How Philly’s new recovery house will serve hundreds of people with substance use disorder — if they can get there

Down a winding road just past Philadelphia’s secluded jail complex, where security announcements blare over an outdoor loudspeaker, stand seven buildings that, until recently, were derelict — and are now being touted as a major salvo in the city’s battle against addiction.

Those buildings make up a portion of the 20-acre Riverview Wellness Village, a Northeast Philadelphia drug rehabilitation facility developed in less than a year by Mayor Cherelle L. Parker’s administration, where people in recovery from addiction will begin living as soon as this month.

There will initially be 340 beds in the renovated cottages that feel something like dormitories, a significant expansion of the city’s existing network. When the facility is complete, it will hold 600-plus recovery beds, more than doubling what’s currently available in recovery houses citywide.

The administration’s goal is to address the yearslong opioid crisis by housing recovering Philadelphians at Riverview for up to a year — that is, once they get there.

Riverview is a recovery house, not substance abuse treatment, meaning people in addiction can only be admitted after completing 30 days of intensive inpatient treatment elsewhere. And there are significant barriers to entering inpatient treatment to begin with, including what some advocates say is a dearth of beds for people with severe health complications. The issue is especially acute among the estimated 800-plus people who live on the streets in Kensington, the city’s largest open-air drug market.

But city officials say Riverview is filling a critical shortage: while there are more than 3,000 inpatient behavioral health and substance-use disorder treatment beds in the city, there are just 500 spots citywide in the recovery houses that come after initial treatment. The city has a recovery bed waitlist of about 200 people at any given time.

Isabel McDevitt, the Parker administration’s executive director of community wellness and recovery, said the city is working with providers to address the barriers to entering inpatient treatment.

She said Riverview will help break the cycle of substance abuse by providing people with housing, job training, and life skills after treatment — all of which can reduce the chance of relapse or a return to the streets.

“To really change one’s ability to cope with all sorts of life challenges while maintaining recovery and also building relationships that are supportive of that recovery, it takes more than 30 days,” McDevitt said. “Having the ability to live at Riverview for a year... is a game changer.”

People in addiction citywide can enter inpatient treatment through a variety of methods, including through public or private medical professionals and outreach workers. They can also be diverted to treatment through the city’s Police Assisted Diversion program, which offers services to some people in addiction who would otherwise be arrested on charges like drug possession.

The Parker administration this month is also launching a controversial “wellness court” in Kensington, where people arrested for using drugs on the street can be brought before a judge the same day and offered treatment. Critics say having people choose between recovery or the criminal justice system amounts to forced treatment.

» READ MORE: Philly is developing a fast-track court for people arrested for drug use in Kensington. Advocates are worried.

But the administration contends it’s an opportunity to connect people to an inpatient facility if they choose — or, first, a hospital, where they can be treated for withdrawal, wounds, and other complications.

Managing Director Adam Thiel, whose office has overseen the effort to expand treatment options in the city, said there are about 1,700 substance use disorder treatment beds and 1,400 behavioral health beds in Philadelphia, and there are routinely openings for both.

» READ MORE: Long wait times and a toxic drug supply make it difficult for Philadelphia patients to get addiction treatment

Kelsey Leon, who works with the Kensington harm-reduction group Community Action Relief Project, said there’s a need for long-term, supportive recovery housing in the city.

But, she said, it’s difficult for many patients to consider recovery housing, like the Riverview facility, because they face barriers to entering addiction treatment in the first place. Philadelphia’s volatile drug supply means that managing a patient’s withdrawal symptoms can be difficult for medical providers, and long wait times in hospitals or crisis response centers without any withdrawal medications can prompt patients to leave before they’re seen.

And Leon said she’s spoken with many people in addiction who have been turned away from rehabs that cannot care for the wounds they’ve sustained from using xylazine, the powerful animal tranquilizer also known as tranq that has in recent years infiltrated most of Kensington’s toxic drug supply.

There are as few as 70 beds citywide that can accept patients with severe flesh wounds, according to Megan Reed, a researcher at Thomas Jefferson University who has studied treatment availability in the city and testified before City Council last year.

Crystal Yates-Gale, the city’s deputy managing director for health and human services, said hospitals treat serious flesh wounds, and that people with open wounds who are interested in inpatient drug treatment can first receive care at a hospital before being transferred to treatment.

There are also limited beds available at facilities that offer both addiction care and wound care. One is Eagleville Hospital in Montgomery County, which serves patients from Philadelphia. Officials said in a statement that they’ve seen an increasing number of patients in recent years, including many who come from other hospitals, who have skin lesions and infections as a result of xylazine.

Leon said some patients can still struggle to find care. She recalled assisting one man who was denied entry to addiction treatment because of a wound, then went to a hospital, where doctors said they couldn’t admit him because the wound wasn’t severe enough.

”He said, ‘What am I supposed to do? Go out and wait for [the wound] to get worse and then come here?’” she said. “It’s incredibly demoralizing.”

If a patient is able to get into an inpatient facility and completes a 30-day program there, they are then eligible to be placed in recovery housing, which is generally defined as places that provide a safe and supportive drug-free environment.

According to state records, there are 59 licensed recovery houses in the city, meaning that they are allowed to take referrals from state agencies or obtain state government funding.

While recovery houses must be licensed to receive funding, that doesn’t preclude people from opening recovery homes outside the state’s purview. Historically, the industry has been plagued with privately-run homes that subject people with addiction to shoddy living conditions and, in some cases, exploitative relationships with inpatient treatment facilities.

A 2017 Inquirer investigation led to a state probe into misconduct in recovery houses in Pennsylvania, including the practice of “patient brokering,” in which a recovery home accepts kickbacks from a treatment center for referring patients there. There were calls for reform, and the state has in recent years licensed 365 recovery homes that must be regularly inspected.

In addition to expanding recovery house beds, the city’s facility at Riverview will also be a reliable place for inpatient providers to refer patients — one that will be funded through public dollars and subject to government regulations.

The city has said it will provide Riverview residents a variety of services, including job connections, various types of therapy, fitness and recreation, and peer support.

There’s also a medical suite that will be managed by the nonprofit Black Doctors Consortium and the group’s leader, Dr. Ala Stanford, who was a prominent voice for health equity during the COVID-19 pandemic. The overdose crisis has impacted every demographic in the city, but a recent analysis shows older Black men are dying at the highest rates in the city.

Providers at Riverview will offer a range of care for acute and chronic medical conditions. For example, the medical suite at the facility is equipped with exam rooms for primary care and disease management, and Stanford said she expects to help uninsured patients get health-care coverage to navigate procedures outside the facility.

Stanford said at her North Philadelphia clinic, the Dr. Ala Stanford Center for Health Equity, doctors and nurses are equipped to debride infected flesh from wounds, and help patients with more serious wounds navigate care elsewhere.

At Riverview, she said, she and other doctors will be able to care for wounds at that level, but a patient with, for example, an exposed bone would need IV antibiotics that would have to be provided at a hospital. She said she expects to work collaboratively with hospitals around the city.

”I’m certainly going to use all my networking capital,” Stanford said, “to get people the care they need.”