"Brooke Peder’s leg was amputated after an infection from a tranq wound bore into the bone. She hopes to save her arm, although she reluctantly injects tranq in it."

So reads a photo caption in "Tranq Dope: Animal Sedative Mixed With Fentanyl Brings Fresh Horror to U.S. Drug Zones/A veterinary tranquilizer called xylazine is infiltrating street drugs, deepening addiction, baffling law enforcement and causing wounds so severe that some result in amputation" by Jan Hoffman (NYT).

Xylazine causes wounds that erupt with a scaly dead tissue called eschar; untreated, they can lead to amputation. It induces a blackout stupor for hours, rendering users vulnerable to rape and robbery. When people come to, the high from the fentanyl has long since faded and they immediately crave more. Because xylazine is a sedative and not an opioid, it resists standard opioid overdose reversal treatments....

Doctors are perplexed by how xylazine causes wounds so extreme that they initially resemble chemical burns. They may not even appear at injection sites, but often on shins and forearms....

People who use drugs often feel too mortified by their wounds to come in from the shadows to get help at emergency rooms. That shame can be perpetuated by health care workers, who may dismiss these patients’ agonizing withdrawal as mere drug-seeking behavior. “Stigma is so deeply entrenched within hospital culture,” said Sara Wallace-Keeshen, a Prevention Point nurse who wears casual clothes rather than medical scrubs, hoping to appear nonjudgmental and welcoming.....