In South Philadelphia — where opioid overdoses are rising but help for people in addiction is still hard to come by — physicians from the University of Pennsylvania are prescribing free treatment from a van on Broad Street.
The program, called Project RIDE (Rapid Initiation of Drug treatment Engagement), launched in July, and aims to get people who need it started on buprenorphine, an opioid-based medication that helps ease withdrawal and curb cravings. Such medication-assisted treatment has been shown in studies to result in more durable recovery than abstinence alone.
Project RIDE is part of a two-year study looking at how to get addicted patients into treatment as quickly as possible.
The van parks at Broad Street and Passyunk Avenue on Tuesdays, Wednesdays, and Thursdays, and provides free treatment for 30 days, or until patients enter a longer-term treatment program.
The staff has helped connect others who don’t want buprenorphine, or can’t take it, to other services or treatment programs, and offers testing for HIV and hepatitis C — both common perils for injection drug users. The van also stocks naloxone, the overdose-reversing drug credited for much of the decline some areas have seen in drug fatalities.
Though the city has worked to expand the availability of medications like buprenorphine, convincing people to enter treatment can be difficult. For people in active addiction, avoiding the pain of withdrawal is paramount, and can make long waits for a prescription or a spot in a treatment program impossible.
The nurse practitioner, the case manager, and the peer recovery specialist who work on the van can have a patient’s first dose of buprenorphine delivered within a day, sometimes even earlier, said David Metzger, the director of Penn’s HIV Prevention Research Division, who’s running the program.
They’ll even make house calls to patients who fear their neighbors will see them going to the van.
That’s a key accommodation in communities like South Philly, where opioid use tends to be hidden behind closed doors, and stigma against addiction runs deep. A few miles northeast in Kensington, where open-air drug use and sales are pervasive, the public health organization Prevention Point runs its own mobile buprenorphine program in addition to services at its brick-and-mortar headquarters.
There are a few buprenorphine clinics in South Philadelphia — the long-running Wedge Recovery Center sits down the street from where Penn’s van parks on Passyunk Avenue, just blocks from the neighborhood’s iconic restaurant row. And CleanSlate, a nationwide outpatient addiction treatment program, just opened a second South Philadelphia location farther south on Broad Street.
But the stigma against seeking help persists, even as overdoses in the neighborhood have risen steadily for the last several years.
‘I don’t know a single family that hasn’t been affected’
Overdoses in the 19148 zip code in South Philadelphia increased by 20% in 2018, from 44 deaths in 2017 to 53 deaths the following year. (Overdoses decreased in the other neighborhoods in South Philadelphia. Just across Broad Street, the 19145 zip code dropped from 40 deaths in 2017 to 30 deaths in 2018.)
The problem is far more pronounced in Kensington and Port Richmond — where the 19134 zip code saw 160 people die in 2018. But that total represented a 23% drop from the year before, a sign that the city’s efforts to flood the neighborhood with naloxone and harm-reduction services has had some positive effect.
Advocates in South Philly say those efforts need to be replicated in their neighborhood, where the opioid crisis is less visible — but no less dangerous.
Many people with addiction in tight-knit South Philly hold down jobs, use at home, and hide their addiction, ashamed to seek treatment, said Destinie Campanella, a harm reduction specialist for the city health department who grew up in the neighborhood and still lives there.
“I don’t know a single family that hasn’t been affected [by the opioid crisis in South Philadelphia]," Campanella said. On her regular rounds through the neighborhood to hand out naloxone, she’s learned to avoid certain corners where people use drugs: Too often, she’ll see people she knew in high school there, old friends who are now too ashamed to speak to her and won’t accept her help.
“I can see the look on their faces when I come by — like, oh, no,” she said. “People are so embarrassed. It’s something I’m constantly struggling with."
The Penn van staff have similar struggles.
About 60 people have visited the buprenorphine van since it launched in July. Only 15 have opted to receive buprenorphine. “We’re still looking for the most effective ways to communicate with people,” Metzger said.
The patients who have come through the van demonstrate the need for more harm-reduction and treatment services in South Philadelphia, the staff says.
One patient told nurse practitioner Jody Gilmore that her boyfriend had died of an overdose in her arms because she didn’t have naloxone. Another brought her mother to an appointment, so Gilmore could teach her how to administer the drug.
“What happens in the home stays in the home in South Philly," said Susan Corrigan, the van’s peer recovery specialist, who lived in the neighborhood for 15 years. Despite the stigma against addiction, she said, families are eager to help their loved ones.
“Every participant in the family system steps up to help. The whole family is affected,” she said.
That community spirit can also help outreach workers build relationships with people in addiction and their neighbors, said Carol Rostucher, the founder of the outreach group Angels in Motion, which started operating a needle exchange in South Philly earlier this year.
Initially, the needle exchange had trouble attracting participants, just like the van. So Rostucher tried to make residents more comfortable with what she was offering.
“We put chairs out and let people sit down and talk. We started getting residents who came by, and asked us about how to clean up needles" left on sidewalks and in parks, she said.
“It’s all different people now who stop by to talk. And it helped people sign up for the exchange, because now it’s hard to tell why someone’s stopping to talk to us. You have privacy.”
In recent months, Metzger and his staff have pushed harder to get the word out about the van. They’ve monitored overdose clusters in the neighborhood to see where the program might be needed most, and have been using a Twitter account to promote the program.
“We’re meeting people where they are, without any judgment about medication,” Gilmore said. “And this is a community that really needs this service.”