Mayor Cherelle Parker proposes $100M to fund ‘triage and wellness facilities’ for people in addiction

Philadelphia is a step closer to establishing city-funded intake centers for people in addiction after Mayor Cherelle L. Parker on Thursday proposed spending $100 million on new “triage and wellness facilities,” part of her pledge to end open-air drug markets.

While the mayor said the centers are a priority for her administration, she indicated during her first budget address to City Council on Thursday that the idea is a work in progress. Details about the proposed treatment options are scarce, and it’s not clear what role law enforcement would play in the facilities, including whether police would take people to them involuntarily.

Parker said administration officials, led by Managing Director Adam Thiel, are “examining every option for providing long-term care, treatment, and housing for those suffering from addiction, homelessness, and mental-health challenges.”

She added that Thiel earlier this month met with leaders from Philadelphia health care systems and insurance companies to develop recovery and treatment plans.

Opening the first such facility would be a shift in strategy for a city that saw a record number of overdose deaths in recent years. It could also be a flashpoint for residents, as some civic groups have long battled against drug treatment facilities opening in their neighborhood.

Locations haven’t been selected, but Parker said in an interview Thursday that she is “hopeful” about one space the administration is exploring. She declined to say where it is.

“We have to find facilities that can get up and running quickly,” she said.

The earmarked funds for triage facilities come a month after City Council members floated the idea. A group of four lawmakers who represent Kensington — the epicenter of the city’s opioid crisis — said they would seek funding for a city-run “triage center” as a means of getting people in addiction off the streets and into treatment.

They proposed that police and outreach workers could bring people who use drugs openly or commit nuisance crimes to intake centers to enter recovery or, if they refuse, they could be arrested. The city already has programs that offer rehabilitation options to people facing criminal charges for such low-level crimes as drug possession and prostitution.

“There will be court-driven treatment or court-driven programs that they will have to attend, or there will be arrest and consequences that may be possible,” Councilmember Mark Squilla said at the time.

Parker has said repeatedly that she’s supportive of the lawmakers who represent Kensington, and Councilmember Quetcy Lozada, who has been outspoken about the neighborhood’s challenges, praised Parker’s budget as “a product of community input.”

But the mayor has not explicitly endorsed the specifics of the Council members’ triage center proposal and said the city needs “multiple” locations.

It’s also unclear how the proposed facilities would differ from existing drug addiction intake centers. The city has at least five crisis resource centers that connect people to such services as detox programs and medication-assisted treatment. Several nonprofits in Kensington offer similar services.

There are also significant barriers that keep people out of treatment in Philadelphia, complicated by the potency of the city’s drug supply, according to a recent study of Philadelphia’s treatment system by Thomas Jefferson University researchers.

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Fentanyl, the powerful synthetic opioid behind most of the city’s overdose deaths, wears off quickly, sending people into painful withdrawal faster. Xylazine, the animal tranquilizer often paired with fentanyl, causes serious wounds and intense withdrawal symptoms that doctors are only just learning how to treat.

People in addiction often face long wait times for a clinical assessment to enter treatment, leading some to return to the streets to stave off withdrawal symptoms. And once cleared for treatment, some people addicted to fentanyl and xylazine are still unable to enter because many treatment centers do not have the medical capacity to treat wounds associated with xylazine.

Philippe Bourgois, an anthropologist at the University of California-Los Angeles, has studied addiction and Kensington’s drug market and said triage facilities could be effective for some users. But he said zero-tolerance policies seldom work on a large scale.

Given a treatment-or-jail ultimatum, Bourgois said, many people relapse. A 2018 study found that recently incarcerated people in Philadelphia faced an outsized risk of overdose in the first two weeks after their release.

“I have seen people who attribute their recovery to a zero-tolerance approach,” he said. “But the general pattern is that the reverse happens: you’re pissed off and angry and when you get out, you’re not open to stopping.”

He said the gold standard for addiction treatment, as found in many European countries, is to “maximize the number of recovery pathways and reduce the punitive alternatives.”

Parker said her administration is seeking input from experts — her budget plan says they include leaders from Jefferson, the University of Pennsylvania and Temple Health. And she said her staff is working closely with state lawmakers to explore programs that ease access to insurance coverage for people seeking recovery treatment.

Still, the $100 million worth of spending — which would come out of the city’s capital budget, meaning it would be paid for through borrowing — is not certain.

Parker and her allies could face resistance in City Council, particularly from members of the progressive wing who have advocated for public-health driven approaches to the overdose crisis and are unlikely to support an initiative if they believe it’s criminalizing addiction.

Negotiations between Council and the administration are already underway, and Council must approve a spending and revenue plan by the end of June before the current budget expires.

Inquirer staff writer Sean Collins Walsh contributed to this article.