Camille Paglia is medical director of the psychiatric Crisis Response Center at Temple University Hospital's Episcopal Campus, something of a MASH unit for Philadelphia's heroin epidemic.
Sitting not far from the train tracks in Kensington where addicts congregate to use — and often, die — the center serves as a rescue station and referral point for treatment elsewhere.
All too often, however, Paglia and her staff are forced to tell patients just saved from overdosing that there are no beds in the rehab system for them. Many return to Episcopal the next day and the next, hoping for better news.
Others go back to the needle right away; they need walk only a short distance to what law enforcement considers the biggest open-air drug market on the East Coast. Some don't survive the night — police have found the bodies of addicts, still wearing hospital wristbands, out near the tracks.
"It's critical that we get more [rehabilitation] beds," Paglia said. "Every day we have to tell people: `There's no bed, there are no beds.' "
Paglia (who is no relation to the academic and social critic of the same name) recently spoke to the Inquirer about what she sees from the trenches of Philadelphia's addiction crisis, what her patients are like, and what is most heartbreaking about her work.
The mother of two sons, Paglia, 55, earned her medical degree from the Temple University School of Medicine in 2008. Twenty years before, she graduated from the University of Pennsylvania Law School and worked as a senior law clerk to a federal judge. She did her undergraduate work at Bryn Mawr College and lives in Narberth.
Tell us about your center.
We're a crisis response center. There are five of them in the city. Ours is the one that's in Kensington. We're being flooded with people coming in who are looking for detox and rehab. The people are coming from all over because of the potency of the heroin in this neighborhood.
The overdoses we tend not to see first. Those are dealt with Narcan [the rescue medication] in the field by fire rescue [paramedics], or they're brought to emergency rooms. Many people having their high ruined will refuse care and leave once they're conscious again. But some will come to us mostly because they are scared they nearly died and seek treatment.
How many people do you treat?
I believe that we are now over 900 patients a month.
Are some of the mental-health complaints actually drug problems?
Drugs exacerbate preexisting mental issues, but certain drugs also produce symptoms like those of mental illness. For example, if you're seeing somebody who's using PCP, they appear psychotic.
We used to hear a lot about PCP, or angel dust, and the disturbing hallucinations it causes. Do you see much PCP?
You would think it went out with the '80s, but we see a great deal of PCP.
What are the most common substances?
Opiates [especially heroin], cocaine. There's a huge amount of benzodiazepine abuse, either prescribed or bought off the street. [These tranquilizer drugs, such as Xanax, are often mixed with opioids to enhance their effect, sometimes with deadly consequences.] Marijuana is almost ubiquitous.
Who are the patients?
They are white, black, Hispanic. They range in age from 18 to 70, believe it or not. There's no common denominator. It completely crosses ethnic, racial, age lines.
They may have come from the suburbs, people who are middle class and who had jobs at some point. This takes away everything they ever had. What I tend to see are people who are hitting bottom when they're coming here.
Many people have some chronic pain issue or were in a car accident or had a back injury and are prescribed Percocet or some other opioid. Then they get cut off and buy the pills on the street. But it's expensive to buy pills on the street, and it's cheap to get heroin.
One addiction expert I spoke to predicted baby boomers will be the next wave of heroin users because doctors who prescribed them pain meds are retiring.
Or are reluctant to keep providing because Pennsylvania now monitors opioid prescribers. Our patient population has definitely gotten older.
Describe what happens when someone comes into your center.
Drug treatment needs to be voluntary. You have to want it. First of all, they have to come through the emergency room and be brought up to us. Then they are triaged by a crisis response technician, then a registered nurse, then seen by a psychiatrist. What we can do depends a great deal on the insurance situation. Most of our patients are Philadelphia Medicaid patients, which means their substance-abuse and mental-health benefits are managed by Community Behavioral Health, which is a city agency. If detox days are approved, we then have to try to find a facility with beds. We at Episcopal do not do detox or rehab here. So we have to call the other facilities in the city and the close-in suburbs. That's where the bottleneck happens. There are not nearly enough beds for the people who want them.
By Friday afternoon and the weekends, it's next to impossible to place anybody.
What if there are no beds?
We'll refer them to an intensive outpatient provider or a recovery house or shelter if they don't have a place to live. We tell them to come back tomorrow, first thing in the morning, and we'll try again. People do. They will come back day after day trying to get into treatment.
Do people want that much to get clean?
It varies. Some people are absolutely desperate. Some people have come back time and time again, have been sent to detox, go to rehab, and relapse the day they're discharged. Part of that is because they're going back to the same neighborhood and their same friends. The cravings don't go away.
What do you want the general public to know about addiction?
I think there has to be more awareness that prescribed opioids are not a benign drug. Being on one of those for any length of time is going to cause dependence and habituation. And, if you have a legitimate pain issue, there have to be long- term options for pain control other than something that's going to lead somebody with a future and a life to shooting up in an alley in Kensington.
The other thing I would want people to know is this is not just inner-city, poor people. This reaches to every part of society.
Some started abusing things when they were kids with their friends. It's a steep, downhill ride. They come from jobs, good school systems, nice parents, lawns, and white picket fences to here.
How common is that?
Pretty common. I mean, you make some bad choices when you're young, and you get on that train, and it's difficult. Then you find yourself doing the things that drug-addicted people do to get the money to buy drugs, and it's sad.
One of the most striking things is looking at people's IDs. They bring them in, and we photocopy them. You can see, if the ID was a couple of years old, the utter deterioration of the person. You had somebody smiling and pretty and all put together. Then you see what drugs have done to them. It's one of the saddest things we see.
What really gets to you?
For me, personally, seeing the young people 18, 19 years old. People the age of my own kids who had everything going for them. We try desperately hard to intervene early on before it becomes an ingrained lifestyle. They've burned every bridge they ever had.