have a specialist looking at it, it can take months to heal,” said Jones, who still has dark scars on her wrists from the wound.

Unsettled

Manufacturers and distributors of opioids like hydrocodone and oxycodone have agreed to pay millions to communities impacted by the opioid epidemic.

And although the largest national settlement with OxyContin producer Purdue Pharma now faces a longer road to fruition following a U.S. Supreme Court decision on Thursday, New York is already set to receive payouts from state and federal legal settlements with other companies.

New York City was first allocated $286 million from state’s settlements in 2022, with $150 million to be provided to the city over five years . But until December of last year, none of those funds had been granted to Staten Island because it did not have a public hospital, the city’s primary method of distributing the settlement funds.

State Assemblyman Sam Pirozzolo (R- Staten Island ) worked with community organizations, including Community Health Action, to negotiate with the city for settlement funding to address the drug crisis in Staten Island. He was with Mayor Eric Adams for a December announcement that an additional $12 million would be allocated specifically for Staten Island based organizations that apply for grants.

Although other boroughs began receiving settlement funding in 2022 through Health and Hospitals, Staten Island has yet to receive its share. Applications for organizations to receive a part of the Staten Island settlement funding closed on June 18, and the city’s Department of Health and Mental Hygiene is currently determining which organizations will be allocated funds.

“There are many nonprofits that deliver services with funding from the government that don’t touch the shores of Staten Island,” said McMahon. “So we’re fierce advocates for more funding to organizations on Staten Island.

Yet Pirozzolo and many other borough Republicans representatives oppose using these funds for certain harm reduction efforts, such as drug checking facilities and vending machines that give supplies like syringes, fentanyl and xylazine test kits and Narcan overdose reversal.

Staten Island Partnerships for Community Wellness applied for settlement funding for a public health vending machine in June.

“If we receive settlement funding for a vending machine, we will have to do a lot of going out into the community to try to help them understand it,” said Abbate. “The community needs facilitated dialogues on the need for harm reduction services.”

And when the Department of Health began an initial educational campaign last year, it was met with resistance by Staten Island politicians and community members who believe the campaigns were too accepting of drug addiction and dangerous for youth to see on public transport.

“Those advertisements normalize drug use, which I think has negative consequences,” Pirozzolo told THE CITY. “We should be spending the money elsewhere.” Pirozzolo explained that he was more supportive of campaigns that offer a path out of addiction and discourage the habit.

“There is no evidence that educational messaging causes people to use drugs,” said Emilie Tippins of Community Health Action. “We have been working on spreading the word about Xylazine, and there are people who still have not gotten the message.”

Councilman Joe Borelli of the South Shore has previously been outspoken against drug safety campaigns and spoke out against educational campaigns in a City Council meeting 2022 . Borelli called for removal of the signs on X, formerly known as Twitter.

When Special Narcotics Prosecutor Bridget Brennan briefed Staten Island politicians on overdose data in September , Borelli expressed frustration that harm reduction efforts have often been suggested as a method of mitigating the opioid epidemic.

“In the past, when we’ve asked for help from the city and state, often times we’re smothered with gibberish about harm reduction and programs,” Borelli said at the meeting.

But for Donna Demarest, the director of harm reduction at Community Health Action, the main priority is keeping all Staten Islanders as healthy as possible.

“When we run our syringe exchange, give Narcan out to the community or we dress people’s wounds, there are people that look at that as an enabling type of activity,” said Demarest. “But it’s a win when someone comes through our doors because they are alive.”

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