There's an answer to the heroin problem we need to try: Safe-injection sites

A group gathers to use a hose for water outside the Last Stop outpost on Somerset Street in Philadelphia.

Inside the sweltering Simpson Memorial Church on Kensington Avenue — now a needle exchange — the gathering crowd fanned themselves with the pamphlets that city officials had handed out at the door: “Combat the Opioid Epidemic in Philadelphia,” the front page read.

At the altar, a city health official clicked through a PowerPoint presentation, listing the grim statistics of the catastrophe unfolding outside: at least 70,000 heroin users in Philadelphia addicted to dope that is purer than anywhere else; 702 deaths in 2015; 907 last year; maybe as many as 1,200 this year.

And the death rate is outstripping that of the biggest U.S. cities. Of every 100,000 residents in New York, 11 will die of an opioid overdose. In Chicago, 15. Here it’s 47.

Philadelphia, he stressed, needs to stop chasing drugs, and start figuring out how to connect with the people addicted to them.

Outside on Thursday evening, the avenue swelled with those people. In front of Somerset Station stood Joe Aster, shadowboxing in sandals, a softball shirt, and Buddy Holly glasses. The 21-year-old rides the El from South Philadelphia most days, ever since a stint in treatment where he learned Kensington was a “heroin buffet” and his favorite brand — the bags stamped with a Mickey Mouse face – could be had for $5 at Water and Indiana, half the going rate back home at Seventh and Oregon.

He’d tried rehab, he said. But on a recent attempt he spent a few days in a chair in a crisis center, soiling himself from the agony of withdrawal, picking at cheese sandwiches, waiting to get methadone, the medication he needed to feel better. Unwilling to wait any longer, he left.

Joe would like to go back now. But two weeks ago, he passed out in his stupor and woke up in the hospital with his phone and ID gone. And there’s no getting real treatment without an ID. Outside the station, he ducked and weaved to stay on his feet.

As much as the city has tried in recent years to address the health crisis overwhelming Kensington — and it has, compared with recent administrations — it’s stymied by gaps and barriers in an under-resourced and often-outdated system of treatments. That system sets people like Joe up to fail. And the bodies mount.

If they continue apace, experts forecast that 10,000 people will be dead before a decade passes. That’s like 30 years of homicides.

These days, those who want to get clean in Philadelphia face daunting obstacles: You can’t get medically assisted treatment without an ID. (Good luck to Joe and the men who sleep in the soon-to-be-shuttered Gurney Street heroin encampment — many of whom were sent here from Puerto Rico, exploited by crooked recovery home operators who stole their identification, and left them to live in a gulch, some for more than a decade.)

If you have papers and choose detox, you may have to wait days for a bed and the sort of medically assisted treatment necessary to calm the withdrawal that tears at a chemically dependent body from the inside.

So, here’s hoping that Wiz, an affable 35-year-old nicknamed for his skills on the guitar, can finally make it through withdrawal.

“It can break the strongest man,” he said. The father of five and Mastbaum grad spoke of wanting to be a pillar for his children – of wanting to get better. Philadelphia, he said, makes it tough to get clean.

You have to hope for a shot at a housing-first slot, a program that offers stability and safety for those still active in their addiction. But, there are only so many slots, about 60 now – with 15 more to come – in a neighborhood with an estimated 400 homeless people. So you must wait. And now, more than ever, a delay of even a day could be deadly.

So, pray for Steven, who is 35 and from West Philadelphia and has landed one of those coveted spots. But until his number is called he treats his habit with the free samples that heroin dealers hand out on the avenue, many spiked with deadly fentanyl or worse. Tall, lean, and bearded, he sat on the church steps during the community meeting at the Prevention Point needle exchange. For now, he’s sleeping in an emergency summer shelter in the basement, the only such place in the neighborhood. He has peace of mind now, he said, knowing he’ll soon have medication and a room of his own somewhere. He said he was done committing crimes to pay for his need.

“I’m too close,” he said. He’ll just have to gamble with the freebies until his number is called.

The city is rightly trying to respond, and quickly, to decades of neglect in Kensington.

Three times now, I’ve written about places in Kensington where addicted people flock. A train gulf where men lived in squalor and trash — but away from prying eyes. A library lawn where children play, but where so many needles litter the ground you could plausibly hide your stash in the grass, and where the librarians race to save overdose victims. A boarded-up church where you could sleep and use in vacant pews, under a real roof, but where men came for tricks and robbers came to score. Sanctuaries, of sorts. But traps, mostly.

Every time, the city has reacted. The camp will be closed (cleanup was scheduled for Monday, but is once again delayed) and the people on the lawn and in the church have been moved out. Officials have increased outreach and efforts to help those without identification. They’ve opened up beds for those living at Gurney Street.

But it is clear that despite the responses, the city is jumping without a net — relying on a system that can’t hope to catch all the people being displaced in Kensington.

Now, we face a new choice, one that I can’t deny my reporting has been leading me to.

If we can’t get people suffering addiction the treatment they need quickly, if we can’t give them a roof over their heads, if we can’t give the neighborhood around Kensington and Allegheny a break from the daily trauma, if we’re only going to push them around and can’t keep people alive, then there’s an answer to the heroin problem we need to try: safe-injection sites.

These are controversial places, where addicted people use under the supervision of doctors — and where they are met by social workers and treatment specialists. Early evidence in places like Vancouver shows the sites usher more people into treatment. They prevent disease. They keep people alive.

They attack an overwhelming challenge with an overwhelming response. The city says it’s exploring the possibility of a site and how to face the legal challenges - and law enforcement pushback - that would arise.

It is a conversation we must start having for real.

If there was a train wreck off Gurney Street, instead of a heroin encampment along its tracks, we’d bring a massive response to pull them from the disaster.

And if they turned down our help, we’d ask why — and try something new.