After that first troubling month of lockdown in the spring, my provider had switched to a low-barrier telemedicine model for the duration of COVID-19 out of concern for patient safety. Temporary regulations instituted by the Drug Enforcement Administration and Substance Abuse and Mental Health Services Administration allowed this.

We now conduct our business once a month over the phone in under five minutes with a series of simple, rapid-fire questions. The doctor asks me how I’m doing, if I have any cravings, and if I’m happy with my dose. “Thank you for getting your urine sample done,” is how he ends every call.

In the middle of a pandemic, I sit in a room where people draw blood and hand over bodily fluids to prove I’m not using drugs.

I also make regular trips to LabCorp, located in a nearby Walgreens, for the required urine screens.

Each month I put on a mask—sometimes two—and head out to my appointment, regardless of stay-at-home orders, infection rates and vaccine availability. In the middle of a pandemic, I sit in a room where people draw blood and hand over bodily fluids to prove I’m not using drugs. I do this to continue receiving lifesaving medication. I do this because of the stigma against people who use drugs.

The federal government’s telemedicine policies for buprenorphine patients, though temporary, are a rare bright spot in a catastrophic year for public health. But beneficial as these models are in bringing low-barrier treatment to underrepresented populations, stigma still prevents permanent implementation.

As the Pew Charitable Trusts noted recently, physicians and public health experts worry that access to treatment could become a problem when the COVID-19 public health emergency ends, as it’s set to do in April. Some groups, such as the Buprenorphine Telehealth Consortium understandably argue that an act of Congress is desirable to extend or make permanent telehealth flexibilities for buprenorphine patients. But could there be a faster immediate way of getting this done?

SAMHSA and the DEA Could Do It on Their Own

A new report from George Washington University, funded by Pew, contends that the DEA and SAMHSA have the power to act unilaterally to extend the nation’s telehealth policies for buprenorphine patients.

Beth Connolly, who directs the Substance Use Prevention and Treatment Initiative at Pew, noted that federal agencies under the Trump administration implemented telemedicine policies rather quickly in the early days of COVID-19. But Pew wanted to know if the temporary regulations in place could be extended without congressional intervention.

The organization partnered with George Washington University and asked researchers to look at a slew of regulations, including the Controlled Substances Act, the Ryan Haight Online Pharmacy Consumer Protection Act, and others, to see if outside agencies had any say in the matter.

They found that the DEA and SAMHSA have not one, but several different ways in which they can extend current telehealth policies.

“In fact, [researchers] have determined that they can be done without an act of Congress, which is huge.” Connelly told Filter.

Bridget Dooling and Laura Stanley, a research professor and senior policy analyst, respectively, at the GW Regulatory Studies Center, who wrote the Pew-funded report, found that the DEA and SAMHSA have not one, but several different ways in which they can extend current telehealth policies. And while both authors told Filter that their work focused on what could be done rather than on whether it should be done, their findings play an essential role in furthering the public conversation.

According to Dooling and Stanley’s findings, both agencies could extend telemedicine flexibilities permanently and unilaterally under a statutory exemption in the Ryan Haight Act, which, the authors note, gives the agencies broad discretion to allow practitioners to prescribe controlled substances without an in-person examination. However, such regulations only apply to X-waivered physicians—meaning SAMHSA would need to issue a companion policy to opioid treatment providers, exempting them from in-person examination requirements.

Next, the authors found that the Ryan Haight Act gives the DEA the authority to set up special registration programs for telemedicine. Another piece of legislation, the SUPPORT for Patients and Communities Act of 2018, actually directed the DEA to do so by 2019, but the agency has yet to follow through. Dooling and Stanley note that, as with the previous option, SAMHSA would also need to issue that same companion policy.

Finally, the report found that both agencies could use declared opioid public health emergencies to extend current telehealth policies although this wouldn’t make them permanent.

“The public health emergency declaration for the opioid epidemic is already on the books,” Dooling said. “We have declared that it’s a public health emergency. And so the question is, what flows from that?”

Dooling and Stanley’s matter-of-fact assessment shows what the DEA and SAMHSA can do. Whether the agencies will take any of these steps is highly doubtful, however, given their well documented inherent biases—illustrated by the fact that they didn’t allow telemedicine until a pandemic practically forced them into it.

But publicizing the agencies’ powers in this area might just make this a productive avenue for public pressure.

Telemedicine Must Have a Future

Activists in the harm reduction community have long lobbied the federal government for telemedicine options to help those in rural communities and others without access to treatment providers. As the GWU report noted, places like Wyoming County, West Virginia, which had the state’s highest overdose death rate from 2014 to 2016, were also without a single physician X-waivered to prescribe buprenorphine.

As promising as the temporary telemedicine regulations are, individual physicians still have leeway to practice within their preconceived biases. Last summer, when my buprenorphine doctor asked me about the burden of going for urine screens, I knew he wasn’t really asking about me. After all, according to my chart, which was right in front of him, I went every month. The question was a compare-and-contrast with his broader patient population.

“A few other patients say it’s difficult to go for a urine,” he said. “I wanted to see if that’s true.”

As a middle-class white man who works from home and has the freedom to come and go, I’m not the best barometer. Plenty of research shows that low-income people of color, along with single mothers and other vulnerable populations, have difficulty accessing health care of any kind, pandemic or not.

Had I said yes, I could have spoken with my doctor about how marginalized people face so many more barriers than I do in getting monthly urines. But I worried it might lose me my script.

“No,” I said, like a coward. “Going for a urine screen isn’t difficult at all.”

For buprenorphine providers in the harm reduction community, such as Philadelphia’s Shoshi Aronowitz, the adoption of telemedicine for patients who would otherwise be left untreated is a net positive. Aronowitz is a research fellow in the National Clinician Scholars Program at the University of Pennsylvania. She also works as a family nurse practitioner at some of the city’s more well-established harm reduction-based substance use treatment centers.

“Telehealth is great because you don’t have to worry about how close the clinician lives to you,” said Aronowitz. She noted the model benefits both rural residents and Black and Hispanic communities—communities that are less likely to have access to buprenorphine providers than white neighborhoods.

“Then there’s lots of people also who live in areas where there are a lot of clinicians, or at least some clinicians,” Aronowitz continued, explaining that a host of reasons beyond geography can make telehealth necessary. “But maybe because of a disability, for example, they’re unable to travel to a clinic, or because of stigma they don’t want to travel to a clinic, or even because of their job or their family responsibilities having to show up at a clinic frequently—because you do for OUD treatment—is not going to work.”

She added that she “can’t even begin to think about” the number of patients who are now in her care because of telemedicine policies.

Telemedicine isn’t an answer in and of itself, as can be seen in the rise in overdose deaths during the pandemic. In addition to low-barrier treatments that bridge the digital divide, telehealth policies need to embrace holistic avenues that aren’t awash in stigma.

Aronowitz understands de-platforming stigma better than most. Earlier this year, she published an article suggesting that urine screens should no longer be central to substance use care. For those doctors who still lean on UDS, or even patients who choose to use it as a measure of their own success, Aronowitz told Filter that there are less traumatizing ways to go about it that don’t include going out to a lab in the middle of a pandemic. Urine cups and oral swabs can be sent through the mail, she said, with the latter observable by the doctor over Zoom.

And when it comes to induction via telemedicine, Aronowitz believes close contact is crucial. She said that providers should build up from smaller doses, ask lots of questions, and check-in often to see if the patient has any concerns.

“It would be horrible if [telehealth policies] were rolled back,” said Aronowitz. She added that she “can’t even begin to think about” the number of patients who are now in her care because of the policies instituted at the pandemic’s start.

“They weren’t able to come in before,” she said. “So they can’t come in now.”

My buprenorphine doctor might never read this piece—in fact, I doubt he will. If he does, perhaps we could finally have that conversation about marginalized people and the need for a buprenorphine approach that truly embraces harm reduction.

Or he may just revoke my script.

Photo by Marek Levák on Unsplash

The post Extending Telehealth Bupe Past the Pandemic Wouldn’t Require Congress appeared first on Filter.

The waiting room walls, once cluttered with rock festival posters, pharmaceutical displays and photocopied warnings—the doctor does not prescribe opioid medications, the doctor does not make up missed Suboxone appointments, the doctor does not replace lost Suboxone prescriptions—were now bare. Packed boxes stood piled in the front of the suite, where the familiar cadre of nurses and office managers had been replaced by a skeleton crew of one.

On my way to the car, I saw him tossing boxes in the dumpster.

My first thoughts leaned toward office renovations. Maybe they’re painting the walls, I naively said to myself. But the sullen look on the face of the remaining office manager—a kind woman with whom I’d shared small talk about my kids and the weather over the years—told me I was wrong. The doctor was immediately retiring, she told me, and this would be my last appointment. There would be no questions about the progress of my recovery, no checking my blood pressure, and no urine samples.

Within minutes, the doctor had handed me a list of SAMHSA-approved providers in the Philadelphia region, a copy of my patient file, and a 30-day Suboxone script. On my way to the car, I saw him tossing boxes in the dumpster.

I took the news to my therapist at the Department of Behavioral Health Services (DBHIDS) satellite office in Northeast Philadelphia. She then spoke to the department’s Suboxone nurse on my behalf, before informing me that I would be required to participate in an intensive outpatient program in order to continue my care.

“Our Suboxone program requires group therapy,” she told me, informing me of one of the many barriers I’d face on my way to continuing treatment—the apparent need to sit in a room filled with strangers three hours a day, three days a week, and talk about my feelings. I slumped into her office sofa—it was one of my last in-person appointments before the pandemic hit—offering fruitless protestations.

After three years in recovery—spent continuously adhering to a strict schedule of Suboxone (the brand name for a buprenorphine/naloxone formulation), Zoloft, individual therapy and clean urines—all I needed was a new doctor to write me a script for buprenorphine.

What I would find instead were barriers to treatment, including a list of SAMHSA-approved Suboxone providers not offering the medication in practice and X-Waivered doctors not accepting new patients. I also experienced burdensome requirements to join group therapy programs through Philly’s DBHIDS—part of an ironic, near-Kafkaesque nightmare, seeing as I had left the department’s intensive outpatient program three years earlier, determined to take control of my own recovery after they refused to give me Suboxone.

The Depressing Norm of Stigma

Though born of sudden bad luck, my situation reflected a perfectly ordinary reality: that access to medications for opioid use disorder (MOUD) in the US is plagued by stigma against people who use drugs. Several studies mirror my personal experience and show that it was far from unique.

Among those studies is a recent one led by Harvard School of Public Health Assistant Professor Michael Barnett, which sought to assess real-world access to buprenorphine treatment. The investigation, colloquially referred to as a “secret shopper study,” found that many providers neither offered new appointments nor provided first-appointment induction to people who were currently using unprescribed opioids. For Medicaid patients like myself, the outcomes were worse.

“If someone with opioid use disorder is coming into the clinic and ready to start buprenorphine, that’s when they should receive it,” said Dr. Barnett, adding that, on a positive note, the study found patient wait times were short once they could make an appointment. “Every single week, every single day that you wait and you don’t actually take advantage of that opportunity is basically just saying we’re ok with overdoses and people dying.”

“Doctors can’t just leave and say, ‘Here’s a list of numbers.’ It has to be more than that.”

Although my doctor gave me 30 pills on his way out the door, it took me six weeks to find a new provider—a frustrating, discouraging process made manageable only because I, like many of my peers, have learned to stash away extra medication over the years. Every doctor’s warning, every pharmacist’s glare, and every paperwork kerfuffle with my health insurance made me realize that the system might at any moment take away my medication when I need it most.

My search began with the names of local providers cross-listed with those of Medicaid doctors. I’d spent my first year in treatment paying out-of-pocket, something I neither wanted nor could afford to do again. One local recovery center that touted its statistics and “one day at a time” memes on social media chose not to return my calls. Several Medicaid-approved physicians were no longer accepting Medicaid.

Only one doctor would see new patients. “The doctor can see you in two months,” a woman told me, matter-of-factly, on the phone. Neither my script nor my stash would last me that long.

I don’t know how many providers I called, how many tuned me down, how many weren’t X-Waivered, or how many weren’t taking new patients. I don’t know how many barriers I encountered, but it was enough—enough that I’m glad I stashed away pills. Without them, what would my options have been, and how much risk would they have entailed? Even with them, I was working on borrowed time.

“[Doctors] can’t just leave and say, ‘Here’s a list of numbers.’ It has to be more than that,” said Dr. Barnett, who, as luck would have it, also studied the general problem of continuation of care. “Patients need a transition plan.”

According to his research, which focused on primary care physicians, the loss of a doctor without a proper transition plan resulted in an increase in the use of specialty, emergency room, and urgent care services, all of which resulted in adverse health outcomes for the populations studied.

As Dr. Barnett noted earlier, barriers such as discontinuation of care and difficulty finding treatment have exaggerated consequences for MOUD patients, too often resulting in overdose and death. The problem continues to play out in real-time and record numbers during the COVID-19 pandemic as quarantines and stay-at-home orders prevent people from accessing the lifesaving treatment they need.

Neither are such risks evenly distributed among different demographics of MOUD patients. As a lower-middle class, white Medicaid patient in a large urban area, finding access was already extremely hard. But our racist and classist medical structure means that many other people, including people of color and those living in rural areas and/or experiencing poverty, can have it much worse.

“Countless people do avoid getting help.”

According to Daniel Garrett, who lives in a small town in Tennessee, lack of access to buprenorphine and other MOUD options is a feature of the system. “Countless people do avoid getting help because they can’t find Suboxone providers,” Garrett, who runs the website Tennessee Harm Reduction, told Filter. “I’ve heard many fellow opioid users say they don’t know where to find Suboxone doctors at.”

Stigma against MOUD can be especially acute in his part of rural Tennessee, said Garrett. He related how last summer, his own search for Suboxone saw him facing unnecessary stints in detox, roundabout trips to various pharmacies, and weekly visits to cash-hungry doctors—a major financial burden for someone without health insurance.

Although, in the end, Garrett found treatment through a grant-funded program with the help of his connections to Tennessee’s harm reduction community, the state’s issues remain. It’s tellingly rare for MOUD providers to advertise their services in rural areas; Garrett can only recall two in Northwest Tennessee in recent years: a short-lived digital billboard, and some blue-and-white ads slapped on telephone poles. And despite spending a good deal of his time handing out syringes, naloxone and other items in the drug-user community, “I heard nothing about these ads,” from anyone in that community, he said.

Nixing the X-Waiver Would Be Just a Start

In recent weeks, the structural problems at the base of many of these barriers, most notably the X-Waiver, are back in the public sphere. The Trump administration, somewhere between burning down the Capitol and being impeached for a record-breaking second time, moved to nix the now-infamous policy, giving doctors more flexibility to treat patients with and prescribe Buprenorphine. But after his first week in office, President Biden blocked that decision. (Pennsylvania legislators, meanwhile, will consider a bill that would make it harder to obtain X-Waivers in the state.)

Whether or not the Biden administration holds to that course, Dr. Barnett pointed out that many barriers to treatment are provider-erected—above and beyond the X-Waiver regulation, and because of stigma against people who use drugs.

“The X-Waiver is gone right now,” said Dr. Barnett, speaking before the Biden administration’s position had emerged. “But the culture and patterns of prescribing and comfort level of prescribing that the X-Waiver put into place did not disappear.”

“It’s much better to have no X-Waiver than to have an X-Waiver,” he continued. “But a lot of the damage has been done and without additional effort, I don’t know that it’s going to necessarily evaporate all barriers.”

I stash away a couple of extra pills, just in case.

My new Suboxone doctor’s office is about 15 minutes away from my house, just a short distance from a methadone clinic that once sent the neighborhood into a fury. He calls my script into the pharmacy every month—something my old doctor told me wasn’t possible as he handed me a paper prescription with each visit. When COVID hit, he switched to a telehealth model, protecting the safety of patients in his care.

And every month, he asks me about the progress of my recovery, whether I have any cravings, and if I want to keep the same dose. With that last question, I always say “yes,” so I can stash away a couple of extra pills, just in case he decides to retire.

Photo by John Salvino on Unsplash

The post When My Suboxone Doctor Quit on Me, It Left a Frightening Void appeared first on Filter.

The harmful consequences of that campaign—resonant amid current South Philly community opposition to Safehouse’s proposed first-in-the-nation safe consumption site—persist to this day.

“[It’s] a bad idea at a terrible location,” said Rep. Brendan Boyle to a crowd of protestors in 2013. Boyle, who at the time was a state legislator, was one of several local politicians and civic leaders at the helm of a losing battle against what would become The Healing Way methadone clinic in the predominantly Irish-Catholic section of Northeast Philly. He told the 300-plus people gathered that day that methadone causes deaths and has unknown side effects.

Northeast Philly was “definitely redlining what they didn’t want in their community.”

Although the fight against the clinic was portrayed as an issue of neighborhood safety by politicians and media, activists with lived experience who’ve battled both stigma and the cultural divide that segregates Philadelphia’s districts offer a different perspective.

“That was definitely redlining,” said Andre Reid, an African American methadone expert in the city who’s the founder of both Phila Nama, the Philadelphia chapter of the National Alliance of Medically Assisted Treatment, and Lived Experience LLC. Reid, a transplant from Baltimore, focuses on addiction issues in black communities. He credits methadone with saving his life.

In 2013, Northeast Philly was “definitely redlining what they didn’t want in their community,” he told Filter. For him, the effort not only stigmatized drug use, but also spoke to how white America frames the narrative around neighborhoods where black people live. “I remember saying, it’s okay to send these kids from this community into our community, it’s okay for them to nod out, it’s okay for them to urinate on our lawn.”

Brooke Feldman, a longtime harm reduction activist and former Northeast Philly resident, recalled that toxic conflict over the clinic. As a person with lived experience who worked in Philly’s Office of Addiction Services during the scrum, Feldman was warned not to attend the public meetings.

“City officials were basically blasted, and the stigma was kind of loud and present,” she told Filter. “I was told that I shouldn’t go because it would be really painful to hear things that are being said.”

Residents wore T-shirts proclaiming themselves to be “100% family/ 100% drug-free.” The local $10 Buck Cuts barbershop displayed a large sign that read “Don’t Let the Methadone Clinic Kill Our Community,” complete with an image of the grim reaper. Residents doxxed the local realtor who leased the building, publicly displaying his home phone number and address at a protest with city politicians in attendance. And when Common Pleas Court Judge Idee C. Fox sustained a Zoning Board appeal to allow the clinic to open, the neighborhood voted her out of office.

And then there was City Councilman Bobby Henon, who, according to Feldman, “led the fight to keep services out of Northeast Philadelphia.”

Henon and O’Neill found a way to effectively ban what they deemed “for-profit” methadone clinics.

When efforts to stop The Healing Way from opening proved unsuccessful, Henon, a Democrat, reached across the aisle to Republican Councilman Brian O’Neill to push through BILL NO. 130770, which created the Northeast Overlay District. This shock-and-awe piece of legislation did not ban methadone clinics outright—which the council knew would never pass a legal challenge—but instead placed a zoning variance on all medical, dental and health practitioners in Northeast Philadelphia.

In other words, the healthcare community no longer had the right to simply set up shop or expand offices in the neighborhood. Local civic associations and the Zoning Board of Adjustment now had to grant approval, which, in the case of methadone clinics, would be unlikely to happen.

Henon and O’Neill found a way to effectively ban what they deemed “for-profit” methadone clinics, and also made it more difficult for healthcare providers in general to operate in those neighborhoods. 

Then-Mayor Michael Nutter’s veto of the bill was overridden by all but one member of City Council, including current Mayor Jim Kenney.

The law, which covers Philadelphia’s sixth and tenth districts—and was later extended by Councilman Mark Squilla to the city’s first district—was adopted through an archaic process called councilmanic prerogative, a city tradition that lacks transparency. Passed at the onset of the overdose crisis, in a city that outpaces most others in overdose deaths, the shameful consequences of the Northeast Overlay District continue.

Feldman noted that Henon escaped significant criticism for what she considers his role in preventing access to treatment at a critical time, when overdoses were just beginning to hit crisis level.

“If there was more access in Northeast Philadelphia to quality treatment where people didn’t have to travel, [if] it was convenient within their own community, would we see as many overdose deaths as we see in Northeast Philly?” she asked.

Rather than address this self-inflicted problem, most Northeast Philly officials prefer to turn their alarmist focus on the highly visible drug use of Kensington Avenue. They stereotype that diverse neighborhood and segregate their own, ignoring what should be a city-wide concern.

Around 4,000 Philadelphians have died an opioid-related death since the advent of the Northeast Overlay District in 2013. Between 2017 and 2018 alone, almost 500 people died of an overdose in the area covered by Henon and O’Neil’s bill. Methadone is shown to reduce mortality for people with opioid use disorder by about 50 percent. Although it would be unfair to say the bill caused all of those deaths, it sure didn’t help.

As of 2018, there were roughly 10,000 people taking advantage of medication-assisted treatment (MAT) services in Philadelphia—not including private or cash-pay programs—of whom around 5,000 were prescribed methadone. But according to a report by the Pew Trusts, most licensed MAT providers were clustered in Kensington and further south, with about eight scattered across Northeast Philly. Of those, just two offer methadone (not including The Healing Way, which is a private clinic).

“It becomes boundaries or barriers that are too hard to navigate, and then maybe people won’t consistently stay in that service.”

“We cannot think that there aren’t people with drug problems in Northeast Philly, because there are,” said Devin Reaves, executive director of the Pennsylvania Harm Reduction Coalition. “And there are people that are in recovery in Northeast Philly and we want to make it as easy as possible for them to begin and sustain their recovery journey and access medications for opioid use disorder.”

“We have this small window of time when somebody says I’m willing to get help,” he told Filter, noting how burdensome it is to have to drive to the other side of town or hop on three buses to make a daily methadone appointment. “It becomes boundaries or barriers that are too hard to navigate, and then maybe people won’t consistently stay in that service.”

Both Reaves and Feldman were quick to point out that, even in the age of qualified doctors being able to prescribe Suboxone, methadone remains a lifesaver for many—whether because it works better for some patients, or because of factors such as insurance coverage or personal preference.

These days, Mayor Jim Kenney is calling for more MAT services across Philadelphia, a result of the Opioid Taskforce he coalesced a few years ago. But even as the city government promotes more access to treatment, pockets of resistance remain in Northeast Philadelphia, with local groups organizing against clinics, recovery houses and, yes, Safehouse.

The disparities are partially a product of a growing racial divide in Northeast Philly, which was originally home to white-flight settlers in the 1960s and 70s, but has in recent times experienced an uptick in immigrant populations and communities of color. In 1990, the area was 92 percent white, according to a report by the Pew Trusts. By 2010, that number fell to just under 60 percent, as white people migrated out and African American, Asian and Hispanic communities grew.

Despite its growing diversity, Northeast Philadelphia can still feel segregated from the rest of the city. In 2012 a local swim club made national headlines when management used racially charged rhetoric to bar scores of black children from entering. When Wilson Goode was elected Philadelphia’s first black mayor in 1983, racial animus stoked a movement led by local politicians in which the area attempted to secede from the rest of the city. The ultimately failed proposal would have made Northeast Philadelphia an independent municipality called Liberty County. And every four years, populist mayor Frank Rizzo, the city’s own version of Donald Trump, receives a few write-in votes in the mayoral election, even though he’s been dead since 1991.

As Andre Reid observed, the movement to limit treatment options in Holmesburg and Mayfair not only succeeded in further segregating the city, but also helped to widen health disparities in black neighborhoods. White residents dying in communities of color caught the attention of local officials, at least while the cameras were rolling; black people slipped under the radar.

“We’ve got to start looking at disparities in African American communities.”

“It came back to bite them,” he said of the communities that pushed against local methadone clinics. If they hadn’t done so, “Now, you wouldn’t have to ride down Kensington on Christmas with a trunk full of gifts looking for your child. You would have been able to go and drop them off around the corner and meet their therapist, and the methadone program would have become part of the community. But you didn’t want to address the issue. You said, ‘We don’t want it here. It could be anywhere else but here.’”

He also called for more significant investment in the black community around this issue. “We’ve got to start looking at disparities in African American communities,” said Reid. “We’ve got to start looking at these young black boys messing with these perc 30s. We’ve got to start looking at the counterfeit drugs that when the doctors are slowing up more counterfeits are making it to the street.”

Things may finally be changing, however slowly.

Following the 2018 appointment of pro-reform District Attorney Larry Krasner, activist groups from across the city came together to form the Alliance for a Just Philadelphia. The initiative resulted in the People’s Platform—a document that outlines a bold, progressive vision for the city’s future on everything from criminal justice to income inequality to housing affordability and more.

The Platform strongly supports harm reduction, including Safehouse’s proposed safe consumption site in South Philly. And it calls for an end to the ban on methadone clinics in Philadelphia’s first, sixth and tenth districts.

It’s potentially a winning proposition, too. Last year Alliance member and Working Families Party candidate Kendra Brooks adopted the Platform when she became the first-ever third-party nominee elected to a City Council seat. As Brooke Feldman noted, the city needs elected officials to care about this issue. However, politicians are only part of the solution.

“Not only should Northeast Philadelphia be held accountable for being supportive of its residents,” said Feldman, “and that includes offering treatment resources right there in the community, but Northeast Philly should also be accountable for not pushing its problems on the poorer parts of the city.”

Image is a detail from a 2010 graphic, representing the predominant racial populations in Philadelphia (blue = black; red = white; orange = Hispanic; green = Asian) based on 2000 census data, by Eric Fischer via Flickr/Creative Commons 2.0.

The post The Legacy of Northeast Philly’s “Redlining” Against Methadone Clinics appeared first on Filter.