As wounds and amputations spike, experts say Philly’s $100M addiction treatment center must ensure adequate medical care for patients

Mayor Cherelle L. Parker plans to build a $100 million addiction treatment center and shelter near the city’s jail complex on State Road but so far has shared few concrete details on what services might be offered there.

The center could help fill gaps in the city’s addiction treatment network, if the city invests in a wide breadth of services there, experts in health policy and addiction treatment told The Inquirer.

A key need identified: specialized medical care for people suffering from wounds caused by the animal tranquilizer xylazine, which has contaminated most of Philadelphia’s illicit opioid supply.

Nicole O’Donnell, a certified recovery specialist at Penn Medicine, has been in recovery for over a decade and now works with people in active addiction as they seek treatment. Since the rise of xylazine in the city’s drug supply, she has struggled to help patients access care for addiction and get treated for serious medical conditions resulting from its toxicity, such as infected wounds, amputations, and endocarditis, an infection of the heart valves.

“They need wound care, IV antibiotics, levels of medical care that are so limited,” she said, noting that the Parker administration has “an opportunity to build something that covers nonexistent levels of care.”

Addiction treatment facilities often won’t take patients with serious wounds, she said, and skilled nursing facilities that could handle a patient’s medical needs balk at providing them with addiction treatment medications.

It will also be important for the facility to provide psychiatric treatment, said Barbara Schindler, a professor of psychiatry and pediatrics at Drexel University who is also the founder and medical director of an addiction treatment center for women, Caring Together. About 90% of her patients deal with a mental illness in addition to addiction.

“You can’t have people going one place for mental health and one place for addiction treatment,” Schindler said.

The proposal follows Parker’s pledges to provide support for potentially hundreds of people with addiction living on the streets in Kensington, as her administration moves to end the neighborhood’s entrenched open-air drug market.

Stabilizing Kensington will require expanding long-term treatment and housing, Parker has acknowledged. Yet an initial effort to expand housing for people with addiction by adding more beds to an existing shelter in Fairmount was met with intense resistance.

In recordings obtained by The Inquirer, city Managing Director Adam Thiel told City Council members in a budget meeting last month that the site would offer counseling, medications for addiction, job training, and long-term housing connections.

City officials have said they expect the facility could house more than 600 people and would be complete within three years, with some beds open as early as next year.

Sharon Gallagher, Thiel’s spokesperson, said in a statement that the city is “excited” to hear feedback on the proposal from experts in the field. They are currently hosting “input sessions” with addiction treatment experts and consulting City Council and community members about services that could be offered at the site, she said.

She added the city hasn’t yet made decisions on specific services the site will offer, “especially in terms of treatment.”

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The proposed facility’s relatively isolated location on State Road concerns some experts, who say that the city must provide adequate transportation for residents who need to leave the facility and that housing people with addiction far from their neighborhood communities and support systems could deter them from seeking treatment.

“If the goal is to help people be part of the community, how does being so separate from the rest of the city work towards that goal?” said Shoshi Aronowitz, an assistant professor at the University of Pennsylvania’s School of Nursing. “That could obviously impact people wanting to go there voluntarily.”

Gallagher said that experts the city has consulted have also raised questions about transportation to and from the site.

City officials should be clearer about their goals for the facility, how services there will be funded, and how patients will return to their communities, said Danielle Gadson, an assistant professor at Villanova University who studies how social factors like race and socio-economic class affect public policy.

The city must ensure that people treated at the State Road site are supported once they leave, Gadson said.

“It saddens me to think about where these 600 folks are eventually going to end up even if our plan is ‘successful,’” she said, especially given intense pushback from neighbors in areas where the city has proposed other facilities for unhoused people with addiction.

“We’re still at a place of, ‘Get them out of here. Get them help, but not here,’” she said.

And Gadson and others were concerned about the prospect of sending people to the State Road site involuntarily. Thiel had told Council members that could be an option for some people sent to the site.

People who don’t want to engage in treatment might seek out drugs as soon as they leave — but, because of their time in treatment, will have lost their tolerance for opioids. That puts them at a higher risk of overdose.

“Involuntary commitment doesn’t work,” O’Donnell said. “It’s also dangerous.”