Originally published via The Philadelphia Hall Monitor on March 12, 2024
BY: Allison Beck

While the only bills currently in Council surrounding the city’s new approach to the opioid crisis in Kensington are proposals for a business curfew, an investigation of stop-and-gos, and tracking for Narcan use and impermissible camping, members of Council say they want to go further, removing harm reduction groups and centralizing services.

Earlier this month, the city purchased a former strip club for $7.1 million amid reports that they plan to turn it into the city’s new triage center.

“The focus has been on getting people into care,” Councilmember Mark Squilla said earlier this month. He listed wound care, rehab, medicated addiction treatment, and mental healthcare through city hospitals as some of the options that would be offered.

Harm-reduction advocates countered that this only offers people two options: rehab, or prison. When medical facilities fill up or the program’s funding runs out, patients’ only option will be prison.

Multiple members of the Kensington Caucus say they believe mass arrests aren’t the answer. Still, if a person is booked on any charges, like drug possession and impermissible camping, Squilla says they will go through the criminal justice system. He believes that the Accelerated Misdemeanor Program, in which a defendant enters a no-contest plea and agrees to certain conditions, such as community service and mental health treatment, will be key to their strategy.

This comes with a number of questions, especially surrounding what, exactly, individuals would be prosecuted for, or who would do the prosecuting. As it stands, even if someone is arrested for a crime like possession, they usually only spend 2 to 3 days behind bars. 

Researchers warn that cycling users in and out of jail could worsen Philly’s overdose crisis. Studies show drug users are at least 10 times more likely to overdose within two weeks of being released.

Longer incarcerations might not work, either: Philly’s prisons are overwhelmed as it is. The past few months have seen not only inmate escapes, but violence, security issues, staff shortages, overcrowding and claims of human rights violations.

There’s also the issue of prosecution itself, as there’s no guarantee that DA Larry Krasner will cooperate with the city’s tough-on-crime approach. With mass arrests and a drought of harm reduction resources, including bathrooms, showers, needle exchanges, and wound care, Kensington and Allegheny could quickly become even more of a public health emergency.

If Krasner is replaced by a SEPTA special prosecutor, as per Act 40, tougher prosecution may follow. But the act faces challenges in court, and convictions under that prosecutor could be overturned if those challenges succeed.

Whether a person faces prosecution or not, the Kensington Caucus says they plan to make sure that rehab is a major part of the equation.

But questions remain about the efficacy of forced treatment. A 2016 literature review by researchers from across the globe pushed policymakers to prioritize voluntary treatment options, citing the risk of human rights abuses and a lack of evidence backing forced rehab. More recent studies found that forced treatment is not only ineffective, but potentially detrimental to recovery.

Funding is also a concern. The average individual cost of residential rehab per person in Pennsylvania is $56,708 according to drugabusestatistics.org, a rate that may rise with the longer stays necessary for those addicted to opioids like fentanyl and xylazine.

Even if the Kensington Caucus were able to secure funding from the state and local governments within the next month, there are not currently enough rehab beds open for the several hundred people currently living and using in Kensington, due to a workforce shortage.

Councilmember Jim Harrity says that the city’s contracts with facilities both inside and outside of the city will be able to accommodate these needs. 

When people enter rehab or prison, another health problem emerges: Xylazine withdrawal. It can lead to life threatening complications, including heart attacks and seizures, according to the University of Pennsylvania.

Those recovering from xylazine addiction and public health researchers have described withdrawal symptoms including uncontrollable shaking and vomiting, anxiety and physical pain. Many rehab facilities lack training on how to handle this form of detox.

“Our lack of updated withdrawal protocols is raising the recidivism rate,” said Sarah Laurel, the founder and executive director of the Kensington harm reduction organization Savage Sisters. “It’s lowering retention rates in treatment facilities and it is causing a strong resistance from the people that we serve to enter into a facility because they are not being treated medically or compassionately in a proper way.”

Laurel also mentioned the impact of the ulcers caused by xylazine, which not only complicate cuffing and transferring people, but also impact prison health systems, as people addicted to the drug tend to have both localized and full body infections that may not be treated for weeks. These ulcers, which can become so severe that they require limb amputations, can quickly become life threatening.

Even with these issues, City Council, the Mayor’s Office, and the Philadelphia Police Department are poised to begin implementing their new strategy in April, if not sooner.