“The people I photograph want others to know what they’re going through,” the photojournalist Suzanne Stein, who has been documenting life in Kensington, Philadelphia, for almost a year now, tells me. 

This neighborhood is defined, in part, by contradictions. It’s home to tight-knit families, gardens, parents hard at work, and school children at play. At the same time, parts of Kensington have been hard hit by addiction illness and the widespread availability of Xylazine, known as “tranq” on the streets, a horse tranquilizer that’s used to cut fentanyl. 

It’s a drug with devastating consequences, including open, infected, or necrotic wounds that can ultimately lead to amputation. People suffering from addiction illness in Kensington, many of them very young and experiencing homelessness, are also vulnerable to abuse from people both inside and outside of the community. 

“Some people I’ve met feel that they want their images to bring awareness to the tragedy in Kensington,” Stein says. “There is an incredible amount of injustice in this neighborhood. There’s the feeling that nobody on the outside is listening, or even knows what’s really going on.“

Other times, she thinks the people she’s photographed might not fully understand the effect their portraits will have on other people. A young woman named Karii, for example, likely didn’t know when she granted Stein permission to share her photo just how much compassion and interest her story would inspire.

“There are people here in Kensington who are extraordinary and have a phenomenal presence that may not necessarily be obvious initially or to passersby,” the photojournalist says. “Very quiet people can possess a subtlety that is beautiful and captivating. They will engage viewers long enough to allow me to get a point across. They make people pay attention.” 

We asked her about her time in Kensington, the suffering caused by tranq dope, the people caught at the center of this tragedy, and the stories the mainstream media has missed or overlooked along the way. 

How and when did you first start visiting and documenting Kensington?

“I grew up in the Philadelphia area. I left when my son was three, almost 17 years ago. I returned for a visit in 2018 and very much wanted to go to Kensington at that time, but without a car, on foot with my camera, alone. Although I had already been photographing Skid Row in Los Angeles extensively, I didn’t have the courage at that time to go into Kensington. 

“It wasn’t until last August 2022, after I had a bout with Covid, that I decided it was really important for me to make a commitment to photograph Kensington to the best of my ability. My son had been struggling with addiction and had been in some rough situations. I began to see the population shooting fentanyl/tranq openly on the streets as extensions of my own experiences with my son.”

Can you tell me a bit about what life is like for those experiencing homelessness on Kensington Avenue? 

“It’s hard for me to describe the lives of the people I have photographed because I’m an outsider. Only people who have been on those streets (who are insiders, a really critical separation) are qualified to offer a description. 

“But here are my observations combined with what I’ve been told by people I know. It’s a life characterized by the extreme need to get well. Getting well does not always mean getting high, or feeling euphoric, or good. It is sometimes a question of just not feeling withdrawal pain. 

“Kensington is very dirty, lots of trash, incessantly whining motorcycles popping wheelies, and the industrial odors of paint and motor oil and other difficult-to-identify odors, including fentanyl as it’s being smoked, and reefer. 

“I’ve witnessed beatings and heard many stories from people about the torturous abuses suffered on the streets, of random, vicious attacks on the population of addicts. Kids and adults from the surrounding area routinely visit areas where people congregate, using drugs, and shoot at them with pellet guns, gel blasters, and real guns. Passing cars hurl eggs and verbal insults, women are targeted, assaulted, and beaten by men who show up in the area specifically to act out on the population of vulnerable addicts on the street. 

“The culture of abuse runs like a river with little tributaries throughout the neighborhood….fights, thefts, and generally inconsiderate behavior is the norm, and moving past all of this chaos is a skill developed by anyone who has chosen to stay in the area. The addicted population, while certainly victimized, is also part of this abusive culture. Friends cannot always trust each other, and people have told me of a need to keep their circle small. 

“Going to sleep, even for a few minutes, can mean that someone you know goes through your pockets and belongings and steals everything from you. Getting well can mean becoming insensible, passing out…and losing everything. People rob each other to buy drugs and have told me many stories of loss.”

Can you tell us a bit about tranq dope and and tranq addiction illness?

“Xylazine is a cheap, legal horse tranquilizer. Fentanyl is a shorter high than heroin (heroin has virtually disappeared), and Xylazine is cut into the supply of fentanyl to extend the length of the high and also to augment profit. Fentanyl began to be noted in Philadelphia in the late 2000s.

“Tranq addiction is tricky, and the withdrawal is brutal. There is medication available to manage withdrawal from fentanyl, but the tranq component is much more difficult to navigate when people try to get clean. There needs to be much more research done on how to medically manage withdrawal symptoms from tranq. Additionally, there are no current options to reverse tranq overdose, as Narcan reverses fentanyl overdose. Rescue breathing is the only option to treat the combination overdose of fentanyl/tranq.”

When did you start to notice the true scope of this problem?

“I started to notice people bent at the waist in a characteristic posture. I saw this in New York City a few times, and as I began to research Kensington prior to my arrival, I saw physical characteristics of the people using the drug combination of fentanyl and tranq. I believe that, in addition to skin lesions and amputation caused by tranq, there are other effects on connective tissues that need further research. 

“There are physical characteristics that are commonly observed in users. The drug is literally causing disability. My first encounter with this drug was with Bethany, a transgender woman in New York City who I’ve been photographing since 2019. I care a lot about Bethany and began to occasionally note her odd posturing after hitting. I suspected that her fentanyl was adulterated with tranq sometimes.”

Tranq dope has been in the nationwide media lately. For how long was this going on before people started paying attention? And is it too late? Is there still time? 

“I am not sure exactly when tranq got into the supply of opioids in Philadelphia, but the best estimate is around 2006. It’s spreading across the country. It’s never impossible to make an impactful change….in an absolute sense. 

“But for some people, it is too late. They’ve lost limbs, have deep, disfiguring scars, and I believe that it doesn’t stop there. People I met in September 2022 and whose wounds I photographed are generally much, much worse. Tranq does more than cause lesions that start on the skin. It’s doing something to connective tissues, causing people to become disabled, bent, and unable to walk. Changes in body composition.

“These are my observations. So it’s really important that we see it graphically and then get busy finding solutions so it’s not your son or daughter, sister, or best friend getting ensnared.”

In the captions for one of your portraits on Instagram, you wrote, “No apologies…graphic is necessary to illuminate the grave nature of the problem.” Can you tell us a bit more about why it’s been so vital to you to show what’s truly happening here? 

“I have a young adult son who recently had an extremely rough time because of drug usage. When I truly began to become deeply disturbed by this crushing acceptance of drug use in the young adult population of the United States, and the legalization of marijuana in places where responsible use is not the norm, I decided it was time to go to Kensington. 

“When I saw the neighborhood, I was in a state of shock. I always photograph exactly what I see, and Kensington is basically an ongoing tragedy. Nothing less than absolute social realism will suffice. In corporate media outlets, I see a lot of images that leave out the rough edges. Mostly euphemism when it comes to issues in the USA, with a few notable exceptions. Kensington needs to be seen in a brutally honest way to get a belated and difficult discussion going about what’s helping and what’s making the problems worse. Images help, but people have to see what it really looks like.”

Do you always ask permission before talking about people’s lives publicly? If so, why is that important?  

“When I meet someone on the street and ask to photograph them, most times I hear very personal details while working. Sometimes talking in detail about personal experiences to an empathetic stranger is a release. I’ve been told so much that I would never, under any circumstances, repeat in a public forum of any kind. 

“Having a social media outlet is a privilege in that it allows me to reach people and get my images and narratives seen, often content that is not reported or discussed in corporate media outlets. But social media posts can also be used inappropriately, and revealing very personal details about someone’s personal history is something that I think is unethical in most situations. 

“I will talk about particular experiences—sometimes rough or traumatic experiences—they’ve had that relate with general issues in the population of Kensington that I think are pressing and have urgency. I will say something like ‘I want to tell this story’ or ‘can I tell this story?’ It’s obvious what my intentions are because I’m doing a detailed portrait study while the person is speaking.

“Most times, I ask questions about their experiences on the streets in Kensington…facts that the public needs to understand because these details reflect some serious societal dysfunction that needs to be aired out and addressed, as opposed to being ignored or treated euphemistically. 

“Social media allows people to troll and depends very much on the ability of viewers to be empathetic, as well as understanding the goal of photojournalism when attacking difficult subjects within the United States. I have had some very negative experiences with social media users, and I use care when I create my posts about people I’ve photographed.”

You’ve spoken out a bit about the “YouTube coverage” of this area—where YouTubers go in and film vulnerable people—and how it’s hurt them. What do these YouTubers/YouTube outlets miss, overlook, or misunderstand when covering this complex issue? 

“Kensington is a place that’s been hit hard by YouTube videographers. Although there are a few that are genuinely trying to help, most of these guys are not journalists….I will leave it at that. Some of them have GoFundMe accounts that turn a profit. 

“Most of these accounts are run by neighborhood men that ask highly personal questions and are clearly playing to titillate viewers. They can be judgemental and intrusive, generally interviewing women. Despite proclaiming to be advocating for the population, they’re generally repetitive views of people who are passed out.

“There are women who are literally stars on YouTube videos about Kensington, having done multiple interviews, and they are easily recognizable. Everyone knows that the area has a high level of notoriety, and there are so many videos done from cars, scooters, iPhones hidden in shirt pockets…voyeuristic stuff with tens of thousands of views.

“What are they missing? Everything! There’s no narrative imagery, no artistic efforts to portray the situation with any degree of sensitivity. They focus solely on the addiction situation (especially as it relates to women on the street) and completely ignore the drug dealers, the families with children…the entire neighborhood! These YouTube videos lack courage and do not show the neighborhood as a mosaic.”

A New York Times story on tranq dopementions that the stigma around this addiction is preventing some people from getting help. Have you noticed this happening yourself?

“No one has expressed to me feelings of stigmatization relating to getting help. In my experience, the reason that they don’t go into treatment is because it’s very, very hard and hugely traumatic. No matter how deteriorated, or ill, or covered in tranq lesions, or disabled someone might be, going through withdrawal symptoms and making a huge life change is what keeps people away from rehab. Of course, some rehabs are not very hospitable and can be downright unpleasant. 

“One woman told me that she felt that she’d never actually experienced life as an adult. She was 35 but felt that she’d been so irresponsible from the age of eighteen until the present that she didn’t know if she would ever be able to face her life as a grownup, make up lost time, or understand how to navigate life off the streets. 

“The universe that is Kensington is a place that many feel comfortable in. It is without judgment of addiction, and it is a world that they are at risk of relapsing and returning to, even after long stretches of being clean. It’s been described to me as a lifestyle that—for reasons unimaginable for most outsiders— has something undefinable that calls people back to the streets.”

What can be done to stop the spread of tranq dope? Have you seen any potential solutions? Have any people (activists, survivors, doctors) given you hope? 

“I have very strong opinions about what needs to happen in Kensington to get on the road towards solving this crisis. The first thing is open, respectful, and honest dialogue. An accurate and dispassionate assessment of the situation is critical, objective, and devoid of petty politics and dogmatic ideology. It’s nearly impossible to have a discussion with multiple points of view, I have found. 

“Since becoming involved with people on the street, photographing extensively, observing carefully, and learning a great deal about the way things work in Kensington, I have come to the conclusion that there are too many things being done that make it easy for people to stay in Kensington. They flat out tell you that they come for the drugs, easy to buy, and plentiful, and the food and clothes and drug paraphernalia given out make it easy to become sicker and slide deeper into addiction. 

“With one exception, not one person I’ve photographed has gotten better. All are worse, some catastrophically. So something is clearly not working. I think that some of the harm reduction groups working on the streets are definitely making the problems worse. Only the most basic services should be offered—clean needles, wound care, and fast, easy access to rehab services. 

“This would save lives and prevent people from flocking to the area so they can become sicker, suffer being abused on the street, and eventually dying. I don’t feel hopeful right now….the opposite. I’ve found too many closed minds in this neighborhood, police who have given up, harm reduction groups who are non-profits making profits and who are territorial and dogmatic. 

“Local media have not dived in head first to address and initiate hard debate about the urgent situation on the street. Some of these problems have the potential to create discomfort in the general community. There is real fear of creating offense and anger in viewers….which is necessary to get things moving.

“There are some grants coming through, however, and going forward, more help for people going into rehab. But so much more is necessary.”

Is there a question you wish I’d asked you that I didn’t?

“Yes: ‘What do you want to achieve with your work? Do you have a goal?’ I want very much for my images to do two things. 

“I think Kensington is a complex mosaic, and it’s never been photographed comprehensively. I love the neighborhood full of families and kids and memorials to victims of gun violence….gardens and pop-up car washes…so much more here to see than the opioid situation. I want to create a series of images that pays attention to the people ignored and forgotten in this neighborhood known only for addiction. 

“The second reason, and my first priority, is to have my images widely seen by people of all ages before they begin using drugs of any kind, and especially narcotics/opioids. To give them a moment to contemplate whether or not they really want to roll the dice with their future. To see themselves and family and friends in these images, have compassion for those in this struggle, and consider abstaining completely.” 

All images and captions © Suzanne Stein. Follow the photographer and her ongoing coverage of life in Kensington on Instagram at @suzanne_stein.

Further reading:

• Painful But Unforgettable Portraits of Life on Skid Row

• The Trauma of Life on Skid Row, in Photos

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