Six months in, Philly assesses its smoking ban in inpatient rehabs

Six months into a ban on smoking in all city-funded inpatient drug treatment centers, Philadelphia officials say the prohibition hasn’t impacted the number of people seeking or staying in addiction treatment — in fact, they say, more people are entering rehab.

But advocates call the ban an unnecessary barrier to treatment in the middle of an overdose crisis. They say they’ve been fielding stories for months of people who are reluctant to seek treatment because of the ban — and of patients who leave treatment because they’ve been caught smoking, or simply aren’t ready to quit cigarettes.

The ban took effect in January of this year, and city health officials at the time cited studies showing that people who quit smoking at the same time they quit heroin had a lower risk of relapse.

In an interview Monday, David T. Jones, commissioner of the Department of Behavioral Health and Intellectual disAbility Services noted that tobacco is killing far more Philadelphians than opioid overdoses, with an estimated 4,000 deaths a year related to smoking. (In Philadelphia, 1,217 people died of overdoses in 2017, and another 1,116 people fatally overdosed here in 2018.)

In the first quarter of 2019, the department wrote in a press release, 2,890 people entered inpatient drug treatment funded by the city through Medicaid, an 18.8 percent increase over the same period in 2018. About 20 percent of patients left treatment against medical advice, the department said, and that rate has not significantly increased or decreased since 2015.

“Our goal is to have each individual achieve their best health outcome, and particularly as it pertains to people with substance use disorder, is for each of them to achieve long-term sustained recovery,” Jones said.

Still, advocates like Brooke Feldman, a vocal opponent of the smoking ban, say they believe the rise in people seeking treatment in Philly may be due to other efforts the city has made to lower barriers to treatment — like opening a 24-hour clinic that sends people as quickly as possible to treatment, with no IDs necessary.

Those improvements, she said, could be pushing more people into treatment while eclipsing the number of people who aren’t seeking treatment because of the ban.

Advocates have also argued that the smoking ban — which only applies to inpatient treatment programs in the region that take Medicaid funding — disproportionately affects lower-income people from Philadelphia. Several local treatment programs that only take private insurance still allow patients to smoke.

Feldman, who manages a CleanSlate outpatient rehab center in Philadelphia and is in long-term recovery herself, said she’s not pro-smoking: Quitting cigarettes was an important part of her own recovery journey. But, she said, people in active opioid addiction who aren’t ready to quit smoking shouldn’t be forced to.

“If people are willing to address their imminently deadly fentanyl use, but they’re not ready to quit smoking cigarettes just yet, we should be ready to meet them where they’re at, not making treatment irrelevant to them,” she said.

A former employee at Eagleville Hospital, who requested to speak anonymously so as not to affect future employment prospects, said patients had left the Norristown drug rehab against medical advice because they wanted to smoke. After leaving their job at that facility, the former employee said they were still fielding calls from people looking to get into treatment — who wouldn’t enter a treatment facility in Philadelphia because of the smoking ban.

Another employee at a city outpatient rehab facility said their center is sometimes swamped with people leaving inpatient treatment earlier than usual because of the smoking ban.

Still, health officials said, many patients are sticking it out despite the smoking ban. Daniel Jones III said he entered the Kirkbride Center, an inpatient facility that contracts with the city, in January — his first time in treatment for an addiction to heroin. He was surprised to learn he could not smoke there. But the nicotine patches and lozenges the center dispensed were a help, he said, as was counseling.

Some friends of his were discharged during his stay after smoking inside one too many times, he said. “Most of them are still on Somerset and Allegheny getting high,” he said. “It’s a shame.”

Frederic Baurer, Kirkbride’s medical director, said the center discharges patients on a case by case basis; they don’t have a rigid policy on discharging patients over smoking, and don’t aim to kick anyone out simply for breaking the smoking ban. “If someone is administratively discharged,” he said, “there are usually other factors involved” beyond smoking.

In a memo issued to treatment providers last week, city officials said they don’t support “punitive measures” for people caught smoking, and that discharging patients should be a “last resort."

Baurer said the ban has been a “double-edged sword” for his facility. “It’s clearly motivated some people to consider quitting, and act on quitting,” he said. The ban has also engendered a “prohibition-type” atmosphere surrounding cigarettes, though, he said.

Still, Daniel Jones said he supports the ban: “I think [quitting smoking] is a small price to pay, just to get some treatment. You can always smoke when you get out."

Indeed, he took up smoking again after he left treatment — but he’s been drug-free for seven months.