Amid a wave of synthetic drugs in recent years, Kensington has emerged as the locus for a different kind of experimentation, through a new generation of freelance entrepreneurs. Their bathtub chemistry is often guided by trial and error—leaving doctors, public health officials and harm reductionists struggling to understand the latest side effects. Over the past 12 months alone, these have included palsy-like rigidity in the hands and arms of some drug users; an outbreak of necrotic skin lesions; and a rise in the number of people who inject drugs losing consciousness, or wandering into traffic in a state of semi-consciousness.

Last year, a concerned toxicologist from the nonprofit Center for Forensic Science Research & Education (CFSRE) at the Fredric Rieders Family Foundation, the academic and research arm of NMS Labs outside Philadelphia, conceived of a new testing program. It employs sophisticated mass spectrometry to reveal the composition of retail-level street drugs.

Alex Krotulski, an associate director of the CFSRE, says the ultimate goal is to predict the next poisoning outbreak before it happens.

“Through various surveillance and monitoring initiatives, paired with information about drug use habits and preferences, we decided it was vitally important to develop a program that could answer complex questions about drug use and trends by using accurate and reliable scientific data,” Krotulski told Filter.

The program, called NPS Discovery, deals with many aspects of drug use, markets and trends, but its reliance on real-time testing of street drug samples is what sets it apart. (Full disclosure: I was an unpaid adviser to the program during its inception and provided some early samples for testing.)

“Our program focuses … on timely information for rapid dissemination to all affected communities.”

Relatively few programs unrelated to law enforcement have both the will and the technology to fully analyze drug samples and compile data. The Dope Project, in the Bay Area of San Francisco, was a trailblazer when it began a sample testing program several years ago. The Urban Survivors Union in North Carolina recently acquired a mass spectrometer to decipher the ingredients of street drugs. Another program, supported by Brandeis University, exists in Massachusetts.

But most research on the evolution of synthetic drugs continues to rely on postmortem toxicology, or the results of tests taken in conjunction with civil or criminal court cases. Since these tests are focused on what happened in the past rather than taking a snapshot of the current market, they have little preventative value.

“The drug market remains a highly dynamic landscape … data and information from six months to a year ago is likely already out of date and not actionable in the current climate,” said Krotulski. “Our program focuses specifically on the acquisition of timely information for rapid dissemination to all affected communities.”

Krotulski’s mission bore fruit with the release of NPS Discovery’s revealing first report earlier this year. It’s a mission driven by Philadelphia’s recent experiences.

What Happens When We Don’t Know

Over the past several years, novel psychoactive substances (NPS)—a catch-all term used to describe countless synthetic variants of completely different drugs—have taken the United States by storm, in some cases all but displacing demand for their organic predecessors.

In 2000, when synthetic cannabinoids were first hitting US streets as an alternative to marijuana, young Kensington residents on probation particularly favored them. They were a means to avoid positives on drug tests that didn’t detect K2 or Spice, as some of the variants were branded.

Then came fentanyl. By around 2016, it had displaced heroin as the primary ingredient in Kensington heroin, as my own informal testing confirmed, among much other evidence. This cut the cost of a bag of “dope” in half, from $10 to just $5. People could now fix up for the price of a Starbucks latte. But the impact of uncertain dosages of the powerful synthetic on people who often didn’t know what they were using was deadly. In 2017, more than 1,200 people died in Philadelphia of drug overdoses—three times the previous average annual rate.

City health officials responded by flooding the streets with the overdose reversal drug naloxone. But in the summer and fall of 2018, a new drug concoction would test the limits of that strategy when many hundreds of people fell ill after injecting Kensington dope. In most cases naloxone didn’t seem to help—people who received it were experiencing unusual reactions and becoming severely agitated.

To Krotulski, the event revealed the limits of toxicology reports in deciphering Philadelphia’s increasingly Balkanized synthetic drug market.

Subsequent testing revealed the cause. Several brands of Philly dope had been mixed with a powerful synthetic cannabinoid. Not only was naloxone ineffective at reversing that drug’s effect, in some cases it made things worse—by blocking the sedating effects of any opioids in the mix, and leaving people experiencing the often-unfavorable hallucinogenic properties of the synthetic cannabinoid alone.

“I felt like I was trapped in a box and I couldn’t get out,” one middle-aged man told me in the weeks following the outbreak. “I thought I was gonna die. I never want to feel that way again.”

That situation lasted only a couple of months. But it demonstrated how harms follow when public health responses are two steps behind rapidly changing drug markets.

Krotulski helped to identify the key contaminant in that case: It was 5F-AFB, one of several hundred potent synthetic cannabinoid variants. To him, the event revealed the limits of toxicology reports in deciphering Philadelphia’s increasingly Balkanized synthetic drug market. And this inspired what became NPS Discovery.

“Before we investigated these cases of 5F-ADB and heroin/fentanyl, we understood the possibility of drug mixing and the implications of taking different psychoactive substances together, but we did not fully understand the downstream effects on drug users, clinical providers, laboratories, and many others,” Krotulski explained. “These circumstances stressed the need for investigating raw drug materials, as this was the only way we would understand the true nature of the drug supply and its potential harm.”

The Project’s First Findings

NPS Discovery has grown and now has many collaborators and partners, including Philadelphia’s Department of Public Health. In February, these organizations collectively released their first report.

The report illustrates a market in  a state of constant flux—driven by drug laws, and the creative chemistry and marketing designed to circumvent them.

Nearly 100 drug samples were obtained and tested. While heroin is still present in some bags of Philly dope, as well as fentanyl and its analogs, the predominant ingredient has become xylazine—a non-opioid animal sedative whose emergence I reported on for Filter in 2019. Every single “heroin” sample tested positive for the drug, which can be readily obtained by anyone with a veterinary license.

Xaylazine—a vasoconstrictor that impairs blood flow to the extremities—is believed to be responsible for an outbreak of necrotic skin lesions around the injection sites of some people who use drugs. Researchers from the University of North Carolina told me they are concerned about xylazine causing dangerously low blood pressure, and are investigating a link with low red blood cell counts.

Counterfeit pills also remain an issue. In one case, a tablet sold as “ecstasy” turned out to be methamphetamine and caffeine. In another, a “generic oxycodone” tablet was revealed to contain no oxycodone at all, but rather was pressed with para-Fluorofentanyl—an analog that Krotulski said is believed to be synthesized in Mexico and is showing up in more powder and pill samples.

The white powder samples did indeed contain cocaine—typically cut with lidocaine, levamisole or caffeine.

In some cases the data showed improvements in market conditions, or else dispelled long-running myths about the composition of street drugs.

Powder cocaine, sold in Kensington in bags ranging from $5-$20, has been the subject of much conjecture among people who use it. “All this coke is junk,” Ana, my long-time fixer and translator has told me. “It’s got bath salts in it.” Dozens of other people have told me that much of Kensington’s coke is really composed of the plethora of cathinones colloquially known as “bath salts.”

However NPS Discovery’s mass spectrometry testing did not reveal a single cathinone. The white powder samples did indeed contain cocaine—typically cut with lidocaine, levamisole or caffeine.

Meanwhile, methamphetamine in Philly seems to be largely unadulterated, according to all of the samples tested. NPS Discovery is working on instituting quantitative mass spectrometry testing to determine drugs’ purity levels.

In one piece of good news, Krotulski’s report suggested that the deadly practice of pressing fentanyl into “benzodiazepine” pills (particularly “Xanax”) may be over in Philadelphia. None of the pills sold as Xanax that were tested showed up positive for fentanyl. Instead, pill pressers seem to have discovered the handful of unscheduled benzodiazepine analogs readily available in the research chemical market, including etizolam and flurazepam. In this case, supply-side innovation worked to the benefit of harm reduction, not against it.

The NPS Discovery program and others like it make clear, as if we needed a reminder, that prohibition has failed—miserably so. Economics will always beat bans. Drug suppliers don’t want to harm their clients, but negligence and inexperience will create harms when bad policies dictate the means of pursuing profits.

Our policies incentivize bad business practices, with no regulatory oversight. Product innovation, for example, seems to have eliminated the potential for someone to die of an opioid overdose in Philadelphia after taking what they believed to be Xanax. But I’d bet my last dollar that if pressed etizolam becomes more widespread, that will be pushed underground too.

It is hoped that more NPS Discovery reports, of increasing scope, will follow. It will be up to public health officials and harm reductionists to put their potentially lifesaving information to the best possible use.

For a deep dive into the findings of NPS Discovery’s first report, listen to Christopher Moraff’s upcoming interview with forensic toxicologist Alex Krotulski on the podcast Narcotica.

The post The Mission to Save Lives by Deciphering Philly’s Volatile Drug Supply appeared first on Filter.

In a 2-1 decision, the Appeals Court adopted a broad interpretation of 21 USC S856—the section of federal code known as the “crack house statute” that was added to the Controlled Substances Act in 1986, making it a felony to “knowingly open, lease, rent, use, or maintain any place for the purpose of manufacturing, distributing, or using any controlled substance.”

The nonprofit group Safehouse—founded in 2018 by former Pennsylvania Governor Ed Rendell, along with Ronda Goldstein of the AIDS Law Project of Pennsylvania and Jose Benitez, executive director of Prevention Point Philadelphia—has been seeking to open the first sanctioned SCS in the United States. The group maintained that the law does not apply to SCS, since the “purpose” of a facility such as Safehouse is not to facilitate drug use, but to to save lives.

Writing for the court, Justice Stephanos Bibas took aim at Safehouse’s interpretation of the language of the law, and included would-be clients of the site as pertinent actors in determining intent.

“Safehouse’s visitors will have the significant purpose of drug activity,” he wrote. “True, some people will visit Safehouse just for medical services or counseling. Even so, Safehouse’s main attraction is its consumption room. Visitors will bring their own drugs to use them there. And many of Safehouse’s services will revolve around the visitors’ drug use there.”

As I wrote in 2015, before he was appointed to the Third Circuit by President Donald Trump, Bibas holds some extreme views that include simplistic moral pronouncements on the roots of criminal behavior (a lack of self-discipline), the nature of addiction (bad choices) and prison violence (incarcerated people aren’t praying enough).

Many in the public health and harm reduction communities, distracted by COVID-19 and the recent political crisis, were caught off guard by the latest ruling, which was argued before the court back on November 16.

Calling the decision “misguided,”  Lindsay LaSalle, managing director of policy for the Drug Policy Alliance*, said in a statement: “As the COVID-19 pandemic is exacerbating the already devastating overdose crisis, the Third Circuit’s reversal of the earlier court’s decision—which held that safe consumption sites do not violate federal law—will inevitably result in the unnecessary loss of countless lives.”

“We still believe this is a lifesaving initiative and we are as committed to the idea as ever.”

Reached for comment on the day of the ruling, Safehouse’s Ronda Goldfein seemed in a better mood than she might have been, however. “We are certainly disappointed that these two judges didn’t see it our way,” she told Filter, “but two judges’ opinions of the law don’t mean they are correct. We still believe this is a lifesaving initiative and we are as committed to the idea as ever.”

I also spoke with one of the founders of a Philadelphia activist group that was quietly planning to open an unsanctioned SCS in 2017, who asked to remain anonymous to avoid potential legal repercussions.

“What many of these judges and legislators don’t think about is that no matter what they decide is illegal, or not legal, or however they want to interpret the possibility of establishing a lifesaving harm reduction intervention that has been proved to work over decades … consumption sites already exist, whether they like it or not,” the activist said. “I honestly don’t care what the court thinks. The evidence and the firsthand experiences of those in other countries with legal SCS speak for themselves: Safe consumption sites save lives, they prevent the spread of communicable diseases, and they affirm the humanity of people who use drugs. The longer we talk, the more people die, and those deaths are in part on the hands of those who continue to oppose harm reduction.”

Regarding legal options, Goldfein said that Safehouse could take the case back to the District Court level and reargue the case based on the Religious Freedom Restoration Act—which grants religious exemptions under federal law (and was most famously invoked by Hobby Lobby to avoid offering contraceptives under its employee health plan). Safehouse included a RFRA argument in its initial filing but it became moot after Judge McHugh ruled in the group’s favor on statutory grounds.

Another option—to push ahead to the Supreme Court—seems unlikely to bear fruit, given the court’s current composition.

“I am hopeful that a new administration, one that believes in science, will see it differently.”

Going back to the lower court leaves open the possibility that a Biden Justice Department will be more sympathetic to Safehouse’s position. “I am hopeful that a new administration, one that believes in science, will see it differently,” said Goldfein.

However, given that Biden, as a Senator with a long history of supporting the drug war, penned a portion of the law in question, it’s very far from a given that he would embrace SCS.

Having covered the fight for SCS in Philadelphia since 2017, I found the latest news a shock but not a surprise. Ever since Mayor Jim Kenney’s reluctant January 2018 embrace of SCS (which came two months after the election of District Attorney Larry Krasner, who had already said he wouldn’t prosecute good-faith efforts to prevent overdoses), local pushback has mounted.

Following two significant court victories, in which Federal Judge Gerald McHugh Jr. first declared Safehouse’s mission did not violate federal law, and then refused to stay the ruling until the Third Circuit heard the federal government’s appeal, Safehouse announced it would open its first facility in South Philadelphia, surprising many who had been told the group would open a site in north Philly’s Kensington neighborhood first.

A press conference on February 26, 2020 was packed with angry South Philly residents, some of whom took out their vitriol on Gov. Rendell personally, as Filter reported. “You blindsided us!” shouted one woman. “This is unacceptable, and you were a sneak about it. Look at us when we tell you, Mr. Rendell: You were a sneak. I will no longer call you governor because you’re not a governor, you’re a sneak.”

The following week saw hundreds of anti-SCS protesters take to the streets, many of them wearing pro-Trump swag and MAGA hats. But local Democrats also promised that no site would open in Philadelphia. One councilmember introduced legislation to require 90 percent community support before a SCS could open in any neighborhood.

But another man’s words ring in my ears today. When I reported for Filter on Safehouse’s big court win in October 2019, Alex Kral, a leading proponent and researcher of SCS, wasn’t ready to celebrate.

“Having been at this for 12 years and having had so many victories nullified along the way, I’m still a bit wary of what comes next,” he told me. “The champagne isn’t popping yet.”

It’s sad to have to give credit where it’s due, but he called it.

*DPA previously provided a restricted grant to The Influence Foundation, which operates Filter, to support a Drug War Journalism Diversity Fellowship.

Photograph of overdose victims’ images displayed outside a Safehouse hearing in Philadelphia in 2019 by Christopher Moraff

The post Appeals Court Overturns Ruling That Legalized SCS; Safehouse Fights On appeared first on Filter.

As we embraced in celebration, it never dawned on us that we, like so many others, were about to enter the most harrowing year of our lives—marred by the COVID-19 pandemic and the hardships of lockdown, and by the arrival of National Guard troops, armed with automatic rifles, onto the streets of Kensington, North Philadelphia, following protests and brutality after the killing of George Floyd.

Amid all this, Carolyn stayed home, while my work required me to keep venturing out into the field, to report on these situations and complete the filming of a documentary I’m co-producing on Philly’s fight for safe consumption sites. So she spent too many days quarantined alone during her pregnancy, and experienced the anxiety so common in these times.

Most of all, she was fearful she might contract the coronavirus from me. “Irresponsible” was a word that came up a lot—a hard one for anyone with a pregnant partner to stomach, and all the more stinging to a former chaotic heroin-user like me. But we compromised, worked things out and remained there for each other. We got through it.

And on August 26, Carolyn gave birth to a beautiful girl we named Olivia-Rose, Carolyn’s third child and my first.

In the weeks after Olivia’s birth, Carolyn and I would learn what it feels like to be thrust under the microscope of suspicion around supposed drug exposure.

Olivia arrived through an emergency C-section triggered by Carolyn’s preeclampsia, a prenatal condition involving dangerously high blood pressure. Despite that difficult circumstance, the event should have brought nothing but joy—and joy was, and remains, our overwhelming emotion.

But in the weeks after Olivia’s birth, Carolyn and I would learn what it feels like to be thrust under the microscope of suspicion around supposed drug exposure. It culminated in an unannounced visit by two investigators from the Department of Human Services (DHS), who scrutinized our growing assembly of baby-related goods and questioned me about my decades-old arrests, within earshot of Carolyn’s parents.

But I’m getting ahead of myself.

Carolyn’s Kratom Use

Carolyn, who has no history of substance use disorder, suffers from a chronic illness known as Ehlers-Danlos syndrome (EDS)—a painful condition of the ligaments and joints that causes periodic subluxations (partial dislocations). During especially bad flare-ups, this can keep her bedridden for several days.

Few people are familiar with EDS—and for years, Carolyn was misdiagnosed with fibromyalgia, which falls under the rubric of a rheumatological disorder. Some doctors continue to deny that fibromyalgia even exists. And even those who don’t are reluctant to treat it, because it typically involves prescribing opioids.

EDS, with which Carolyn was finally diagnosed, is characterized by at least some objectively measurable hallmarks, such as hyper-flexibility, skin that bruises easily and digestive issues. However a verified diagnosis requires expensive generic testing, which is not covered by most insurers.

When I first met Carolyn about six years ago, she was frequently in pain. In 2017, when she finally got a long-awaited referral to a pain management clinic (and had waited another three months for her appointment), the physician told her she was “too young” to be on pain management. She was 36 at the time, a fact evident on her intake forms.

It didn’t prepare me for the abject hopelessness of my own loved one being “too much trouble” to have her basic medical needs met.

I offered to go back to the doctor with her and demand an explanation, or at least a refund of her co-pay, but like so many downtrodden pain patients, Carolyn was resigned to the decision. “The more you ask for what you need, the more it looks like you’re drug-seeking,” she said.

Like almost anyone suffering from one of the so-called “invisible diseases,” Carolyn has endured stigma and mistrust, particularly from within the medical community. Even sympathetic doctors have been reluctant to prescribe the medication she needs during flare-ups.

Years of covering the impact of opioid policy on the chronic pain community didn’t prepare me for the abject hopelessness of my own loved one being “too much trouble” to have her basic medical needs met.

When Carolyn acquired some Vicodin from a friend during one particularly bad flare-up, I  tested the pills she bought. They were negative for fentanyl. But that’s when I asked her if she’d ever heard of kratom.

Kratom, derived from a shrub grown in Southeast Asia, has mild-to-moderate painkilling properties and has been the subject of controversy in recent years. During the last year of the Obama administration, the Drug Enforcement Administration announced its intention to schedule it. Faced with widespread backlash from the pain community, the DEA balked and punted the issue to the Food and Drug Administration, which in 2018 classified kratom as an opioid. The move has left those who depend on kratom, especially former opioid patients, in a state of fear as the legal status of the supplement remains in jeopardy.

For Carolyn, it’s been a game-changer. It’s enough to keep her pain under control.

Kratom is already illegal in at least five states, and active-duty military personnel are prohibited from using it. But in Pennsylvania the supplement is sold openly and legally in many herb and smoke shops.

Although many people say that kratom has helped them to quit or replace conventional opioids, the FDA has cracked down against marketing it for that purpose. For what it’s worth, several people I know who use heroin and fentanyl have not found kratom to be helpful in this way.

But for Carolyn, it’s been a game-changer. She buys kratom in bulk from a reputable supplier, and drinks it mixed with hot chocolate—about three or four mugs a day. The mechanisms involved may be under-researched, but it’s enough to keep her pain under control. I have never seen her exhibit any signs of opioid intoxication. Indeed, she would no longer use Vicodin or other pharmaceuticals now that she has kratom.

Carolyn’s kratom

Yet the active compound in kratom—mitragynine—does stimulate the opioid receptors, meaning it can cause physical dependency. And although Carolyn insists she has never experienced kratom withdrawal, we discussed the pros and cons of her staying on it through pregnancy.

As my Narcotica podcast co-host Troy Farah reported for Filter in late 2018, there is a dearth of research on the effect of taking kratom during pregnancy. But at the time, the scientific literature held only seven cases of infants born of kratom-using women in North America exhibiting signs of opioid withdrawal.

Faced with such dilemmas, physicians generally consider whether the potential harms of taking a medication outweigh the benefits. Given that Carolyn was placed on oral Dilaudid during the final weeks of her previous two pregnancies, due to intense pelvic pain caused by her EDS, it seemed sensible that she should continue to use kratom.

Olivia’s Birth and the Finger of Suspicion

Olivia’s entrance into the world at Pennsylvania Hospital in downtown Philly happened so fast that I could barely process what was happening. With Carolyn’s blood pressure rising and Olivia’s heart rate dropping, Carolyn was abruptly wheeled into an operating room. I was left standing in the hallway. “Just wait here,” a nurse told me.

Twenty minutes later, I was presented with my daughter and a small bottle of formula to begin feeding her. We had been in the hospital just over an hour. I held Olivia for 40 minutes before Carolyn joined me, floating in and out of consciousness as her anesthetic wore off.

That’s when a nurse noticed that Olivia was having trouble keeping her formula down, and expressed mild concern over her gag reflex. Still, she acknowledged that babies born of C-sections frequently hold fluid in their lungs that would otherwise be expressed during a vaginal birth.

And that’s when I made a decision that I will likely forever question: I mentioned Carolyn’s kratom use.

A little while later, a nurse entered and asked Carolyn’s consent for a drug test.

Unsurprisingly, the nurse had never heard of it. Then came the pediatrician on call. She had never heard of it, either. “I don’t think this has anything to do with the kratom,” she told me.

A little while later, a nurse entered and asked Carolyn’s consent for a drug test. She was in no condition to give consent, and I emphasized to her that she was not obligated to do so. But a technician proceeded to draw several tubes of blood. Carolyn does not remember any of it.

Her test came back negative for opioids, and positive for THC (which does not pass the placental wall, meaning Olivia’s own test was negative). There were also traces of the Adderall Carolyn which takes for ADHD, but had largely cut out during her pregnancy.

A hospital social worker later admitted that Carolyn’s negative opioid test was met with some dismay.

“We thought for sure there would be something there,” the social worker told us, hinting that doctors believed I mentioned kratom in order to cover for some other opioid use.

Carolyn was transferred to a private room and Olivia to the neonatal intensive care unit (NICU). We were told that due to COVID-19, the general nursery had been closed, and only one parent could visit the NICU at a time. For the next two days, I visited Olivia, marveling over her tiny fingers and huge dark eyes. She slept in my arms and did exactly what I had been told babies should do after they are born: eat, sleep, poop and cry.

The subject of kratom didn’t come up again.

The staff had put our daughter on morphine, without consulting us, and with no presence of any opioid in her system.

Olivia had been born on a Wednesday. By Friday, Carolyn was able to make it to the NICU to begin nursing her.

On Saturday, we learned from a nurse that the staff had put our daughter on morphine, without consulting us, and with no presence of any opioid in her system.

In case you missed that: Doctors at a major city hospital introduced morphine to a newborn baby with no opioid previously present.

For the next two weeks we stood by helplessly, watching as a team of doctors struggled to explain a decision they were clearly beginning to question. One rotating pediatrician would decrease the frequency of Olivia’s dosing, only for the next to increase it. Before long, even hospital staff had to acknowledge that our baby was becoming dependent on morphine.

Carolyn was also told to continue her kratom use on the off-chance that whatever small amount made it through into her breast milk would help ease Olivia’s withdrawal from morphine.

My call to one of the pediatricians who treated Olivia to request comment was directed to the main pediatrics line, and no comment had been received by publication time.

Babies can’t tell you how they feel, so pediatricians rely on a metric called the Finnegan Scale to determine levels of neonatal abstinence syndrome (NAS). The scale includes 21 metrics, such as sweating, poor feeding and crying up to five minutes without consoling—and many of them are highly subjective. According to one assessment, the scale is “a complex and complicated tool for routine use in many nurseries,” and the “reliability and validity of the Finnegan Scale is not well established.”

An Unsatisfying Outcome

While Carolyn and I were open to the possibility that some mild NAS might have resulted from her kratom use, we were not prepared for the uninformed assumptions, nor for the total lack of medical knowledge about the subject. Not one of our daughter’s caregivers had so much as heard of kratom. I could practically hear the clicking of computer mice throughout the hospital as doctors, nurses and social workers struggled to learn what it was.

By Day Ten we were exploring both a transfer to another hospital, and the idea of taking Olivia home against medical advice. But by then, a social worker who had previously told us she conferred with supervisors and saw no legal obligation to file a report with the state Department of Human Services—which includes child protective services—called them anyway.

When we confronted her about this decision, she explained she was in fact obligated to call after all—not because of the NAS, but due to the presence of THC in Carolyn’s system. Despite the fact that it was not present in Olivia’s.

The investigators peppered us with questions about drug use and our criminal records.

Investigators of child neglect arrived swiftly and unannounced. One afternoon during our ordeal, I was leaving Carolyn’s parents, who live near the hospital and have been helping with her care, when I got a call from an unknown number. It was the DHS. They were a block away and asked if we could meet.

Moments later, they arrived at the posh apartment where Carolyn’s parents live. It was satisfying to inform them they would have to get approval from the concierge before entering.

Inside, the investigators peppered us with questions about drug use and our criminal records. In my case, that meant describing past misdemeanor arrests, the last of which was in 2003. These questions perturbed me, in part because all that information could easily be found in a public docket search.

After Carolyn’s mom proudly showed off all the baby gear that had been accumulating (the function of some of which I still don’t understand), the agents left. They would be in touch, they said.

The hospital went on to inform us that Olivia would not be released without their stamp of approval.

But after 15 days, with Carolyn spending entire nights in the NICU so she could be there to nurse, the hospital was beginning to come to terms with the possibility that they made a mistake.

By then, they had dropped Olivia down to the lowest dose of morphine possible, once every 12 hours (which, given the rapid half-life of the drug, makes no sense). Another doctor proposed further reducing the dose, to once every 24 hours. This sparked a backlash from nursing staff, who explained that reintroducing morphine after 24 hours of abstinence was counterproductive and to their knowledge, not even practiced.

I am left to wonder if the risk of a lawsuit was playing on staff’s minds at this point, as they sought to prevent further disruption to the beginning of Olivia’s life.

Finally, after 19 days in the NICU and 48 hours off of morphine, the hospital signed off on Olivia’s release.

Carolyn and I got to see our daughter together for the first time as we left the hospital.

Adding insult to injury, the hospital social worker missed a DHS call confirming permission for this. We waited three extra hours before I personally called the agency investigator.

“I left her a message, didn’t she tell you?” the DHS worker said.

Carolyn and I got to see our daughter together for the first time as we left the hospital. As we embraced, one doctor with whom we’d developed a good relationship approached, asking if she could use our case for a paper about kratom and NAS.

“Absolutely,” we said, and she and Carolyn arranged a time for an interview.

We received no apology or explanation for what happened to us. But with more people taking kratom amid anti-opioid fervor and a world that criminalizes drug use during pregnancy, if our experience can be used to prevent something like this from happening to others, we’ll have to take that.

Photographs by Christopher Moraff

The post My Daughter’s Birth Exposed the Medical Community’s Anti-Drug Stigma appeared first on Filter.

John’s drug use varied. He regularly smoked crack cocaine and marijuana, but avoided opioids. Since moving last year to South Philadelphia—a neighborhood second only to Kensington in Philly overdose fatalities—I regularly met John outside the subway stop or the local bodega where he panhandled. Our short conversations and shared cigarettes gave me my first foothold into the insular drug subculture of South Philly, so different from my usual beat in Kensington.

Then, in early August, I stopped seeing John. It was several weeks before he returned, having visibly gained weight. He told me he’d been in rehab and was looking for a recovery house to take him. I later learned from one of John’s confidantes that he had been arrested for drug possession and spent several days in jail, before being transferred to a court-ordered treatment program—stigma must have stopped him disclosing that.

At the time of his arrest, John was regularly smoking crack. But during his confinement he began regularly using Suboxone—the buprenorphine-naloxone combination widely prescribed to treat opioid addiction—despite not using opioids previously. He continued using it after his release.

Until recently, I had never met a Suboxone user who didn’t previously or concurrently take another opioid.

There has been an abundant market for Suboxone on the streets of Kensington for several years, as I’ve reported for Filter. And some municipalities, including Philadelphia, have begun dropping criminal penalties for possession without a prescription. But until recently, I had never met a Suboxone user who didn’t previously or concurrently take another opioid.

Those I spoke with in Kensington all used Suboxone in the context of their other opioid use. For some, it was just the next best option at times when heroin and fentanyl were less available. Many employed the partial opioid agonist in a practice known as “chipping”—using heroin only occasionally while filling in with Subs. Others bought Suboxone on the street for the purpose for which it’s widely prescribed—to help them recover from an opioid addiction when they lacked access to healthcare providers, or perhaps to supplement a prescribed dose that they found too low.

It was disconcerting to begin meeting people for whom Suboxone was their first opioid, when harm reduction advocates (and I) have often maintained that no such market for diverted Subs exists. Yet the fact that it does exist—on however small a scale—doesn’t change the fundamental point that diversion is nothing to fear.

The reasons for its emergence are complex, but a significant factor is the ease with which Suboxone, thanks particularly to its sublingual film form, is smuggled into jails and prisons—and then concealed and divided once inside. Together with synthetic cannabinoids (called  “deuce” on Philly street corners), Suboxone is anecdotally the favorite drug in Philadelphia County’s carceral settings.

Formerly incarcerated people have told me that a single strip of Suboxone, or one of its generic rivals, retails for $80 inside, representing an enormous profit margin for those who provide it. I once met a grandmother who would smuggle in the thin strips during visits with her son in state prison. “It’s easy, they never check under here,” she said, pointing to her breast.

Once inside, the strips are cut into smaller pieces which are taken orally, or else dissolved in water and snorted. The euphoric effects of buprenorphine on a person without opioid tolerance are indistinguishable from other prescription opioids. Regular use can lead to physical dependency. So released people, as they have recently described to me, have been returning to the streets with a taste for the orange films, which are sold up and down Kensington Avenue and on street corners across Philadelphia.

But incarceration isn’t the only factor. Around the time John found himself in handcuffs and on his way to rehab, I got a call from Nas, a Kensington resident, complaining about a hike in Suboxone prices there.

“Man, I just paid $15 for a strip,” Nas told me—a 50 percent markup from the usual $10. “And it took me forever to find anyone with Subs.”

That surprised me. Before I was forced to retreat into coronavirus-induced quarantine with the rest of the city, diverted Suboxone was so abundant in Kensington that sellers would practically trip over each other to make a deal. What Nas was telling me seemed impossible.

So I recently returned to Kensington Avenue to see what was happening. Sure enough, there were visibly fewer people selling Suboxone. However, I did find that prices were reliably still $10 a strip (which, it’s worth noting, is the medication’s retail price in pharmacies across the city).

But evidently something was going on. The shouts of “Subs! Subs!” that were ever-present around the transit stations of North Philadelphia had noticeably quietened. One day this month, I encountered just one person hawking Suboxone—which is still illegal to sell, although possession was effectively decriminalized by District Attorney Larry Krasner at the beginning of the year.

It was tempting to draw an easy connection between that reform and the apparent shortage of street Suboxone, but that would be naive. I have seen countless drug corners reopen moments after a raid, and not a single person I know factored marijuana decriminalization into their decision to smoke or not.

“At least you know what you gettin’.”

So I went to the best place I could think of for answers.

“B” is a 32-year old aspiring rapper who sells Suboxone to supplement his income as a dishwasher. He’s very tuned into the dynamics of Kensington’s drug markets, which have changed rapidly since 2017, when the closure of “El Campamento” pushed drug selling eastward from West Kensington onto corners manned by mostly Black freelancers, who, like B, frequently commute to work (in his case from West Philadelphia).

“Young Black men grow up seeing fiends on the block buying dope [heroin] and hard [crack], so they draw a hard line between those drugs and pharmaceuticals like Percocet and Adderall,” said B, who takes Adderall himself. “At least you know what you gettin’.”

But the introduction of prescription monitoring databases has made prescription fraud and doctor-shopping harder. Thirty milligram oxycodone pills, long a favorite among pharmaceutical opioid users, have shot up in price recently, B said—from an already-pricey dollar per milligram to as high as $50 a pill.

Other sources seem to confirm this hike. One contact bragged that she could get me the pills for $25 a piece, “but only for you, and only if you buy the whole bottle.” A different seller told me he recently moved a bottle wholesale at $45 per pill.

With oxy prices so high, B said, and heroin eschewed by many youth of color for its stigma and dangerous adulteration, many people are finding Suboxone an alluring alternative, which means increased demand for the drug. That, combined with potentially large numbers of people coming out of jail who have become habituated to Suboxone, seems to have led to this changing market—one that includes first-time, recreational Suboxone use.

“If more people are taking it, instead of playing Russsian roulette with pills or street dope, that I consider a benefit to harm reduction in the city.”

Again, this is not necessarily a bad thing—and quite likely a good one, as some doctors are happy to point out. If anyone is seeking out Suboxone having never used opioids before, consider what they would likely seek instead if Suboxone were unavailable.

“I hear more people are taking Suboxone, with or without a prescription, and I think good,” said Dr. Joseph D’Orazio, an emergency room physician and addiction medicine practitioner at Temple University Hospital in North Philadelphia.

D’Orazio said he has never had anyone present with a “Suboxone addiction”—and added that buprenorphine’s 24mg a day “ceiling effect,” which makes the drug ineffective in large daily doses, means Subs are just about the safest drug sold streetside.

What’s more, Suboxone’s tamper-proof packaging and unique sublingual delivery formulation (which was so valuable to Suboxone’s manufacturer that the company fought for years to keep generic versions off the market) all but eliminate the possibility of counterfeit versions and the adulteration and danger they would present.

“I work in one of the busiest emergency rooms in Philly and have never once encountered a Suboxone overdose,” D’Orazio told Filter. “If more people are taking it, instead of playing Russsian roulette with pills that could contain fentanyl or using street dope, that I consider a benefit to harm reduction in the city.”

Suboxone, which was introduced as a prescription drug in 2001, has many benefits. But much about its over-regulated availability, or lack of it, remains deeply unsatisfactory. Some prescribing physicians are reputed to charge as much as $350 for an intake visit, followed by $150 a month for follow-up visits for a medication that, as a Schedule III controlled substance, qualifies for five refills.

If non-prescribed Suboxone uptake increases on any scale, it’s difficult to know what long-term impact that might have on use of much riskier opioids. Perhaps some people, finding Suboxone unavailable or unsatisfactory, will move to other opioid alternatives. But for the time being at least, the little orange strips are likely saving the lives of Philadelphians who would otherwise be taking much bigger gambles.

Photograph by Christopher Moraff

The post Suboxone Is Now a Drug of Choice for Some in Philly. That’s No Bad Thing. appeared first on Filter.

According to research conducted by Express Scripts and cited by Harvard Medical School, prescriptions for medications to treat depression, anxiety or insomnia increased by 21 percent between February 16 and March 15, peaking in the final week of that period as the coronavirus accelerated. During that week, 78 percent of all prescriptions filled in these categories were new prescriptions.

Prescriptions of anti-anxiety medications rose the most—by 34 percent over the month studied, with a week-on-week increase of almost 18 percent in that final week.

These figures—and it’s highly likely that subsequent months saw further surges—reflect widespread mental health issues, driven by worries about the coronavirus, experiences of it, personal isolation and financial struggles.

Benzodiazepines—a category including drugs like Xanax, Klonopin, Ativan and Valium—are highly effective at treating anxiety. Their use in drug combinations—not alone—has been a critical factor in the overdose crisis.

In 2016, for example, just about 80 percent of deaths involving a synthetic opioid also involved another drug (including alcohol). Benzos and opioids are a particularly risky combination: The National Institute on Drug Abuse states that over 30 percent of opioid-involved deaths also involve benzodiazepines. In this reality, the term “overdose,” with its implication of too much of a single drug, is arguably a misleading one.

“Benzodiazepine and opioid combinations have become of important concern due to addictive [and] depressant effects which can lead to death,” Alex Krotulski, a research scientist at the Center for Forensic Science Research and Education (CFSRE), told Filter.

The arrival in US illicit drug markets of fentanyl, with its increased potency when compared to heroin, exacerbated a problem that already existed. During the first fentanyl wave in 2006—when more than 1,200 people died in half a dozen major cities from a batch of “china white” traced to an industrial facility near Mexico City—fully 89 percent of fatalities in Allegheny County, Pennsylvania involved a mix of illicit drugs and legal ones—primarily benzodiazepines. Similar trends have continued as deaths increased during the last six years.

So where are many people who seek benzos to manage their anxiety, and who may be dependent, going to turn?

It’s important to emphasize that when used alone and as prescribed, benzos are pretty safe. They are, however, associated with dependence in many people. And this leads—particularly in these times—to a high-risk development.

Pharmaceutical companies and mental health advocates are currently warning of a shortage of critical drugs, including benzodiazepines. Periodic shortages of pharmaceutical drugs predated the pandemic, but have been exacerbated by disruptions to global supply chains in recent months.

Additionally, of course, many people have inadequate access to healthcare providers in the first place—a situation worsened by tens of millions of job losses this year. And some providers find dealing with patients on controlled substances too much of a headache, offering non-benzo drugs instead, like the powerful antihistamine hydroxyzine. (I was prescribed this once. It did nothing for my anxiety, although it did help me sleep—often at times I was expected to be awake).

So where are many people who seek these drugs to manage their anxiety, and who may be dependent on benzos, going to turn?

In Philadelphia, “bars”—the term for tombstone-shaped “Xanax” pills—have become the hottest commodity on street corners. Every day I encounter someone on the streets who is scrambling for 2 mg bars—the most common street benzo, given their strong punch and quick action. Most I’ve spoken with have been prescribed benzos, but ran out.

Prices illustrate issues of supply and demand. In Philadelphia, a 2 mg Xanax bar that sold for $8 a year ago now costs $12. And first you have to find them.

Out of 20 pressed benzo pills he tested, only one came up negative for fentanyl.

Illicitly manufactured, “pressed” pills—Kat Humphries wrote an excellent guide to identifying them, and to wider benzodiazepine harm reduction, for Filter in 2018—can present acute dangers.

When I was testing pills in 2018 and 2019 in Philly, positive results for fentanyl were rare. But recently, a source in the harm reduction community told me that out of 20 pressed benzo pills (“Xanax” and “Klonopin”) he tested over the previous weeks, only one came up negative for the powerful synthetic opioid. He spoke on condition of anonymity, since the pills were for personal use.

It’s little wonder that unscheduled benzodiazepine analogs showed up as the most prevalent Novel Psychoactive Substances (NPS) identified by CFSRE in its NPS Trend Report for the second quarter of 2020.

Benzodiazepines accounted for 59 percent of NPS samples obtained by the lab during the COVID crisis, compared to just 7 percent for analogs of fentanyl. Two drugs in particular, flualprazolam and etizolam, make up the bulk of the illicit market. Both are currently unscheduled (benzodiazepines generally are in Schedule IV), but that is likely to change. I sat in on a DEA symposium on NPS in 2018 that included a section on the growth of the etizolam market, calling it a “disturbing new trend.” 

“The NPS benzodiazepine market has shifted recently to flualprazolam, and the market has begun to diversify more broadly like other NPS classes,” said Krotulski of CFSRE. “Our NPS trends show that it is critically important for laboratories to remain aware of the changing NPS landscape as new substances emerge and old tests may become obsolete.”

However, unlike many drugs designated NPS, etizolam is prescribed by doctors in several countries, including Japan and India.

I have found my anxiety increasing with age, and following a messy divorce in 2017, I decided to see what was out there. I made a few inquiries. A week later, I had 100 bubble-wrapped etizolam pills delivered to my door from a company in India.

The truth is, it’s highly likely I could have simply gone to the doctor and left with a script for Ativan. But even 20 years after my last problematic bout with illicit drug use, I still carry an internalized fear that I will be deemed a “drug seeker.” It just felt easier to avoid the risk of judgement.

It’s difficult to describe the effect of a drug you need; the etizolam did as advertised. It didn’t knock me out, it just helped me cut through the fog of anxiety and function the way others may take for granted.

It was a reminder—one not needed by millions of Americans who are prescribed benzos for anxiety and other reasons—that these are useful drugs with a vital role to play. We just need safe access and sound advice about their use—not increased restrictions and crackdowns that would result in the streets becoming even more littered with tainted pills.

Today, I struggle by on a single prescribed, 1 mg Klonopin pill a day for my anxiety. It used to be 0.5 mg until I gathered the nerve to switch doctors. I remain undermedicated, as many others are.

No one wants to be dependent. But if you‘ve never had a panic attack, you’re forgiven for imagining that dependency is worse than avoiding benzos altogether.

Photograph by Christopher Moraff                 

The post How COVID-19 Is Driving Risks in the Illicit Benzodiazepines Market appeared first on Filter.

It’s being challenged in Kentucky on the grounds that it violates the First Amendment, as well as a person’s constitutional right to due process and equal protection under the law. The suit was brought by the Kentucky Department of Public Advocacy, the state’s public defender office, on behalf of an unnamed client in late June.

The complaint is currently sealed, making it difficult to ascertain the details of the case. (Filter reached out to the Kentucky Department of Public Advocacy for comment; this article will be updated if they respond.) But the constitutional ramifications of civil commitment for drug use have echoed through many states and cases.

Over the past decade, civil commitment laws have taken off—an unfortunate consequence of the evolving national conception of addiction as a “disease.”

While all states have procedures for committing individuals to psychiatric care if they are perceived to be violent or in imminent danger of hurting themselves, until recently these laws did not typically apply to substance use cases, which were frequently the domain of the criminal courts.

Over the past decade, civil commitment laws have taken off—an unfortunate consequence of the evolving national conception of addiction as a “disease” over which sufferers have no agency. According to a dataset published last year by researchers from Health in Justice Action Lab at the Northeastern University School of Law, by March 2018, 37 states and the District of Columbia had laws on the books detailing procedures for civilly committing people with substance use disorders. Most of the statutes were enacted or expanded between 2015 and 2018, at the height of the overdose crisis.

The Kentucky law’s namesake, Casey Wethington, died in 2002 of a heroin overdose. He was 23 at the time. After his death, his mother, Charlotte Wethington, began strongly advocating for a law to provide an avenue to force people with substance use issues into treatment—even those who are not charged with a crime. In 2004, the law was passed unanimously by the Kentucky Senate and 94-1 by the House, although according to a study of its use in Kentucky, it was rarely invoked prior to 2014.

Charlotte Wethington described her reasoning in a 2017 blog post:

“The reality is that everyone using an illegal substance has committed a crime. People driving drugged have committed a crime. Many, like Casey, are never incarcerated and ordered to treatment, dying before their arrest. Casey’s Law is the intervention that can come before the crime and an untimely death.”

No one would wish to unduly criticize a bereaved parent, but the problems with this framework of criminalization and paternalistic control—the very opposite of a harm reduction approach—are evident. It falls into the category of punishing people for behaviors that are not crimes; while possessing drugs may fit the bill, simply being someone who uses them is not a prosecutable offense.

Under Casey’s Law, a friend or family member of the impacted person can petition for up to 360 days of forced treatment for a person who is:

“suffering from alcohol or other drug abuse who (1) presents an imminent threat of danger to self, family, or others as a result of alcohol or drug abuse, or there is a substantial likelihood of such a threat in the near future, and (2) can reasonably benefit from treatment.”

The committed person is granted an evaluation and the right to appeal a decision. They can be held at any certified treatment facility, with the cost paid by the petitioner (not the state).

The Kentucky challenge is currently being argued before the state Court of Appeals. Attorney General Daniel Cameron insists the law is constitutional. “Casey’s Law is critical to Kentucky’s ongoing fight against the drug epidemic, and we are doing everything in our power to defend it in court,” he said in a July 1 statement. “With a rise in illicit drugs like crystal meth and fentanyl, Casey’s Law is an important intervention.”

Studies show that forced treatment is frequently ineffective, and fraught with ethical issues.

But efficacy—even if we were to accept that doubtful premise—does not imply that something is ethical or legal. Even if a tactic worked 100 percent of the time, that wouldn’t make it constitutional. Studies show that forced treatment is frequently ineffective, and fraught with ethical issues.

In other states the legal hurdles to involuntary commitment are even lower than those required by Casey’s Law. In Florida, for example, anyone with direct knowledge of a person’s drug use can file a petition—from a disgruntled ex to an angry neighbor—with no more direct evidence than probable cause.

Beyond the basic ethics of involuntary confinement per se, conditions are another factor. In Massachusetts, for example, civilly committed people—whose confinement may be requested by a police officer, among others—are held in facilities at prisons or jails. This has resulted in at least one lawsuit, as Filter has reported. Harm reductionist and Filter contributor Jesse Harvey was held in a jail treatment program earlier this year, and responded to his detention by going on hunger strike.

Given the sensitive nature of such decisions, it’s hard to pin down just how often laws like Casey’s Law are applied; even in Kentucky, application varies greatly by county. But beyond statistics are so many human stories of suffering and harm.

In February 2019 I wrote for Filter about a paraplegic man I called “Jay,” who found himself surrounded by police in his own driveway one afternoon as he ate lunch. Without other options, Jay had taken to using illicit fentanyl he bought in Kensington, Philadelphia to mitigate the lingering effects of serious injuries sustained in a motorcycle accident.

I learned late last year that Jay had passed away.

The police weren’t there to arrest him, though, as he had committed no crime. With the overdose crisis in full swing, it was the opinion of Jay’s father that the young man’s fentanyl use made him a danger to himself; so he contacted the authorities in his suburban community and had Jay taken to a psychiatric facility. He would be kept there against his will for nearly a week under Section 302 of Pennsylvania’s Mental Health Procedures Act.

Jay was capable and cautious, and had done enough research on the efficacy of fentanyl in treating his condition that he convinced a psychiatrist at the facility to prescribe him several days’ worth of fentanyl patches after he was finally released. He was a vulnerable person who should never have been subjected to that experience.

Absent a regular safe supply of the drug, however, Jay soon found himself back in Kensington purchasing the street variety of fentanyl. I learned late last year that Jay had passed away. His death was reportedly due to complications related to his injuries.

Those of us who find involuntary commitment a gross violation of vulnerable people’s rights and autonomy should watch the current Kentucky case with interest. Just as the 2004 adoption of Casey’s Law had widespread influence, a finding in favor of the plaintiff now may have ripple effects that could help unwind a troubling, dangerous trend.

The vast majority of people who use drugs are not “severely mentally impaired.” Many use for pleasure, and many for other rational reasons. Most drug use is not harmful. If all potentially deadly activities were considered cause for civil commitment, extreme sports, motorcycles and a whole variety of other activities would suddenly fall under the rubric of compulsory psychiatric care.

Civil commitment could actually increase overdoses, by releasing people still likely to use drugs, but now with reduced tolerance.

Meanwhile, detaining a person who is charged with no crime, based solely on how their drug use is perceived by others, has potentially severe long-term repercussions.

“Involuntary commitment gives someone a lifelong marker that interferes with their ability to get health care coverage or own a firearm, and it could prevent them from getting certain jobs, like federal employment,” Mary Catherine Roper, of the the American Civil Liberties Union of Pennsylvania, pointed out when I interviewed her for the Daily Beast in 2017, just as states were ramping up their involuntary commitment laws.

Roper added that even in cases where drug users are openly suicidal, once they are detoxed it will become increasingly difficult to justify involuntary detention. That means that, in practice, the period of commitment is likely to be much shorter than a petitioner would like.

And in that context, civil commitment could actually increase overdoses, by releasing people still likely to use drugs, but now with reduced tolerance due to an enforced spell of abstinence. One study of incarcerated people in North Carolina found them 40 times more likely than the general population to die of an overdose in the first two weeks after their release.

The case against Kentucky’s law is welcome. But given the extremes of drug panic and stigma, it’s sadly likely that the US Constitution will continue to be bent to the will of those who spread fear.

Photograph of a facility that hold civilly committed patients in Massachusetts, via Hampden County Sheriff’s Office.

The post Kentucky Challenge to “Casey’s Law” Strikes Against Involuntary Commitment appeared first on Filter.

In the wake of the pandemic and the George Floyd protests, “the nerves of citizens are frayed by fear and uncertainty,” Judge McHugh wrote—effectively ending any plans for the nonprofit Safehouse to open a site in the immediate future, though without contradicting his previous ruling on its legality.

Ronda Goldfein, who sits on the Safehouse board, told Filter that while the judge’s ruling—which came in response to a motion from the US Attorney for the Eastern District of Pennsylvania, Bill McSwain—brings further delay, it also ultimately strengthens the judicial case in favor of Safehouse.

“In the ruling the judge goes point-by-point with even more detail on why he believes this lifesaving intervention does not violate [the Controlled Substances Act]. We now have three published legal rulings that support our position,” Goldfein said, adding that Safehouse did not have any immediate plans to open anyway.

The city has a long history of fluctuating between historic reform and regressive populism.

Safehouse will now file its case with the Appeals Court on June 29, and Goldfein said that a conclusion to the legal saga could come by the fall.

The city has a long history of fluctuating between historic reform and the kind of regressive populism common in old strongholds for ward-style machine politics. It’s been three years since Philadelphia Mayor James Kenney convened a task force to “combat the opioid epidemic” in the city. Coming in the wake of a sharp rise in overdoses attributed to illicit fentanyl, its result was a set of imperfect but promising recommendations, including methadone and naloxone awareness, that seemed likely to put the City of Brotherly Love on a better path.

The election of Larry Krasner as district attorney later that year, on a platform that included support for safe consumption sites (SCS) to prevent deaths, seemed to confirm this direction.

Overdose fatalities in Philly have declined, according to official figures and just about everyone working in harm reduction in Philly. But drug issues are more divisive than ever.

Drug policy reform advocates learned that anew at the beginning of this year, during a rally in South Philadelphia which featured the surreal sight of prominent Philadelphia Democrats stoking anti-SCS sentiment before a sea of people in Trump 2020 swag. Safe consumption, they promised, was as good as dead in Philadelphia.

In February, after Judge McHugh declared SCS legal in Eastern Pennsylvania, South Philly neighborhood opposition, including a petition, rapidly ended the Safehouse plan to open a site there immediately.

By other measures, the lives of Philadelphia’s most vulnerable drug users, many of whom are unstably housed or homeless in Kensington, are worse than they have been at any time since February 2017, when I began covering the neighborhood full-time. Law enforcement clearances of encampments that functioned as de facto safe consumption sites have spread misery, and the awful year of 2020 has seen the community buffeted, as Judge McHugh noted, first by the impacts of the coronavirus lockdown and then by those of the George Floyd protests and police responses.

Although the coronavirus was an act of nature that caught civic planners and just about all of us off guard, it doesn’t take a keen eye to see that things have been unraveling for years.

A few years ago, the park was hailed as the first step in a community revival.

One symbol of this is the fate of a major effort to revitalize a dilapidated park in Kensington called McPherson Square (pictured above). It had been known for many years as “needle park,” both to locals and to the visitors who went there to inject drugs.

A few years ago, the park made news for its transformation, and the naloxone-carrying librarians at the McPherson Square branch of the Philadelphia Free Library symbolized a massive collaborative effort to bring historically high overdose rates down. It was hailed as the first step in a community revival, although the presence, as recently as 2018, of a 24/7 mobile police headquarters in the park divided opinion.

“Kids are starting to call this park ‘their’ park,” said Awilda Ocasio, president of Friends of McPherson Square Park, in a 2014 interview with the Philadelphia Inquirer, shortly after the opening of a new playground. “There was so much apathy before. Last year, we planted about 90 trees, beautiful trees, and the kids on the playground now will be here to see them grow. We’ve come a long way.”

Yet city officials would learn that a single victory, in the context of status-quo drug war politics, is easily reversed. Today, the park is once again full of visitors using drugs—people who might have chosen to visit a sanctioned safe consumption site, were one available.

“The police don’t bother us at all,” said Macy, who lives in Wildwood, New Jersey, but spends a couple of days each week at McPherson Square. I encountered her the other day in the park, as she was searching for something she had lost. “They don’t come in unless they have to. No one really gives a shit.”

She happily gave permission for me to take and publish her picture.

On the other side of the park, by the playground, I started up a conversation with Victor, a young, tattooed Latino man who was attending to several small children. I asked if the public drug use bothered him.

“Yeah, I mean, I don’t like them to see that,” he said, nodding toward a boy who looked about six. 

But he seemed resolved to the reality all the same. “If I come in and someone is already getting high, I won’t tell them to move. But if they sit down and get started while the kids have been playing, then I’ll say something.”

I found something admirable in his openness to the idea that the park belongs to everyone. But his words also served as a sad reminder of the unique indignities suffered by low-income and marginalized communities. I then asked about the safety aspect: Was he ever afraid his kids would play with the used syringes that are strewn around?

“God, no,” he said. “They know. I’ve taught them.”

McPherson Square’s makeover did take into account the possibility that some people would continue to inject there—in the form of a single sharps container at the front of the park that took years to get installed.

Some cops on the nearby streets have continued with an utterly counterintuitive strategy.

Although the police are rarely seen at McPherson Square these days, some cops on the nearby streets of Kensington have continued with a strategy so utterly counterintuitive that it’s hard to imagine anyone actually came up with it.

Since the police closed the last of four bridge encampments that housed or temporarily sheltered hundreds of people throughout the winter of 2018, small encampments have sprung up down the secluded side-streets off the main business strip of Kensington Ave, where drugs are often sold. The cops have kept on pushing people out of those.

This senseless protocol ironically echoes what drug sellers across Kensington, whose work the police have failed to significantly disturb, have long termed, “Cop and roll.”

But where are people without homes expected to roll to?

Many have made their way back to “needle park.” Others, in further demonstration of the absurd futility of this city strategy, have even begun to gather at the site of one of the old bridge camps, where just a year ago they were forbidden to so much as sit down.

A few days ago, I sat under the shade of a makeshift tent next to a set of railroad tracks on what, in 2017, was the most contested piece of land in the city—pitting Mayor Kenney against the railroad behemoth Conrail in his effort to stop people from injecting drugs on the company’s property.

I was there with a source of mine, who injected a speedball while I swatted at mosquitoes. Two other people soon joined us in a small patch of cleared foliage behind a hole in a fence that was constructed by Conrail, under the threat of a lawsuit filed by the city. The hole is almost as old as the fence itself.

For all the time, effort and money spent on closing the area, it’s open again, with only a swarm of hungry mosquitoes to contest it.

Photographs by Christopher Moraff

The post Philadelphia’s Latest Backward Step Is Nothing New appeared first on Filter.

After two months of lockdown, the several hundred participants were marching together down the Ben Franklin Parkway to City Hall. Most wore masks and some distancing was in evidence, with small groupings rather than a single crowded mass. The march resounded with chants of “No justice, no peace.” At City Hall, everyone knelt in silence to honor George Floyd.

As protests against racist policing exploded across America and the world, the event offered Philadelphians of color and their allies a chance to express outrage at the horrific murder of Floyd, when a Minneapolis police officer knelt on his neck for almost nine minutes, slowly killing him on camera.

“We just want to be heard.”

But whatever arises from the protests, 2020 will go down as a dreadful year for people who are poor, homeless or addicted, for people of color and for many other vulnerable groups—nationally, and most definitely here in Philadelphia.

First came the coronavirus, with Philly’s first case reported on March 6—Philadelphia County has now suffered over 1,200 COVID-19 deaths. Lockdown soon followed. The city’s March 23 stay-at-home order left many vulnerable people in a high-poverty population broke, sick and without a safety net.

Poverty- and overdose-hit Kensington saw marginal incomes extinguished, drug supplies threatened, and an uptick in tensions and violence, as I reported for Filter in April.

Philadelphia’s streets felt dystopian already, with people hustling through the streets in masks. Now, government buildings, businesses and cars have burned, and different groups of protesters are split over what constitutes legitimate protest. Police have responded brutally. And there has been vigilante retaliation in some neighborhoods.

I’ve been covering the ever-shifting developments non-stop for the Daily Beast since Philadelphia’s protests began. There was a unity then that now seems absent.

“This was a peaceful protest that at some point broke into two separate factions and one faction was focused on looting,” Asia Sparks, a protester who runs a group called Hands up Don’t Shoot, told me later on May 30 with tears in her eyes. “That’s not our message.”

“We just want to be heard,” she continued. “But guess what: Black men are dying at an extinction rate.”

Despite Sparks’ peaceful approach, she would later become one of the many victims of police reprisals. On Monday, June 1, she tweeted: “Peacefully protesting today & we get ambushed, blocked in, and tear gassed.” 

Asia Sparks

As Sparks was speaking on May 30, thick smoke rose behind her from a Starbucks that had been set ablaze. I followed the smoke around City Hall to the shopping district on Chestnut Street, and found members of the other faction Sparks had described.

“Where should we hit next?” I heard a young woman say to her friends. Almost in unison the small group responded: “Foot Locker.”

The looting I witnessed in Kensington on Sunday, May 31 represented the powder keg I previously described blowing open. It was noticeable that the people raiding stores—mostly young but of all races, and many, according to locals, not from the neighborhood—were the only ones consistently wearing masks. For most others, the masks were off.

The stores hit included Walmart and MetroPCS, but also locally owned mom-and-pop shops, up and down Kensington Avenue. Some, already struggling under lockdown, may never open again.

Dozens of nearby open-air drug corners were unaffected, and continued brisk business all day. It made me wonder how the dealers felt about unfolding events—“Respect the block” is a phrase often heard here, typically as a warning not to do anything that could harm the business.

“I fucking love it,” said a young woman hawking “hard” (crack) on a popular side street.

Even the massive influx of law enforcement?

“Yeah,” she replied, “But you don’t see any here, do you?”

They weren’t there, but they weren’t far away. Police began assembling en masse near Kensington in the early afternoon of May 31 after the looting of a North Philadelphia Walmart. They arrived as people were carrying off electronics, clothing and other goods, and made several arrests.

“Shit’s about to pop off.”

Simultaneously, groups of police were making their way southward along Kensington Ave. “There’s cops in helmets everywhere,” Buck, a part-time rapper and drug dealer, told me on the phone. “Shit’s about to pop off.”

It was then that Evie and Michael Achuff, a white couple in their 20s, were beaten with metal batons after they went out to take their dog for a walk and Michael began criticizing the huge police presence. Michael said the cop assaulting him, as I reported for the Daily Beast, told him: “Hear that? We’re beating up your girl,” in what sounds like an attempt to incite him to violence. The Philadelphia Police Department has not responded to multiple requests for comment on the incident.

Most of the looting had down by the time I arrived on Kensington Avenue, but a 29-year-old woman I met showed me how information about targets was being shared on Facebook—sometimes announcing locations clear on the other side of town.

Activists are split over looting; it is not comparable to the situation being protested. Still, nearly every person of color I spoke with who was not involved in the protests objected. “Protesting isn’t a code word for robbery,” a 34-year-old Black man on the subway told me on June 1. “This shit have to stop.”

“We’re still in a red zone. I am worried this will set us back.”

In Kensington on May 31, I ran into Allison Herens, the harm reduction coordinator for the Philadelphia Department of Public Health and Welfare. She was concerned about the absence of social distancing and masks amid the uprisings. “We’re still in a red zone,” she said. “I am worried this will set us back.”

By that night, residents of the working-class, predominantly white neighborhoods in South Philadelphia and Fishtown were out in force, despite the city’s announcing a mandatory 6 pm curfew. Perhaps as many as 100 white people lined the stretch of businesses along Front Street near Snyder Ave.—a traditionally Irish and Italian neighborhood.

I heard some of those residents make references to being armed, and footage from June 1 emerged of a group of dozens of white men in Fishtown carrying anything from golf clubs to sledgehammers. Journalist Jon Ehrens, who filmed them, reported that he was assaulted by the group.

The overall situation became slightly more peaceful on June 2, with the main protest group conducting a nine-minute silence to honor Floyd. But earlier that day, one of over 30 reported attempts to break into ATMs had ended in the death of a 24-year-old man who had been using an explosive device.

Deep racial and economic injustices and a connected overdose crisis were severe problems long before the coronavirus, and will outlast the search for a vaccine.

In many senses, the strife suffered by this city, and by certain neighborhoods and marginalized populations above all, looks set to continue.

Just a week previously, things were about to get a little better for those struggling under the lockdown: The city had set June 5 as its target date for dropping the coronavirus threat assessment from red to yellow. Yet deep racial and economic injustices and divisions, and a connected overdose crisis, were severe problems long before the coronavirus, and they will outlast the search for a vaccine.

Any right-minded human being has been sickened by the murder of George Floyd, and the deep-rooted, callous and systemic racism that is its context. Those are the pressing issues faced by our country, including Philadelphia.

There are signs that the worst of the violence may be over in Philly. But until systemic changes are made, it may be only a matter of time before the “shit pops off” again.

All photographs by Christopher Moraff

The post Police Brutality and Fear: Hits Keep Coming for Philly’s Most Vulnerable appeared first on Filter.

It has been distressing to witness the additional strife within the community I cover, the most vulnerable of Philadelphia’s populations of people who use drugs.

Despite widespread fears of a drought, trade in illicit drugs in the Kensington neighborhood has so far continued at a steady pace. “You look around the city and it’s like there’s nobody out,” a corner dealer told me. “But not Kensington.”

“Look around you,” he said, gesturing to the crowded street corners. “If you out here, you either buyin’ drugs or you sellin’ them.”

For a reporter who has been on this beat for years, one odd impact of the pandemic has been the instant clarification of who’s buying and who’s selling: The former are usually wearing medical masks, the latter usually not.

But amid the brisk business, tenuous supply lines seem to have led to a significant decline in the potency of many of the drugs available. Heroin users, for example, rate the drug on its “rush”—the initial impact of the drug—and its “legs,” or length of time before withdrawal sets in. Sources report a decline in both.

In one way, it’s a good thing: Fatal overdoses in the city have declined from an average in the region of three or four per day to something more like three or four per week, according to daily tallies released by police, EMTs and Prevention Point Philadelphia, a needle exchange program.

But the decline in potency hasn’t come without consequences. Illicit markets work best—in terms of both product safety and violence reduction—when they are free to operate organically. Under the pressure of uncertainty, fear or desperation, the cracks in Kensington’s already-troubled community are showing.

An Uptick in Violence

Visible violence between people who use drugs has increased dramatically over the past three weeks. I’ve seen people punched and knocked to the ground for no apparent reason along the main strip of Kensington Avenue, and witnessed cellphones ripped from owners’ hands just as the subway door opens.

A disagreement over money or drugs may be the spark in some cases, but the general tension that comes from diminished prospects and mounting hopelessness surely contributes.

Despite dramatic falls in recorded crime rates across the US and the world, thought to be a result of lockdowns, Philadelphia’s homicide rate is up by double digits over last year.

Not all killings, of course, are related to the illicit drug market, but some are. Many acts of violence seem random. On March 30, Nicholas Troxell, a heroin user well known by many in the Kensington community, was shot and killed on an El train passing through North Philly. That same week the attempted robbery of a man selling pills further south, in the Fishtown section of the city, ended with three people wounded by gunfire.

The decline in product purity has kept many opioid-dependent Philadelphians in a state of near constant fear and anxiety, which is not a good combination in Kensington.

“I guess they didn’t like that he was passing them and buying from somewhere else.”

One long-established source of mine, who uses heroin and crack cocaine, described watching a man he knows get pummeled by members of a drug dealing “set”—allegedly for just passing by their corner without making a purchase.

“If you got garbage on the street, no one is gonna buy your stamp; we have to make our money stretch as much as possible,” this source told me. “I guess they didn’t like that he was passing them and buying from somewhere else. Maybe he was a regular customer.”

There was a time in Kensington when the culprits of such senseless violence would probably have been disciplined, perhaps by being banned from working the block altogether. But aggressive drug policy, by targeting and removing gang leadership, erodes the structures that support such codes of conduct. It’s one of the ways that prohibition increases violence.

[Update, April 15: A few hours after this article was published, a man called Mike, who has been a source or fixer of mine in Kensington since 2017, was attacked at Philadelphia’s City Hall station—apparently for money, although he had none. His attacker simply asked, “What are you looking at?” before jumping on him. Mike suffered a broken rib among other injuries. The photograph below, taken shortly afterwards, is shared with his permission.]

Drug Shortages Due to Fear Itself?

Illicit drugs—albeit in less-potent form—are still plentiful in Kensington. But with traffic across the US-Mexico border now limited to “essential services,” there is a perception, at least, that it will become harder to get drugs like fentanyl and heroin to East Coast markets.

Scott Stewart, a cartels expert with the geopolitical intelligence publisher Stratfor, told Filter that the flow of illicit drugs across the border has not visibly slowed.

“I wonder if street dealers are buying that hype and cutting their product out of fear.”

“Most of the tractor trailers and trains are still crossing the border [for purposes deemed essential], and we know the cartels are pretty good at hiding stuff in the midst of that commercial traffic,” he said.

He speculated that local drug supply issues may be produced by the fear of a shortage, rather than a shortage in absolute terms. “I wonder if street dealers are buying that hype and cutting their product out of fear of a supply cut.”

In Kensington, people who use heroin/fentanyl and cocaine have experienced a recent decline in quality. But methamphetamine remains abundantly available at pre-pandemic purity levels, my sources say. Stewart said he’s heard that there is so much surplus meth on the market that the cartels are “sitting on it” until prices rebound.

The diluted opioid supply subjects people who rely on it to additional pressures. One man told me last week that it was taking him twice his normal dose to get well. A couple of days after we spoke, he injected himself in a public bathroom in Kensington, and subsequently collapsed in the parking lot outside.

He awoke, surrounded by paramedics. But he was not given naloxone, because whatever it was that knocked him out briefly, it wasn’t an opioid. (My guess would be xylazine, a large-animal tranquilizer that is present in most of Kensington’s dope supply.)

In a show of good faith, most of Philly’s methadone clinics have been giving the maximum allowable number of take-home doses to clients under state law (one week), even those who wouldn’t normally qualify. But one clinic doctor, who asked that he not be identified due to his employer’s restrictions on talking to the media, told Filter that there is a virtual moratorium on new intakes.

Vanished Incomes, Safe Spaces

In addition to any drug supply issues, many of the most marginalized drug users have seen their fragile incomes disappear. With so many streets in the wider city empty, panhandling has become fruitless. Clientele for casual work, like window washing, have dried up. Sex work has been curtailed. Some of my regular sources have recently phoned me in tears, begging for any small financial help I can offer. I oblige whenever I can; when I can’t, I feel hollow.

Others have found some limited opportunities in the new reality. After Philadelphia’s Police Commissioner, Danielle Outlaw, announced in mid-March that her officers would no longer bring in nonviolent offenders for booking, but rather issue a summons to appear in court, the subways and trains became moving bazaars for stolen goods.

We’re not talking high-end merchandise. On a single day just over a week ago, I was offered disposable razors of every brand imaginable, USB chargers and bags of candy—all at cut-rate prices.

“The hardest hit from this crisis will be the most vulnerable populations.”

The Southeastern Pennsylvania Transit Authority (SEPTA) has lately come under fire for its decision to shutter a number of stations—part of massive cutbacks following a drop in ridership of over 80 percent. (SEPTA had already temporarily curtailed its 24-hour train service, which for years has served as a last resort shelter for homeless people.)

Two of those stations, Somerset and Tioga, are in the heart of Kensington. Somerset, in particular, has been a de facto safe zone for transient drug users, and a conduit to numerous drug corners within a two-block radius of the station.

Vince, who is from New Jersey but has been homeless in Kensington since the winter of 2018. Photo by Seth Dalton.

Jamie Moffett, a neighborhood organizer and philanthropist, phoned me when news broke of the closures. “I’m concerned [that] closing these stops will concentrate vulnerable folks with pre-existing conditions and no ability to purchase masks or personal protective equipment to the Allegheny stop on Kensington Avenue,” he told me.

Kensington and Allegheny—”K&A”—is already a primary gathering spot for people who are homeless and addicted. “The potential for a ‘super spreader’ coronavirus event at K&A would be deadly,” Moffett said, “especially to folks who can’t shelter in place, as they have nowhere safe to shelter.”

“The downsizing decisions were really tough,” Thomas Nestel, chief of the SEPTA Transit Police, told Filter. “The Authority is in dire financial status, losing employees every day. I hope this crisis lets people know just how many unsheltered use SEPTA as their home.”

“When this is over,” he continued, “I believe the hardest hit from this crisis will be the most vulnerable populations—the drug addicted, the homeless, the mentally ill.”

Nestel’s agency, which has jurisdiction not only in Philadelphia but five of its surrounding counties, has seen some of the worst local impacts of both the overdose and coronavirus crises. In recent times, overdose incidents on SEPTA’s train, trolley or bus lines have occurred daily.

Nestel notably declined any new officers when the City Council offered them to him last year as a response to other police departments’ shutting down nearby encampments. He requested that 10 social workers be hired for him to deploy instead. That program was approved, but has been put on hold due to COVID-19.

A Lesson for Drug Warriors?

What hasn’t been put on hold is the suffering of Philadelphia and Kensington’s most vulnerable.

This past week, filmmaker Seth Dalton and I were forced to take an indefinite hiatus from filming a documentary we’ve been making about addiction, failed drug policy and the fight for safe consumption spaces in Philadelphia.

I’ve reported from these streets for years, through every kind of crisis. But our obligations to protect others in our lives from the virus have made the streets and subways too unpredictable right now.

There is only one time I can remember seeing it this bad—and unlike COVID-19, it was a political creation. It was in 1998, when I was a young heroin user myself, and then-Mayor John Street launched Operation Sunrise—a saturation offensive that flooded Kensington with police 24/7.

In the year that followed, I had a gun pointed at my head by a nervous teen robber, I was arrested twice, and I fought off another drug user who on two separate occasions tried to steal my drugs as I walked to the train. He failed, but the man who broke my jaw with one punch later that year didn’t.

If there is a lesson in the COVID-19 crisis for drug warriors, it’s this: Even adding a deadly pandemic to the existing threats of overdose and law enforcement will not end drug use. Nothing will. We need approaches that focus solely on reducing the suffering we see all around us.

Top photo, showing a man in a mask outside the Allegheny train station, Kensington in mid-March, by Christopher Moraff. 

The post Tensions Rise in Kensington, Philadelphia as Lockdown Bites appeared first on Filter.

Goldfein told Filter she was surprised by the level of vitriol expressed at the February 26 press conference. She said Safehouse will “regroup” to decide the best course of action, but added, “At the end of the day, supervised consumption is legal in the city of Philadelphia. And if we’re having a discussion with neighbors—and that’s part of a democratic process to have that discussion—it doesn’t change the fact that supervised consumption is legal in Philadelphia. This is a turn, not a derailment.”]

Harm reduction won an historic victory on February 25, when a federal court ruling gave Safehouse, a Philadelphia nonprofit, the official green light to open the nation’s first sanctioned safe consumption site.

The site will now open in South Philadelphia within a week, said Ronda Goldfein, the vice president and cofounder of Safehouse. It will prevent overdose and other harms by allowing drug use in a setting equipped with medical staff and harm reduction supplies. “Philadelphia, like the nation, is in an overdose crisis,” she said. “This is a medical model.”

US District Judge Gerald Austin McHugh granted Safehouse a Declaration of Final Summary Judgment, formalizing an interim decision he made in October. He found that the group’s model for overdose prevention does not violate the so-called “crack house statute” of the Controlled Substances Act, which prohibits the operation of facilities solely for the purpose of drug sales or consumption.

Yet the very next day came a reminder that social change often arrives even more slowly than legal decisions. The nonprofit’s leadership—which includes former Pennsylvania governor Ed Rendell—took a verbal lashing from some South Philly residents.

“You blindsided us! This is unacceptable, and you were a sneak about it.”

A morning press conference at Rendell’s office on February 26 was packed with both supporters of the site and angry residents, who said they were not consulted on the decision. Some of them took out their vitriol on Gov. Rendell personally.

“You blindsided us!” shouted one woman. “This is unacceptable, and you were a sneak about it. Look at us when we tell you, Mr. Rendell: You were a sneak. I will no longer call you governor because you’re not a governor, you’re a sneak.”

Goldfein pointed out that Safehouse would be holding community meetings in the coming weeks where residents can voice their concerns, and will maintain a phone hotline for people with questions or complaints. 

One middle-aged South Philly resident, who said he was in recovery from heroin addiction, also objected to the placement of a safe consumption site (SCS) in his community.

“Who’s gonna protect our kids?” he asked,without clarifying exactly what they need protection from.

Goldfein responded, “We understand that your children should never have to see people use outside, and the goal here is to have them use inside.”

Pressed by a reporter, the man argued instead for more abstinence-based treatment facilities and detoxes. Research has repeatedly shown that treatment with methadone or buprenorphine is more effective than abstinence-based treatment at preventing fatal overdose in people who use opioids.

Safehouse still faces further challenges beyond the opposition of some locals—although one survey last summer showed that 90 percent of residents in Kensington, the neighborhood where Safehouse was originally slated to open, supported an SCS.

Safehouse changed its original plan to open in Kensington in part because it anticipated more demand there than it could meet, and also because the owner of a building it was set to lease got cold feet and pulled out of the agreement.

State Senator Larry Farnese, a Democrat who represents Pennsylvania’s First District, covering Philadelphia, called the site change a “bait-and-switch.”

“Safehouse was beginning to build public support through a patient and transparent dialogue with Philadelphians,’” he said. “Trust has been lost. If Safehouse believes it is easier to ask forgiveness than permission, we will prove them wrong.”

Members of Safehouse raised concerns that federal officials would target patrons of the facility.

Goldfein acknowledged that public discussions about the facility had largely revolved around the Kensington neighborhood, which suffers the highest rate of fatal overdoses in the city. She said South Philadelphia, which ranks second in drug fatalities, was chosen in part because its smaller numbers of transient drug users would enable the organization to maximize its limited resources. Budget estimates place the annual cost of operating the SCS at around $2 million.

Members of Safehouse also raised concerns that federal officials would target patrons of the facility, after US Attorney Bill McSwain—who launched the legal case against Safehouse in February 2019, and fought it on the basis that it would be illegal and fail to save lives—threatened to take any and all measures to prevent the site from opening before an appeal could be heard.

Safehouse recently hosted a workshop for lawyers who wish to volunteer escorting  people to and from the site.

Rendell said South Philadelphia is just the start, and that Safehouse will continue to scout other locations, including Kensington. “Look, we do intend to open in other areas,” he said. “And we will modify this as we see what happens in South Philly.”

South Philadelphia has been on Safehouse’s radar for months as a potential SCS location, and it’s been an open secret among harm reduction advocates that a site there was imminent.

Filter received a tip several weeks ago from a reputable source in Philadelphia’s harm reduction community that an SCS had already quietly opened at a South Philly medical center. However, we were unable to corroborate that, and a source in Mayor Kenney’s administration, who asked to remain anonymous, told Filter that as far as they knew, Safehouse “doesn’t even have the keys yet.”

Following the press conference, as news vans sat outside the building, a staff member of an adult day care located at the planned SCS site told Filter that she is developing contingency plans in preparation for the site’s opening.

“We are mostly concerned about protesters,” she said, asking to remain anonymous. “We don’t know what it’s gonna look like out here.”

The decision to open in South Philly makes sense for a number of reasons. The eastern portion of the neighborhood, just a stone’s throw from the stadium district where all of the city’s professional sports teams play, has been hit harder by fatal overdoses than any other Philly neighborhood except Kensington. Yet harm reduction outreach, including naloxone distribution, is virtually nonexistent here.

In contrast to Kensington, which is known for its open-air drug markets, drugs and drug paraphernalia are not visible on the streets of South Philly. Most dealers conduct their business by phone and sometimes make house calls. The population is predominantly Italian American, with a tradition of children continuing to live in their parents’ homes into adulthood.

The majority of fatal overdoses here happen inside the home, with no one present to intervene. Compare that to Kensington, where injection drug use is often conducted in the open, and frequently in groups. Kensington’s proximity to Prevention Point Philadelphia also provides ready access to naloxone and sterile syringes.

No comparable program serves people who use drugs in lower South Philly. Few of the injecting drug users I’ve spoken with here carry naloxone, and for most, the only way to obtain sterile syringes is to purchase them from a pharmacy, making access less likely.

“We’re not gonna make it easy for you.”

Many South Philly residents are unswayed by these arguments, and oppose a SCS in their neighborhood on the flawed grounds it will draw more drug users to the area. They have pledged to wage a disruptive campaign against the site.

“We’re not gonna make it easy for you,” one woman said.

“It’s disgusting,” said a local resident who gave her name as Rose, and whom I encountered outside the medical facility where Safehouse is set to open. “This was a nice Italian neighborhood and it’s being turned to crap. I’d rather have the Mafia.”

The efficacy of SCS in saving lives and improving health is not in doubt. But as Safehouse begins formal operations, it will need to devote significant energy not just to helping the population it directly serves, but to heading off opposition from hostile residents and the feds. 

Photo by Christopher Moraff shows Gov. Rendell next to Ronda Goldfein at the press conference on February 27.

The podcast Narcotica, which the author co-hosts, will feature more on this story later today, including audio from the press conference.

The post Safehouse Won a Great Victory for Harm Reduction, NIMBYism Blocks It for Now appeared first on Filter.