Can Philadelphia Better Address the Needs of People Suffering From Addiction?

Courtesy of Pathways to Housing PA

In Philadelphia, where nearly 10,000 people have died from drug overdoses in the last eight years, the Pew Fund for Health and Human Services supports several front-line organizations that offer comprehensive care to people diagnosed with opioid use disorder.

They have found that the best way to help those struggling with addiction is to deal with the whole person, not just the opioid dependence. It must start with lifesaving measures and then address immediate needs such as food insecurity and a person’s other, often urgent, health issues. Just pointing a person in the direction of treatment isn’t enough.

It’s hard, slow work with no promise of immediate success. Outreach workers, some of whom have experienced substance use disorder themselves, are critical to building rapport and trust in the community. They seek out people on the streets of Kensington and elsewhere who use drugs, hoping to partner with them on a journey that stabilizes their lives, gets them into treatment, and reintegrates them into society.

Yet it’s not uncommon for people who use drugs to resist this assistance for a variety of reasons, including distrust for institutions they feel have failed them or an attachment to the community they’ve found on the streets. And success in this work, when it comes, takes many different forms.

We talked to representatives of three Pew Fund grantees in this field about their observations of the treatment system:

	Kara Cohen, associate director of street medicine at Project HOME, which offers housing, education, medical care, and employment opportunities to people who are or have been homeless.
	Christine Simiriglia, president and CEO of Pathways to Housing PA, which has a drug intervention program that currently serves more than 200 people.
	Dr. Lara Carson Weinstein of Thomas Jefferson University, who provides clinical care through Project HOME Health Services’ Federally Qualified Health Center at Pathways to Housing PA in North Philadelphia and at The Stephen and Sandra Sheller Consult and Bridge Program at Jefferson.

Here are some of the lessons they shared from their experiences:

The barriers to getting addiction care need to be lower (as a Pew-supported University of Pennsylvania study points out). Some services may be “available,” Lara Carson Weinstein said, but they’re not truly “accessible,” or they come with a lot of conditions attached. Ideally, she said, a provider would adjust to the individuals seeking help and not expect them to adjust to the provider’s way of doing things. Kara Cohen said that when offering health care on the streets, her organization removes barriers to care so that people understand that other than signing a consent for treatment form, “There is nothing that you have to do to be my patient.”

Building trust is essential, no matter how long it takes. It can start with saying hello or giving out water or hand warmers or shoes, then gradually finding what levels of medical care people on the streets are willing to accept. “You figure out what they need and want, and sometimes you have to deal with the wants before the needs,” said Christine Simiriglia. “You build that trust. And the trust allows them to take the next step.”

Help people connect to a broad range of services. Beyond basic health care and substance use treatment, people with substance use disorder also need help with transportation, child care, food, and obtaining government-issued identification. “Just think if you woke up without an ID,” said Cohen. “How would you prove who you are?” Having more locations where people can receive support from multiple providers and services is essential. The goal, Weinstein said, should be creation of “one-stop shops.”

React quickly to the changing drug supply. The appearance of fentanyl and xylazine on the streets has changed life for people who use drugs—and for health care providers. Use of xylazine results in wounds that can be life-threatening. Painful withdrawal symptoms from fentanyl can occur in three or four hours, leaving little time for health providers to treat physical health needs or connect individuals to treatment. And now, a new veterinary sedative—medetomidine—has entered the drug supply with unique withdrawal symptoms that send users to intensive care for days at a time. “We’ve realized that we need to continually develop new solutions,” Weinstein said, “or risk remaining behind.”

Recognize that housing stability is essential and requires social support. Getting permanent supportive housing through Pathways or Project HOME is a huge step toward stability. Pathways provides immediate access to housing with no preconditions as part of its Housing First model. But people coming off the street may be fearful of the responsibility of taking care of their own place and the prospect of being alone. So, helping residents reconnect with their communities or establish new ones is critical. That’s why housing is combined with support to foster social connections. “Pathways offers a Community Inclusion Department with staff who work to ensure that our participants feel like they are part ‘of’ the community and not just placed ‘in’ the community,” Simiriglia said. “Those community and neighborhood connections are essential to housing stability and wellness.”

While some addiction treatment providers are moving toward more patient-centered approaches, the grantees say there must be more comprehensive, flexible services for people. Even though overdose death totals have fallen in the past year or two, there is more work to be done. And grantees remain optimistic about their ability to support those they serve and help them reclaim their lives and find meaning.

Said Cohen, "There’s just so much benefit in engaging with people, reestablishing ideas for wellness, and telling them: Hey, you know we can help you get healthier again.”

Jessica Gillespie is a senior officer with the Pew Fund for Health and Human Services in Philadelphia; Larry Eichel is a senior adviser with Pew’s Philadelphia research and policy initiative.