In Portland, Homelessness Can Literally Cost You an Arm and a Leg

Inside Portland’s humanitarian crisis—where losing a limb has become commonplace.

Losing a limb on the streets of Portland has almost become a rite of passage. It’s not a matter of if but when. Many assume frostbite is the main culprit, but more often it’s a side effect of Xylazine, a horse tranquilizer that has been getting added to opioids like fentanyl for several years, but has flooded the streets over the last three years.

Originally, Chinese cartels began mixing Xylazine into fentanyl to intensify its effects, likely to compete with cheaper fentanyl from Mexican cartels. In just three years, the price of a fentanyl pill dropped from $5 to about $1. At first, many homeless users welcomed the change because “tranq” extended their high. Some even asked dealers if their fentanyl had the “extra ingredient.” For a while, it became a selling point.

This is the side effect of Xylazine

But the honeymoon didn’t last.

Soon, addicts began developing abscesses and painful skin ulcers caused by vasoconstriction, which restricts blood flow. One man insisted his wounds came from “drinking oil.” Others believed they had government-injected micro-robots in their bloodstream. Despite these terrifying side effects, drug use didn’t stop. Heavy fentanyl users already in a zombie-like state often seemed too confused to care.

Warning: Graphic.
Soon, I began encountering addicts with exposed bone — their limbs literally melting away. One woman downplayed her condition even as a third of her ankle bone was visible.

After that, I spent the next year warning every addict I could about the dangers of this new, deadly combination. As sores spread and limbs were lost, I started noticing a shift — addicts were now asking specifically for Mexican fentanyl, which, by and large, does not have Xylazine added to it, according to the few hundred addicts I interviewed. But for many, it was too late. Dozens of homeless people I know personally have lost one or both legs.

Frostbite is the second leading cause of amputation. Portland is cold in the winter, but not that cold. With the right gear and awareness, frostbite can be avoided. The problem is that Oregon leads the nation in mental illness and addiction, and many unhoused individuals lack the capacity to care for themselves. During snowstorms, you’ll find people sleeping directly on the ground, often without shoes, socks, or dry clothing.

One night, my team and I found a man refusing emergency services despite freezing temperatures below 30 degrees. He had no socks or shoes. It took four of us two hours to convince him to go to a warming shelter but he finally agreed, and we drove him there.

What was most alarming: that entire night, on the coldest evening of the year, not a single social service provider was out there. Four volunteers did what a $724 million homeless services budget couldn’t get people out of the cold. Just a few thousand dollars of that could have funded outreach and transportation services that might have prevented countless frostbite cases.

Stories from the Streets

This is Paul, a homeless man with multiple sclerosis and cerebral palsy. He was abused as a child and has lived on the streets since his youth. A few years ago, another homeless man — suffering from mental illness — held him down and cut off three of his fingers with an axe.

He is one of the sweetest and loneliest person I have ever met. My photographer friend Tara Faul and I have been taking him out to lunch regularly for the last year and a half. His family has invited him back home, but this is the very family that abused him as a child, and he has rightfully refused.

Then there’s a 19-year-old homeless man who was attacked with an axe after merely glancing at someone’s motorcycle. He doesn’t remember the attack — only that the assailant tried to decapitate him. You rarely hear about violence like this because the homeless live by their own code: no police, no reports, street justice only.

A Declared Emergency — Without an Emergency Response

In January 2023, Oregon Governor Tina Kotek declared a state of emergency on homelessness. You would expect a FEMA-style response aid stations, medical tents, intensive outreach, and a statewide call to action.

The City of Portland declared its own emergency in September 2024. But an emergency means nothing if leaders don’t act like one is happening. Most local officials and nonprofit directors seem numb, saying all the right things, achieving very little.

The truth is, local government will not end this crisis. Bureaucracy, lack of vision, and political paralysis have ensured that. This they will never admit. What they will do is if only they had a bigger budget, we could end this crisis once and for all. Having worked in social services for almost three decades and lived through two (We will end homelessness in ten years), I promise you, we did not have a plan.

What will make the difference are ordinary citizens who volunteer to walk the streets, see the suffering firsthand, and act with compassion instead of waiting for permission.

Social service providers often insist they’re the trained experts. I’ve worked in that world for nearly thirty years. The reality is, passionate volunteers can often achieve more than paid professionals — because they’re not bound by grant restrictions or political agendas. Many other social workers today are radicalized, blaming homelessness and addiction on capitalism rather than addressing the suffering in front of them. Their focus isn’t ending homelessness, it’s ending capitalism.

Tara Faul and I

As for these so-called trained outreach professionals. I have interviewed thousands of homeless people over the last three years, and about 80% of them have never even come into contact with an outreach worker. I find that very concerning, considering my photojournalist friend Tara Faul and I have met well over 70% of the entire homeless population of Portland.

And anyone interested in helping. Hit the streets, have an open mind, and let common sense guide you on how to help.

As for these social service providers who see a massive increase in their funding every two years, we must demand immediate oversight of every taxpayer dollar spent, create a nonpartisan accountability committee, and require measurable outcomes, or their funding will be pulled. Most importantly, we must elect and hire leaders who treat this for what it is: a humanitarian emergency.

That’s how we save our city.

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