Alarmante desafío de salud: venden opioides mezclados con tranquizilantes para animales en barrio de Philadelphia

Los traficantes utilizan xilacina, un sedante barato no autorizado, para cortar el fentanilo, un opioide sintético 50 veces más potente que la heroína. El nombre callejero de la xilacina es “tranq”, y el fentanilo cortado con xilacina se llama “tranq dope”.

Muchas personas del barrio de Kensington, en Philadelphia —el mayor mercado abierto de drogas al aire libre de la costa este— son adictas y aspiran, fuman o se inyectan al aire libre, encorvadas sobre cajas o en los escalones de las casas. A veces es difícil saber si están vivos o muertos. Las jeringuillas ensucian las aceras y el hedor de la orina inunda el aire.

Las aflicciones del barrio se remontan a principios de los años 70, cuando la industria desapareció y el tráfico de drogas se afianzó. Con cada nueva oleada de drogas, la situación se agrava. Ahora está peor que nunca. Ahora, con la llegada de la xilacina, un tranquilizante de uso veterinario, nuevas complicaciones están sobrecargando un sistema ya desbordado.

“Hay que poner manos a la obra”, dijo Dave Malloy, un veterano trabajador social de Philadelphia que trabaja en Kensington y otros lugares de la ciudad.

Los traficantes utilizan xilacina, un sedante barato no autorizado, para cortar el fentanilo, un opioide sintético 50 veces más potente que la heroína. El nombre callejero de la xilacina es “tranq”, y el fentanilo cortado con xilacina se llama “tranq dope”.

La xilacina lleva una década diseminándose por el país, según la Agencia Antidroga (DEA). Su aparición ha seguido la ruta del fentanilo: empezando en los mercados de heroína en polvo blanco del noreste y desplazándose después hacia el sur y el oeste.

Además, ha demostrado ser fácil de fabricar, vender y transportar en grandes cantidades para los narcotraficantes extranjeros, que acaban introduciéndola en Estados Unidos, donde circula a menudo en paquetes de correo exprés.

La xilacina se detectó por primera vez en Philadelphia en 2006. En 2021 se encontró en el 90% de las muestras de opioides callejeros. En ese año, el 44% de todas las muertes por sobredosis no intencionales relacionadas con el fentanilo incluyeron xilacina, según estadísticas de la ciudad. Dado que los procedimientos de análisis durante las autopsias varían mucho de un estado a otro, no hay datos exhaustivos sobre las muertes por sobredosis con xilacina a nivel nacional, según la DEA.

Aquí en Kensington, los resultados están a la vista. Usuarios demacrados caminan por las calles con heridas necróticas en piernas, brazos y manos, que a veces llegan al hueso.

La vasoconstricción que provoca la xilacina y las condiciones antihigiénicas dificultan la cicatrización de cualquier herida, y mucho más de las úlceras graves provocadas por la xilacina, explicó Silvana Mazzella, directora ejecutiva de Prevention Point Philadelphia, un grupo que ofrece servicios conocidos como “reducción del daño”.  

Stephanie Klipp, enfermera que se dedica al cuidado de heridas y a la reducción de daños en Kensington, dijo que ha visto a personas “viviendo literalmente con lo que les queda de sus extremidades, con lo que obviamente debería ser amputado”.

El papel que desempeña la xilacina en las sobredosis mortales pone de relieve uno de sus atributos más complicados. Al ser un depresor del sistema nervioso central, la naloxona no funciona cuando se trata de un sedante.

Aunque la naloxona puede revertir el opioide de una sobredosis de “tranq dope”, alguien debe iniciar la respiración artificial hasta que lleguen los servicios de emergencia o la persona consiga llegar a un hospital, cosa que a menudo no ocurre. “Tenemos que mantener a las personas con vida el tiempo suficiente para tratarlas, y eso aquí es diferente cada día”, explicó Klipp.

Si un paciente llega al hospital, el siguiente paso es tratar el síndrome de abstinencia agudo de “tranq dope”, que es algo delicado. Apenas existen estudios sobre cómo actúa la xilacina en humanos.

Melanie Beddis vivió con su adicción dentro y fuera de las calles de Kensington durante unos cinco años. Recuerda el ciclo de desintoxicación de la heroína. Fue horrible, pero después de unos tres días de dolores, escalofríos y vómitos, podía “retener la comida y posiblemente dormir”. Con la “tranq dope” fue peor. Cuando intentó dejar esa mezcla en la cárcel, no pudo comer ni dormir durante unas tres semanas.

Las personas que se desintoxican de la “tranq dope” necesitan más medicamentos, explicó Beddis, ahora en recuperación, quien ahora es directora de programas de Savage Sisters Recovery, que ofrece alojamiento, asistencia y reducción de daños en Kensington.

“Necesitamos una receta que sea eficaz”, señaló Jeanmarie Perrone, médica y directora fundadora del Centro de Medicina de Adicciones de Penn Medicine.

Perrone dijo que primero trata la abstinencia de opioides, y luego, si un paciente sigue experimentando malestar, a menudo utiliza clonidina, un medicamento para la presión arterial que también funciona para la ansiedad. Otros médicos han probado distintos fármacos, como la gabapentina, un medicamento anticonvulsivo, o la metadona.

“Es necesario que haya más diálogo sobre lo que funciona y lo que no, y que se ajuste en tiempo real”, afirmó Malloy.

Philadelphia ha anunciado recientemente que va a poner en marcha un servicio móvil de atención de heridas como parte de su plan de gastos de los fondos del acuerdo sobre opioides, con la esperanza de que esto ayude al problema de la xilacina.

Lo mejor que pueden hacer los especialistas en las calles es limpiar y vendar las úlceras, proporcionar suministros, aconsejar a la gente que no se inyecte en las heridas y recomendar tratamiento en centros médicos, explicó Klipp, que no cree que un hospital pueda ofrecer a sus pacientes un tratamiento adecuado contra el dolor. Muchas personas no pueden quebrar el ciclo de la adicción y no hacen seguimiento.

Mientras que la heroína solía dar un margen de 6-8 horas antes de necesitar otra dosis, la “tranq dope” solo da 3-4 horas, estimó Malloy. “Es la principal causa de que la gente no reciba la atención médica adecuada”, añadió. “No pueden estar el tiempo suficiente en urgencias”.

Además, aunque las úlceras resultantes suelen ser muy dolorosas, los médicos son reacios a dar a los usuarios analgésicos fuertes. “Muchos médicos ven eso como que buscan medicación en lugar de lo que está pasando la gente”, dijo Beddis.

Por su parte, Jerry Daley, director ejecutivo de la sección local de un programa de subvenciones gestionado por la Oficina de Política Nacional de Control de Drogas (ONDCP), dijo que los funcionarios de salud y las fuerzas del orden deben comenzar a tomar medidas enérgicas contra la cadena de suministro de xilacina y transmitir el mensaje de que las empresas deshonestas que la fabrican están “literalmente beneficiándose de la vida y las extremidades de las personas”.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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As Opioids Mixed With Animal Tranquilizers Arrive in Kensington, So Do Alarming Health Challenges

The veterinary tranquilizer xylazine, the choice du jour of local drug dealers to cut fentanyl, leads to necrotic ulcers and leaves street medics and physicians confused about how best to deal with this wave of the opioid crisis.

Many people living on the streets in Philadelphia’s Kensington neighborhood — the largest open-air drug market on the East Coast — are in full-blown addiction, openly snorting, smoking, or injecting illicit drugs, hunched over crates or on stoops. Syringes litter sidewalks, and the stench of urine fouls the air.

The neighborhood’s afflictions date to the early 1970s, when industry left and the drug trade took hold. With each new wave of drugs, the situation grows grimmer. Now, with the arrival of xylazine, a veterinary tranquilizer, new complications are burdening an already overtaxed system.

“It’s all hands on deck,” said Dave Malloy, a longtime Philadelphia social worker who does mobile outreach in Kensington and around the city.

Dealers are using xylazine, which is uncontrolled by the federal government and cheap, to cut fentanyl, a synthetic opioid up to 50 times stronger than heroin. The street name for xylazine is “tranq,” and fentanyl cut with xylazine is “tranq dope.” Mixed with the narcotic, xylazine amplifies and extends the high of fentanyl or heroin.

But it also has dire health effects: It leaves users with unhealing necrotic ulcers, because xylazine restricts blood flow through skin tissue. Also, since xylazine is a sedative rather than a narcotic, overdoses of tranq dope do not respond as well to the usual antidote — naloxone — which reverses the effects of only the latter.

Xylazine has been spreading across the country for at least a decade, according to the Drug Enforcement Administration, starting in the Northeast and then moving south and west. Plus, it has proven to be easy for offshore bad actors to manufacture, sell, and ship in large quantities, eventually getting it into the U.S., where it often circulates by express delivery.

First detected in Philadelphia in 2006, xylazine was found in 90% of street opioid samples in the city by 2021. That year, 44% of all unintentional fentanyl-related overdose deaths involved xylazine, city statistics show. Since testing procedures during postmortems vary widely from state to state, no comprehensive data for xylazine-positive overdose deaths nationally exists, according to the DEA.

Here in Kensington, the results are on display. Emaciated users walk the streets with necrotic wounds on their legs, arms, and hands, sometimes reaching the bone.

Efforts to treat these ulcers are complicated by the narrowing of blood vessels that xylazine causes as well as dehydration and the unhygienic living conditions that many users experience while living homeless, said Silvana Mazzella, associate executive officer of the public health nonprofit Prevention Point Philadelphia, a group that provides services known as harm reduction.

Stephanie Klipp, a nurse who does wound care and is active in harm reduction efforts in Kensington, said she has seen people “literally living with what’s left of their limbs — with what obviously should be amputated.”

Fatal overdoses are rising because of xylazine’s resistance to naloxone. When breathing is suppressed by a sedative, the treatment is CPR and transfer to a hospital to be put on a ventilator. “We have to keep people alive long enough to treat them, and that looks different every day here,” Klipp said.

If a patient reaches the hospital, the focus becomes managing acute withdrawal from tranq dope, which is dicey. Little to no research exists on how xylazine acts in humans.

Melanie Beddis lived with her addiction on and off the streets in Kensington for about five years. She remembers the cycle of detoxing from heroin cold turkey. It was awful, but usually, after about three days of aches, chills, and vomiting, she could “hold down food and possibly sleep.” Tranq dope upped that ante, said Beddis, now director of programs for Savage Sisters Recovery, which offers housing, outreach, and harm reduction in Kensington.

She recalled that when she tried to kick this mix in jail, she couldn’t eat or sleep for about three weeks.

There is no clear formula for what works to aid detoxing from opiates mixed with xylazine.

“We do need a recipe that’s effective,” said Dr. Jeanmarie Perrone, founding director of the Penn Medicine Center for Addiction Medicine and Policy.

Perrone said she treats opioid withdrawal first, and then, if a patient is still uncomfortable, she often uses clonidine, a blood pressure medication that also lessens anxiety. Other doctors have tried gabapentin, an anticonvulsant medication sometimes used for anxiety.

Methadone, a medication for opioid use disorder, which blunts the effects of opioids and can be used for pain management, seems to help people in tranq dope withdrawal, too.

In the hospital, after stabilizing a patient, caring for xylazine wounds may take priority. This can range from cleaning, or debridement, to antibiotic treatment — sometimes intravenously for periods as long as weeks — to amputation.

Philadelphia recently announced it is launching mobile wound care as part of its spending plan for opioid settlement funds, hopeful that this will help the xylazine problem.

The best wound care that specialists on the street can do is clean and bandage ulcers, provide supplies, advise people not to inject into wounds, and recommend treatment in medical settings, said Klipp. But many people are lost in the cycle of addiction and don’t follow through.

While heroin has a six- to eight-hour window before the user needs another hit, tranq dope wanes in just three or four, Malloy estimated. “It’s the main driver why people don’t get the proper medical care,” he said. “They can’t sit long enough in the ER.”

Also, while the resulting ulcers are typically severely painful, doctors are reluctant to give users strong pain meds. “A lot of docs see that as med-seeking rather than what people are going through,” Beddis said.

In the meantime, Jerry Daley, executive director of the local chapter of a grant program run by the Office of National Drug Control Policy, said health officials and law enforcement need to start cracking down on the xylazine supply chain and driving home the message that rogue companies that make xylazine are “literally profiting off of people’s life and limb.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Sobering Lessons in Untying the Knot of a Homeless Crisis

The homeless tragedy in Portland, Oregon, now spills well beyond the downtown core, creating a crisis of conscience for a fiercely liberal city that has generously invested in homeless support services.

PORTLAND, Ore. — Michelle Farris never expected to become homeless, but here she was, sifting through garbage and towering piles of debris accumulated along a roadway on the outskirts of Northeast Portland. Farris, 51, has spent much of her adult life in Oregon, and has vivid memories of this area alongside the lumbering Columbia River when it was pristine, a place for quiet walks.

Now for miles in both directions, the roadside was lined with worn RVs and rusted boats doubling as shelter. And spilling out from those RVs, the trash and castoffs from this makeshift neighborhood also stretched for miles, making for a chaos that unnerved her.

Broken chairs, busted-up car parts, empty booze bottles, soiled blankets, discarded clothes, crumpled tarps. Every so often, it was more than she could bear, and she attacked the clutter around her own RV, trying furiously to organize the detritus into piles.

“Look at all this garbage out here — it used to be beautiful nature, but now it’s all polluted,” she said, as a stench of urine and burned rubber hung in the damp air. “The deer and river otters and beavers have to live with all this garbage.”

She paused a moment, glancing in the distance at a snow-capped Mount St. Helens. A line of RVs dotted the horizon.

Portland’s homeless problem now extends well beyond the downtown core, creating a crisis of conscience for this fiercely liberal city that for years has been among America’s most generous in investing in homeless support services. Tents and tarps increasingly crowd the sidewalks and parks of Portland’s leafy suburban neighborhoods. And the sewage and trash from unsanctioned RV encampments pollute the watersheds of the Willamette and Columbia rivers.

The RV encampments have emerged as havens of heroin and fentanyl use, a community of addiction from which it is difficult to break free, according to interviews with dozens of camp inhabitants. Even while reflecting on their ills, many of the squatters remarked on the surprising level of services available for people living homeless in Portland, from charity food deliveries and roving nurses to used-clothing drop-offs and portable bathrooms — even occasional free pump-outs for their RV restrooms, courtesy of the city.

Giant disposal containers for used syringes are strategically located in areas with high concentrations of homeless people. Red port-a-potties pepper retail corridors, as well as some tony family-oriented neighborhoods. In parts of the city, activists have nailed small wooden cupboards to street posts offering up sundries like socks, tampons, shampoo, and cans of tuna.

“Portland makes it really easy to be homeless,” said Cindy Stockton, a homeowner in the wooded St. Johns neighborhood in north Portland who has grown alarmed by the fallout. “There’s always somebody giving away free tents, sleeping bags, clothes, water, sandwiches, three meals a day — it’s all here.”

Portland, like Los Angeles, Sacramento, and much of the San Francisco Bay Area, has experienced a conspicuous rise in the number of people living in sordid sprawls of tents and RVs, even as these communities have poured millions of tax dollars — billions, collectively — into supportive services.

Portland offers a textbook example of the intensifying investment. In 2017, the year Mayor Ted Wheeler, a Democrat, took office, Portland spent roughly $27 million on homeless services. Under his leadership, funding has skyrocketed, with Wheeler this year pushing through a record $85 million for homeless housing and services in the 2022-23 fiscal year.

Voters in the broader region of Multnomah, Washington, and Clackamas counties in 2020 approved a tax measure to bolster funding for homelessness. The measure, which increases taxes for higher-income businesses and households, is expected to raise $2.5 billion by 2030.

But as debate roils about how best to spend the growing revenue, Portland also offers a sobering lesson in the hard knot of solving homelessness, once it hits a crisis level.

What Portland has not managed to do is fix the housing piece of the homeless equation. The city has about 1,500 shelter beds, not nearly enough to meet the need. It lacks ready access to the kind of subsidized permanent housing, buoyed by case managers, medical care, job placement, and addiction treatment, that has proven successful in cities such as Houston in moving people off the streets.

Nor has Portland come close to replenishing the stocks of affordable housing lost as its neighborhoods have gentrified and redeveloped.

Wheeler rejects claims that Portland has attracted homeless people to the region with its array of day-to-day services. But he acknowledged that the city does not have enough housing, detox facilities, or mental health care options to meet the need: “We are not appropriately scaled to the size and scope of the problem.”

“And, you know, is that our fault?” he said, calling for more state and federal investment. He pointed to “a foster care system that delivers people to the streets when they age out,” and a prison system that releases people without job training or connections to community services.

Meanwhile, the mission has grown more daunting. The 2019 homeless count in the Portland region, a one-night tally, found more than 4,000 people living in shelters, vehicles, or on the streets. This year, that number stands at roughly 6,000, according to the mayor’s office, a 50% surge that is, nonetheless, widely considered an undercount.

Making it more humane to live homeless in Portland, it turns out, has not moved people in large numbers off the streets. Nor has it kept those who have found housing from being replaced by people in yet more donated tents and more battered RVs.

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South of the Columbia River in an industrial section of north Portland, not far from Delta Park’s bustling soccer and softball complex, another RV encampment lines a side street that juts off the main drag. Many of the camp’s inhabitants have parked here for years and are protective of their turf. Group leaders hold down the numbers — no more than 20 or so RVs. And they enforce tidiness rules, sometimes using physical force, so as not to draw undue attention from city code enforcement.

“We’ve maintained a symbiotic relationship with the businesses here,” said Jake Caldwell, 38, who lives in an RV with his girlfriend, Sarah Bennett. “We keep it clean and orderly, and they let us stay.”

Nearly all those interviewed in the encampments said they have noticed a sharp increase in the number of people living out of RVs in Portland, a trend playing out up and down the West Coast. Some of the newcomers lost their jobs in pandemic-related shutdowns and couldn’t keep up with rent or mortgage. Others, already living on the edge, described being kicked off couches by family or friends as covid made cramped living situations dangerous.

They’ve joined the ranks of the more entrenched homeless and people who can no longer afford to live here. Minimum-wage earners who grew up in the region only to be priced out of the housing market as wealthier people moved in. People who lost their financial footing because of a medical crisis. People struggling with untreated mental illness. People fresh out of prison. Street hustlers content to survive on the proceeds of petty crime.

And an overwhelming theme: People left numb and addled by a drug addiction. Some lost jobs and families while struggling with drug and alcohol use and ended up on the streets; others started using after landing on the streets.

“It’s like a hamster wheel — once you get out here, it’s so hard to get out,” said Bennett, 30, a heroin addict. “My legs are so swollen from shooting heroin into the same place for so long, I’m worried I have a blood clot.

“I feel like I’m wasting my life away.”

Most of the RVers interviewed in these north Portland encampments openly discussed their addictions. But they routinely cited a lack of affordable housing as a key factor in their predicament, and blamed homelessness for exacerbating their mental and physical ailments.

“You get severe depression and PTSD from being out here,” Bennett said.

Still, she and others consider themselves lucky to have scored an RV, which even broken down can cost a few thousand dollars. One camp dweller said he bought his using unemployment funds after losing his job in the pandemic. Caldwell and Bennett, who both use and deal heroin, said they purchased theirs with help from drug money. Some RVs are stolen; others were donated or simply taken over after being abandoned.

The benefits, RVers said, are innumerable compared with tent-living: Portland weather is notoriously soggy, and RVs offer more reliable shelter. They have doors that lock instead of zip, so you’re not ripped off as often. Women feel less vulnerable. It’s easier to organize possessions.

They also spoke of downsides. With the exception of the “high rollers” who can spare a few hundred for a portable generator, most of the RVers have no electricity. Nor hookups for the septic systems. The city comes by on occasion to pump out the waste, but more often it’s illegally dumped into rivers and streets. Most of the RVs are no longer drivable; occupants have them hauled from site to site. Bennett was among dozens of people who complained about the rats that regularly chew up through the undercarriages.

“A lot of people out here are criminals, flat-out,” said James Carter, 60, who became homeless after losing his job as an automotive refinish technician early in the pandemic and now lives out of a cargo van. “Stolen cars get dropped on this road constantly. There have been dead bodies.”

Carter, too, uses heroin. He and others said they support their habit by using food stamp benefits to purchase palettes of bottled water, then empty the water and recycle the bottles for cash. Some said they steal electronics from big-box stores and resell the goods. They say the retailers generally don’t try to stop them, worried about the risk of violence to their employees.

“We call it getting well, because you feel like shit until you get high,” said Carter, describing a heroin habit that costs him about $40 per day. “There’s a lot of people who need help out here.”

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Laurelhurst Park is a forested oasis in east Portland. Situated south of the Columbia River with the mighty Willamette to the west, it spans 32 acres and features a spring-fed duck pond, running trails, tennis courts, horseshoe pits, and a playground.

But the recreational areas are often littered with debris from a homeless encampment in the park that ballooned during the pandemic and has proven difficult to disband despite a series of law enforcement sweeps. Many homeowners in the surrounding neighborhood, a historical enclave of Craftsman and Colonial Revival-style homes, say they’ve been thrust into the role of vigilantes, leaning on the city to do something about the mess.

They feel Portland’s charm ebbing, as the lives of the unhoused collide with the lives of the housed.

“This used to be the most beautiful, amazing city — now people’s houses and cars are getting broken into, and you can call 911, but no one is going to come,” said TJ Browning, who chairs the public safety committee for the Laurelhurst Neighborhood Association.

“We’re a progressive city, I’m a progressive, but the worst part is I can feel the compassion leaving,” she said. “I recognize people are self-medicating mental illness with drugs, but so many people like me just don’t care anymore. We want the criminal element out, even if it means taking people to jail.”

It’s her job to collect neighborhood complaints, and there has been no shortage as the city has allowed the amorphous encampment to take root in the park and smaller offshoots to pop up on surrounding streets. Every so often, when the neighborhood has complained enough, authorities sweep the camps, only to see them take shape once more.

One night, a propane tank exploded, causing a fire. Children have picked up used needles. Some of the homeless campers rant at parkgoers and wade into traffic. She fields calls from neighbors concerned about nighttime prowlers.

“It’s just not safe anymore,” Browning said. “It’s hard to feel compassion for the person creating the problem, when the problem is a threat to you or your family.”

Like many residents interviewed, Browning is a longtime Democrat who has watched in dismay as her liberal values give way to frustration and resentment. And she understands the good intentions, spawned by liberal policies, that brought Portland to this tipping point.

They include a dedicated effort to decriminalize low-level drug possession; a shift toward “harm reduction” programs that offer addicts shelter and medical care without coercing abstinence; court rulings that make it difficult to clear homeless encampments if the city can’t offer beds to the people displaced.

The problem is not so much the policies, in theory, as it is how they play out in Portland’s broader reality. Drug users stay out of jail, but Oregon has too few drug treatment programs and no easy way to mandate participation. Advocates for the homeless ardently protest efforts to roust the encampments, arguing people have nowhere else to go.

And cuts to police services have left housed residents feeling they are on their own to deal with the repercussions.

In recent years, Portland has made major cuts to police funding, spurred in part by the movement to “de-fund police” and shift resources into economic development and social services. In 2020, the Portland Police Bureau took a funding cut of $26.9 million, and eliminated officer positions assigned to a gun violence reduction team, narcotics, organized crime, neighborhood safety, schools, and traffic patrol.

There are 774 sworn officers in Portland today, down from 934 in 2020.

“The Police Bureau is the smallest it has been in modern times, with fewer sworn members than any time in anyone’s memory,” said Sgt. Kevin Allen, a spokesperson for the bureau.

“It is not surprising that people believe they aren’t seeing as quick a response, or as many officers on patrol — because there aren’t as many. We have to prioritize what we can do based on our resources.”

With crime on the rise — property crimes are up 33% over last spring, and homicides last year eclipsed a three-decade record — Mayor Wheeler has restored some of the funding as part of a broader investment in public safety. But residents say they can’t rely on police to respond to emergency calls.

“If nobody is dying,” Browning said, “no police officer is going to show up.”

In some ways, Portland’s liberal constituency is at war with itself, the devout at odds with the disillusioned.

“We want a more holistic solution to support people out here, and for this neighborhood to be livable regardless if you are housed or unhoused,” said Matchu Williams, a volunteer with the Mt. Scott-Arleta Neighborhood Association.

Williams is helping lead efforts to bring in more public restrooms, free shower services at a community center, and “community care cabinets” with donated items like toothbrushes and canned vegetables. “This is just neighbors coming together buying what they can to put in here, and it’s usually stocked full,” he said. “It’s small, but meaningful.”

Williams gives voice to another core constituency in Portland who say the city has a responsibility to ease the burden of living homeless, while also investing more energy and resources to address the affordable housing shortage he sees as the genesis of the problem. On a brisk spring day, walking past the slick coffee shops and brew houses that have made Mt. Scott-Arleta a draw, he recounted the city’s difficult slog pushing through a 100-unit affordable housing complex in his neighborhood.

Portland residents are quick to approve funding for homeless services, he noted, but more resistant when it comes to supporting sites for low-income and homeless housing.

“There’s been a lot of frustration with how slow things are moving,” Williams said. “It’s important to understand how we got here, but also how we get out of it.”

Others, like Cindy Stockton, whose north Portland neighborhood sits at the confluence of the Willamette and Columbia rivers, wonder if there are lessons to be gleaned from more conservative cities. Phoenix, for example, takes a less accommodating approach to encampments. People living homeless are steered to a loosely designated encampment in the city center that is cordoned off by chain barriers and patrolled by police. Campers are supplied with food, water, sanitary facilities, and medical treatment. But the arrangement comes with the understanding that camping generally is tolerated only within those boundaries.

“I’m a lifelong Democrat, but I find myself wondering if we need to elect Republicans,” Stockton said. “We’ve been Democratic-led for so long in this state, and it’s not getting us anywhere.”

Browning, in Laurelhurst, described a similar transformation: “I look in the mirror, and I see a hippie — but a hippie wouldn’t be advocating for more police. I sometimes can’t believe I’m having these thoughts: ‘Why don’t these people get hauled to jail? Why can’t they get a job?’

“I wonder, what the hell happened to me?”

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Buffeted by the political crosswinds of Portland’s homeless dilemma, Mayor Wheeler is looking to adjust course. Wheeler, who took office in 2017, was elected as part of a wave of progressive politicians seen as standard-bearers for a more socially conscious approach to social ills.

That has meant a focus on police reform, and a host of programs anchored in the concept that people living homeless, addicted, or with untreated mental illness are victims of a broken system. Rather than blaming them for their plight, the idea is to meet their immediate needs with sensitivity while working to get them services to address the issues that put them on the street.

In vogue is a push to create permanent housing options with wraparound services that can start before someone is stable or sober; frowned upon are the old-school emergency shelters with curfews and drug bans that many advocates denounce as warehousing.

But it takes time — and funding and zoning changes and neighborhood buy-in — to design and approve sites for the longer-term programs. Portland’s homeless population has outpaced the city’s efforts.

“Fentanyl is making the rounds, and we have a major meth and heroin problem,” Wheeler said. “There are a lot of people living on the edge, and more and more are living in their RVs. It’s a catastrophe for people living on the streets, and they are absolutely traumatized, but we also acknowledge that this creates a problem for the entire community — for public safety and the environment.”

In the short term, Wheeler said, Portland is trying to address the public health risks by installing public restrooms and hygiene stations and offering RV sewage services. And, he has riled some liberal allies by adopting the stance that the city has an obligation to clear out more encampments and move people into emergency shelters for their own health and safety.

Wheeler’s budget for the coming year, recently approved by the city council, calls for 10 new shelter programs offering nearly 600 beds. He wants to reserve 130 apartments for people living homeless and 200 motel rooms for older homeless people with chronic conditions, and to expand drug treatment options. Most controversial, the city would funnel $36 million over two years to help create eight “safe-rest villages,” a mix of tiny homes and RV parking with support services and space for up to 1,500 people.

The proposal is mired in controversy, with many neighborhood groups opposed. At the same time, Wheeler said, “I am hearing overwhelmingly from the people in this city that they do not want to simply criminalize homeless people and throw them in jail because they are homeless. I don’t think that’s a real solution.”

Larry Bixel, who lives in a 1987-issue Fleetwood Bounder near Delta Park, has his doubts about the city’s ability to put a dent in the homeless numbers, much as he’d like a real house. “I don’t recognize Portland anymore,” he said. “There’s tents all along the freeway. It’s the pills and drugs everywhere.”

A former car salesman, Bixel, 41, said his free fall into homelessness started after he got addicted to painkillers prescribed for a shoulder tear sustained while playing softball at Delta Park nearly 20 years ago. He progressed from Vicodin to OxyContin to heroin, a cheaper habit that his wife also took up. Life spiraled as he wrecked his car and racked up felony convictions. Over time, the couple lost their jobs, their home, and custody of their three young children.

“I went from painkillers after the accident to addiction taking over my life,” he said.

But Bixel hasn’t given up on himself. He thinks with the right opportunities — a job, a landlord willing to take a chance on him — he could find the motivation to get clean again.

“My wife and I, we’re looked at like scum now,” Bixel said. “But honestly, this is also one of the best things that has happened to me. I used to look down at homeless people for not having a job, and if somebody asked me for change, I’d say, ‘I worked hard for this.’

“Now, if someone asks me for a cigarette, I’ll give them two.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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