City Council’s Kensington treatment plan has a big problem. Here’s how to fix it.

The Parker administration, along with City Council, has made it clear that addressing the ongoing opioid crisis in Kensington is a top priority. In 2022, 1,431 lives were lost to fatal overdoses in Philadelphia — the highest number on record — so it’s encouraging to see city government wasting no time in trying to tackle this problem.

Unfortunately, some facets of the city’s approach are not supported by science but are instead a continuation of the failed, decades-old war on drugs.

As part of the Kensington Caucus, made official through a resolution earlier this month, City Council members have introduced a plan to seek funding for the creation of a “triage center” in Kensington, where police or outreach workers could bring those experiencing addiction. There, individuals would be faced with two choices: go to treatment or go to jail.

As substance use researchers and street-based harm reduction service providers serving people who use drugs, we know that coerced substance use treatment doesn’t work. Many research studies have examined compulsory treatment, and there is little evidence that this approach leads to decreases in drug use or criminal reoffending. Since the beginning of the COVID-19 pandemic, states with involuntary commitment and supervised treatment for substance use disorder saw their opioid overdose death rates climb faster than states without them.

Even when choosing to go to treatment, people who use drugs face numerous barriers. Last month, researchers from Thomas Jefferson University published an in-depth look at the state of substance use disorder treatment here in Philadelphia. They found little coordination between city and state agencies, making it nearly impossible to identify the number of treatment spots available at any given time. In focus groups, the researchers found it’s not uncommon for individuals to wait upwards of 12 hours to be assessed for placement, and even then, admission into treatment is not guaranteed.

Barriers to treatment are compounded for individuals from marginalized communities. There are few, if any, options for Philadelphians who do not speak English. Black patients have reported feeling discriminated against during treatment and less able to access medications, particularly the addiction treatment drug buprenorphine. Focusing resources primarily in Kensington also ignores the fact that overdose deaths have dramatically increased among Black residents in West and North Philadelphia.

We’ve heard that many detox and rehab facilities fail to properly manage withdrawal symptoms or to provide appropriate doses of buprenorphine and other medications for opioid use disorder, like methadone. This leads to excruciatingly painful — and sometimes life-threatening — withdrawal, forcing people to choose between suffering in a facility or leaving to manage their symptoms. Managing withdrawal has only become more complex as fentanyl, xylazine, and other opioid analogs have infiltrated the local supply. Furthermore, the COVID pandemic resulted in workforce shortages across treatment settings, making issues with care far worse.

Instead of the current path of forcing people to choose between treatment or jail, we suggest the city adopts a public health approach that prioritizes harm reduction, expands the amount and quality of treatment spots available in Philadelphia, hires the workforce to support them, and provides low-barrier access to medications for opioid use disorder.

Respect, autonomy, and empathy have been shown to positively facilitate substance use treatment and should remain at the core of how we approach those experiencing addiction.

For example, community-based naloxone distribution is a cost-effective way to reduce overdoses, especially when distributed among people who use drugs. Syringe service programs, in addition to preventing the spread of HIV and hepatitis C, reduce drug users’ risk of overdose by teaching safer ways to use. They also significantly decrease the number of improperly discarded syringes in public places.

While some critics argue that needle exchange programs will simply encourage people to use drugs, research shows that people who regularly engage with these programs are five times more likely to enter substance use disorder treatment and nearly three times more likely to reduce or discontinue injection drug use than those who have never used a syringe service program. Besides offering clean needles, these centers facilitate entry into treatment when someone is ready, and can provide medication for opioid use disorder and links to other health-care services.

In addition to expanding treatment availability, providing social supports to individuals in recovery is also paramount. Supportive housing leads to fewer emergency department visits and hospitalizations. Those with co-occurring mental health and substance use disorders benefit greatly from supported employment. For women, providing childcare, prenatal care, women-only programs, workshops, and mental health programming improves treatment completion, birth outcomes, and employment.

Not only does the Parker administration and City Council’s war on drugs-style approach go against the evidence, but it’s also not what the majority of Philadelphians want. While two-thirds of Philadelphians polled said they want to see more mental health and substance use disorder treatment services, less than a quarter said the focus should be on arresting drug users. Community members in Kensington have also expressed concern over the rapidly increasing police presence.

Most Philadelphians have been touched, in one way or another, by addiction. We all want to find solutions to end the ongoing suffering. Science can help us do this, but we need the support of our leaders.

Emily Seeburger (@emilyseeburger) is a data scientist and harm reduction advocate in Philadelphia. Shoshana Aronowitz (@shoshiaronowitz) is a nurse, health services researcher, and harm reduction community organizer in Philadelphia.