SCOTT SIMON, HOST:
In the middle of a morning in Philadelphia along Kensington Avenue, below the elevated train platform, there's a woman in a flowered dress down on the sidewalk, quivering and shivering.
SAM: Well, I know how she feels. Her body's just, like, twitching.
KARA COHEN: Yeah.
SAM: Like, it hurts.
SIMON: Someone named Sam (ph), who knows the woman, runs out into the street and flags down the car we're in with a medical team from a group called Project HOME. They recognize Kara Cohen, who is a nurse.
SAM: I shot her up, Kara. It's why I don't want to shoot people up anymore. It's just killing her. It just - it is what it is. Look around - for real, for real. This is death. Kensington really is death.
SIMON: It is wrenching, sad and often astounding to spend a day in Kensington on Philadelphia's lower northeast side. The drug users we met asked us to use only their first names. The neighborhood may be site of the largest open-air drug market on the East Coast. People are passed out on sidewalks that are littered with needles, slumped in gutters and propped against brick buildings, blinking and staring blankly. Others on their way to work or school are close to all of it, says local council member Quetcy Lozada.
QUETCY LOZADA: They walk through syringes and human feces and in front of folks who are openly dealing drugs and consuming drugs and who not only are consuming drugs, but who are also suffering from a lot of other health issues and open wounds. Our kids have to go through that every day.
SIMON: And health care workers see something new on the flesh and in the faces of those in the street they try to help with bandages, water and food. Kara Cohen says...
COHEN: People started popping up with these wounds. They started nodding differently. They started passing out. We didn't really know what was happening.
SIMON: What's been happening is xylazine, a tranquilizer for horses - for horses, that's been mixed into much of the fentanyl used on the streets where it's called tranq. Experts say they don't know why xylazine is being added to street drugs. Some users say it extends their effects. Dr. Joe D'Orazio an addiction medicine specialist at Cooper University Hospital in Camden, N.J., says tranq, which is in over 90% of the fentanyl supply in some areas, often leaves open wounds on a user's arms and legs and makes them use more.
JOE D'ORAZIO: What most people report is, I used it, and I was asleep for a couple of hours. And then I woke up and I was in withdrawal from opioids, and I needed to go use another bag.
SIMON: We rode along with Project HOME. A couple named Bree (ph) and Jonathan (ph) had made a place for themselves under a muddied green hospital blanket stretched from the side of a corroded shopping cart. They lay on a small field of sodden trash.
BREE: It's horrible, but at the same time, it's not too bad because you feel a little more free. But it's getting horrible, especially...
SIMON: A little more free than if you were...
BREE: If I was in a house. But it's getting rough, especially with winter coming.
SIMON: It's getting cold too, right?
BREE: Yeah. It's getting really cold. Our things get stolen all the time. It's just - it's a mess out here.
SIMON: How are you feeling?
BREE: Stressed out.
SIMON: Yeah. Can I ask what the wounds are on your legs?
BREE: From tranq.
SIMON: We asked Bree what drove her to use fentanyl and tranq - or any drug.
BREE: To take away, I guess, my past. It helps numb a little bit. Like, my fiance died last summer, and I lost my kids. And it's just - yeah, it's kind of the numb things down.
SIMON: It numbs things.
BREE: Yeah.
SIMON: But do you think it's helping now?
BREE: No. It's starting to get out of control, I think.
SIMON: Kara Cohen cleaned the wounds on Bree's legs as Jonathan spoke. Both he and Bree looked drawn and exhausted, their eyes red and watery.
JONATHAN: The only drug I do is crack.
SIMON: Crack? Yeah. I mean, isn't it against the law?
BREE: Yeah. But the cops don't care down here. They really don't. They don't give a [expletive] about any of us, in all honesty. Sorry for my language. It's true. They care about the big guys, not us.
SIMON: What would you want the cops to do?
BREE: Nothing. It's none of my business at this point.
SIMON: Yeah.
JONATHAN: It doesn't matter we in the street with - and doing drug or not drug. We're still human beings, and we still people like everybody else.
SIMON: Those who live from fix to fix on the streets of Kensington feel neglected by local officials. So do many who live, work and struggle to do business here.
DIONICIO JIMENEZ: They don't care about the families, the people who live in this part of the city.
SIMON: Dionicio Jimenez, who worked his way up through restaurant kitchens after immigrating from Mexico 15 years ago, now runs Cantina La Martina with his wife, Mariangeli, in Kensington.
JIMENEZ: Anybody who lives, who stay in the street has no power. But the more entitled, they do whatever they want to do. Then you as a regular citizen live in this part of the city.
SIMON: Kensington does not have the highest rate of violent crime in Philadelphia, but it does have the highest rate of drug crime by far. Mariangeli Alicea Saez says they must pay up to 40% more for insurance and trash removal because drug use is so open in Kensington. As we spoke, there were people passed out a few steps from their restaurant near a drop box for used needles.
MARIANGELI ALICEA SAEZ: What message are we sending to children? What message are we sending that, OK, you're an addict. It's OK to use drugs, so we're facilitating this for you.
LOZADA: Many people are afraid to have the conversation of enforcement.
SIMON: Says councilmember Quetcy Lozada.
LOZADA: Open-air narcotics sales is illegal. And in that particular area, we have turned and looked the other way.
MICHAEL MCCARRICK: So there's a number of contributing factors.
SIMON: We told Chief Inspector Michael McCarrick of the Philadelphia police we had seen just two officers on foot patrol in Kensington that day, and they seemed to look away as people did drugs on the street. Homicides have fallen in the city about 28%, in part, say police, because more patrols are pinpointed at violent crime.
MCCARRICK: Because ultimately, if I lock somebody up and they spend four hours, five hours in jail and then they're back out on the street, that's a repetitive cycle that, yes, you'll see the - a temporary fix, but ultimately, you want to get that individual off the street. I have to make sure the kids are getting to and from school safely. We have to make sure they can get to and from work safely.
SIMON: I mean, I'm trying to interpret what you're saying. What I think you are suggesting is you can't spend as much time as maybe you would like to arresting people for illegal drug trade because if people are slumping over and sleeping, that's not violent. Your officers have to be...
MCCARRICK: We have to prioritize our resources.
LOZADA: There's no enforcement.
SIMON: But councilmember Quetcy Lozada believes this kind of prioritizing may also lead to the rise of other serious crimes. Car thefts have increased over 100%, retail theft 34%, according to police statistics.
LOZADA: Everyone says the same thing. We can't arrest people because they are sick, right? We can't bring people in without them wanting to, without them accepting services. We can't violate their constitutional rights. And I ask, well, how about the constitutional rights of the people that are living there that are raising their children? They're at what point do they become the priority?
SIMON: You can also meet people with stories of hope in Kensington. But they remind us how there is no easy fix for addiction. Monique Taylor is a peer support specialist at Project HOME. She struggled to stop using drugs for years.
MONIQUE TAYLOR: And the biggest fear that we see out in Kensington are the people who are afraid of withdrawal, you know, and - or just being uncomfortable. And you have to realize that it's going to be uncomfortable. It was uncomfortable coming in. It will be uncomfortable coming out. But we're here to support you. When I look at them, I see me, you know, and I just try to give them the strength to believe that you don't have to be here.
SIMON: And we met Ricky Schwetz (ph), who works for a company called Planet Fry, collecting used cooking oil for neighborhood restaurants.
RICKY SCHWETZ: I got swept up in, like, '95 with the whole drug sweep-up thing. Did five years in prison. I was telling her I applied for Penn State, and I wound up in a state pen. It was - obviously they messed up my application.
SIMON: Ricky quit drugs in prison, got out, now has a family and comes to Kensington several times a week for his job. He says just to sit in his car to eat lunch can be horrifying.
SCHWETZ: I can see in the rearview mirror some guy just falls over, and he dies right on the ground. Nobody pays attention to somebody that's dead, like, on the ground, and people are just sort of stepping over him. And I'm continuing to eat my lunch. That kind of stuff is sad, that I even got to that state where it doesn't bother me as much as it probably should. Drug addicts are left out here to die, and the police do absolutely nothing about it. They see what's going on. They - nobody intervenes anymore.
SIMON: There are people who will say, well, the last place that people like this should be is prison 'cause they don't get help there.
SCHWETZ: Yeah. I mean, if it wasn't for me going to prison, I would be dead. You know, I already done drugs and got myself addicted to that stuff. So next thing was death. So, yeah, I think prison saved my life. I think that's the case.
SIMON: Monique Taylor has learned from the work she now offers others that Kensington may help us see how the grip of addiction can choke out life and doesn't easily let go.
TAYLOR: The many ways to get into Kensington is plentiful. People get dropped off. People take the train, the el. People take the bus. They can, you know, get a cab or Uber. But there's not many ways to get out.
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SIMON: Our story was produced by Ryan Benk, Martin Patience and edited by D. Parvaz.
(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.
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