Opioid Crisis

City of Philadelphia

Encampment Resolution Pilot Update – May 17, 2018

Opioid-related homeless encampments present one of the most complex situations Philadelphia has encountered in recent history. The existing encampments are in a densely residential neighborhood, which not only creates an unsafe and unhealthy environment for residents but creates tension.  Making matters more complex is that the affected Kensington “community” is not at all unified in its reaction to the encampments, which is common and understandable. Factions want the camps gone at all cost; they are especially concerned about illicit drug use, trash, crime and the constant feeling that illegal activity is being tolerated. Others are providing tents, food and other necessities to campers. Harm-reduction groups are advocating for the protection of campers and getting additional services to them to save lives and provide easier access to treatment.

The Office of Homeless Services (OHS) and the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) launched a pilot on April 30, 2018 engaging in intensive daily outreach to those living at two Kensington encampments, one at Tulip and Lehigh and another at Kensington and Lehigh. The purpose of the pilot offers services and emergency housing to campers in these two sites, ultimately clears the two camps and pioneers a new service model tailored to this new problem.

The purpose of this document is to provide an update on the progress of the pilot and context surrounding the severity and complexity of the problem it aims to address.

Impact of the pilot program at mid-way point: 

  • The pilot outreach team has engaged many who were camping under the two identified bridges for this pilot, created a by-name list of occupants and obtained information regarding individual needs, interests, and barriers and referred individuals to treatment and more stable housing options.
  • There is a multidisciplinary team on site daily: homeless outreach, nurse, doctor, mobile medical care several days a week, assessors and authorizers for insurance.
  • On-site assessment, transportation, and coordination for ease of access to these services have been successful strategies so far.

 Many aspects of the plan are working:

  • People are accepting services. Nearly 100 people have accepted services so far;
  • About three dozen people have entered treatment, more in the first two weeks of the pilot than in the prior six months;
  • We are getting closer to treatment on demand by bringing services on-site to people, breaking down barriers to accessing treatment: ID, transportation, assessment and referral and insurance authorization. No one has been turned away who teams have referred for treatment. This success has implications for changing the way we provide access to treatment.
  • More than two dozen people have gotten an ID card which nearly half of those surveyed identified as a barrier to leaving the camps;
  • About 40 percent have been homeless for more than a year, most are newly homeless;
  • Daytime encampment numbers are much higher than night time numbers, which are going down. People are accessing the respites including, slowly, the ones further away. This demonstrates that the City’s low-barrier approach is working;
  • The clear majority have a work history and would like to return to work;
  • Prevention Point has been piloting suboxone induction on the street under medical supervision. This is promising because it has been found to be effective elsewhere in helping people think more clearly about their future;
  • We have secured an outside evaluator who is tracking progress from camper and neighbor perspectives;
  • People are using the daytime services. Now they can go directly from the respites to daytime services at Prevention Point Philadelphia.

Camp closing protocol on May 30th:

  • Anyone who is still camping will be offered services again and then, if they refuse, asked to leave.
  • Anyone who remains will have their belongings removed. The campers can put their things in a large crate which they will close and label; L&I will transport possessions to the Prevention Point Respite at 3247 Kensington Avenue where it will be stored until July.
  • Anyone who does not leave will be issued a CVN or Ticket for $20 by the Police.
  • Police will enforce the camp closure. Homeless outreach and access to treatment will continue to be available on site.

The Problem Itself

The opioid epidemic is a public health crisis – the worst we have seen in over a century:

Four times as many people died from drug overdoses in Philadelphia than from homicides in 2017:

  • Opioid Use Disorder is a chronic, relapsing brain disease that can lead to disability and death;
  • Drugs change the brain creating cravings, inability to abstain, and impairment in self-control;
  • There is an increased risk of HIV, Hepatitis C, and skin infections associated with the harmful effects of drug use;
  • Both the disease and the people suffering from the disease are highly stigmatized and socially isolated;
  • Medication Assisted Treatment is an effective evidence-based treatment and there are multiple pathways to recovery.

Poverty and homelessness are both contributing factors to the problem:

  • The opioid epidemic and associated drug trade is centered in a low-income neighborhood that residents believe would not be tolerated elsewhere;
  • Economic opportunity is a significant part of what drives the commerce of selling drugs;
  • Blight and vacant property make the sale and use of drugs more open and accessible;
  • Poverty drives people who have addiction to panhandling and homelessness and makes it harder for them to escape.

We don’t know if the epidemic has peaked. The reality is that we could do everything right and still see the numbers of active opioid users, homeless people and overdose victims grow along with new encampments.

“Supply-side” solutions are not enough.

  • We can’t arrest our way out of this situation. If we learned nothing else from the “war on drugs,” we learned that it can become a war on low-income people that leaves them worse-off than they were before;
  • Nonetheless, we can’t condone lawlessness so police are enforcement laws against drug sales while piloting pre-arrest diversion which they plan to expand, budget allowing.

“Demand-side” solutions are not enough:

  • Access to treatment has not always been easy; treatment on demand is essential;
  • People enter treatment when and how they are ready. They must believe that there is hope and must feel welcomed to access addiction services at their own pace;
  • Need to promote wellness to help people shift from an illness track to a wellness track;
  • Substance use disorder is more prevalent in impoverished areas;
  • State and federal regulations such as a need for ID and barriers to supervised injections are obstacles that systemically need to be navigated and negotiated. These challenges are being addressed by DBHIDS, the City of Philadelphia and the State of Pennsylvania, including a declaration by Governor Wolf that may help to pave the way.

The City is is trying to balance these needs and interests in a legally appropriate and humane way. Specifically, we must:

  • Make the community safer and healthier for all residents, which includes removing needles, trash, human waste, potential sources of Hepatitis C, HIV/AIDS and blood-borne pathogens;
  • Learn from previous public health challenges that have affected behavioral health and medical health to determine the most effective ways to get treatment to people in need meeting them where they are;
  • Uphold the human rights of all, even those who are stigmatized by addiction and homelessness;
  • Enforce the law to the greatest extent possible;

Solve a newly emerged problem that has never been solved before with limited resources and in a highly visible way.


May, 2018

CITY OF PHILADELPHIA

ENCAMPMENT RESOLUTION PILOT

The City of Philadelphia announced the launch of a pilot encampment action plan for the Kensington area as part of the City’s latest efforts in combating the opioid crisis in Philadelphia. The City and partners researched best practices from around the country in addressing addiction related homelessness.

What will this look like?

This pilot intensively engages individuals living under the Kensington and Tulip Street bridges.
Ongoing outreach, engagement, coordinated services, and supports are being provided to individuals living in the encampments every day for 30 days (April 30th—May 30th).

Where will people go?

People have options to access residential and treatment services—options can include:

  • Prevention Point Respite
  • One Day At A Time (ODAAT) Respite
  • Prevention Point Navigation Center
  • Northeast Treatment Center (NET) Assessment Center
    for access to these sites, please contact Homeless Outreach at 215-232-1984
  • Substance abuse treatment services
  • Mental health treatment services
  • Safe Havens
  • Medical treatment options
  • Case management
  • Identification assistance
  • Crisis Response Center

What services are available?

In addition to the on-site outreach efforts at the Kensington and Tulip Street bridges, the following places — always available through DBHIDS and the Office of Homeless Services — are able to help people living in the encampments to get back on a path to wellness.

  • Those who are currently enrolled in Medicaid can call: Community Behavioral Health’s (CBH) 24/7 Member Services at 888-545-2600
  • Those who are uninsured and wishing to access services can call the Department of Behavioral Health and Intellectual disAbility Services’ (DBHIDS) Behavioral Health Special Initiatives Unit (BHSI) at 215-546-1200, Monday-Friday, 8:30am – 5:00pm
  • Engagement and connection to homeless services will occur through Homeless Outreach and can be contacted 24/7 at
    215-232-1984
  • Individuals wanting to immediately be assessed and access substance abuse treatment services can walk- in 24/7 at Northeast Treatment Center, 499 N. 5th Street (5th and Spring Garden)

For more information or support, please contact Centralized Homeless Intake Services
802 N Broad St, Philadelphia, PA 19123 (Monday – Friday, 7:00 a.m. – 5:00 p.m.), 215-685-3700
2601 N Broad St, Philadelphia, PA 19132 (after 5:00 p.m. on Weekdays or on Weekends), 215-225-9230

Download the flier   Español


March 12, 2018

Liz Hersh’s testimony before City Council on Resolution #180037 to assess the City of Philadelphia’s efforts to prevent and treat abuse, addiction, and disease related to the use of opioids

Good morning Councilwoman Bass and other members of the Committee.  My name is Liz Hersh and I am Director of the Office of Homeless Services.  Thank you for the opportunity to testify today.

Using the Kensington Counts plan as the basis, the Office of Homeless Services established a 23-bed respite with Prevention Point last winter. Based on its high utilization, we then expanded it to 40 beds this winter. It has been an overwhelming success. Our method has been to listen to the people on the ground closest to the problem and support their efforts in addressing the problem to the best of our ability.

Similarly, we added 15 dedicated beds to the 60 already being provided by Pathways to Housing, the first-in-the nation street to home program for people with Opioid Use Disorder. To date they have a 100% housing retention rate and half have entered treatment or are practicing abstinence. Again, a remarkable success rate and an approach that we hope to expand in the next fiscal year if the dollars proposed by the Mayor are made available.

Despite this expansion of investments, the growth of homeless encampments driven by the opioid crisis is plaguing Kensington. It is a humanitarian crisis that presents a health and safety threat not only to be the people living there, but to the neighbors who live nearby. We must acknowledge this reality. Our January Point in Time Count found that the number of people experiencing street homelessness in Kensington (zip codes 19133, 19125, 19134) had gone down from 227-210. Yet, Kensington has the second highest concentration of homeless people in the City after Center City.

The homeless encampments in the Kensington area, specifically under the tunnels north of Lehigh Avenue on Tulip, Kensington, Frankford and Emerald streets, have an estimated population of 200 people.

Encampments are a national and growing problem. National Law Center on Homelessness and Poverty found a 1,342% increase in the number of homeless encampments from 19 in 2007 to a high of 274 in 2016 (the last full year for data).  https://www.nlchp.org/Tent_City_USA_2017.

And yet, the new budget proposed by the White House slashes all forms of evidence-based housing assistance leaving communities on our own.

Working in a coordinated effort with partners throughout the City, we have taken a number of steps to manage this dire situation so far:

  • Under the leadership of Eastern Division Police Inspector Ray Convery, established a Homeless Detail, a small group of officers dedicated entirely to the homeless encampment. They do a nightly count of people sleeping, weekly clean-ups and have a constant presence in the community. Deploying the combined “push and pull” of the police officers and homeless outreach teams, the people in the encampments were asked to move to one side of each street to allow for safe passage. This arrangement was the suggestion of Somerset Neighbors for Better Living (SNBL) to enable neighbors to walk through without going into the street. While it is progress, it is far from the resolution needed.
  • The Streets Department has increased to twice weekly trash pick-ups and the encampment residents have been provided with trash containment supplies. At the neighbors’ request, L&I has also inspected all the local scrap metal collectors and one has closed. Scrap metal is a source of income often used for drug purchase that leads to petty theft in the neighborhood and has been the cause of considerable concern.
  • The Office of Community Engagement under the direction of Joanna Otero-Cruz, in coordination with the police has distributed kits to neighbors that include sharps containers, grabbers, no trespassing signs and blue light bulbs to add to empower residents to take back their streets by containing and minimizing the harm of needles on the street and discouraging intravenous drug use in front of their houses. This also enables the police to enforce no trespassing laws.

In addition, our office is aggressively pursuing additional actions:

A respite is a small, low-barrier place in the community for people experiencing homelessness to come in and be cared for. ID and drug testing are not required for entry. It is come as you are. It is based loosely on the model of a Safe Haven pioneered in the 1990s by Project HOME and supported by DBHIDS. In its first year of operation Prevention Point’s respite served 160 people of whom nearly 40% entered treatment and/or got permanent housing. This is a tremendous success.

The respite uses a housing first model. While many of us on the outside wish that those in the encampments would seek treatment first, experience is showing us that providing housing first is working well. We have found that when people have a place to come into to get clean, warm (or cool), fed, get medical care, feel safe and comfortable, THEN they can start to make plans and think about their future.

Based on the success of this model, we have aggressively pursued a second respite in the neighborhood. It has taken several months to identify a site as the community is quite divided. Some believe that Kensington is already a magnet and that any new respite should be sited elsewhere while others are clamoring for more beds. We analyzed the number of homeless facilities in the neighborhood and found that it is quite under-served. There is one shelter the one we established last year.

Today we are pleased to report that Impact Services is in the final stages of negotiating a lease at 3247 Kensington Avenue to provide 40 more respite beds and be operated by Prevention Point.

Encampments require a new strategy. The Office of Homeless Services researched other cities to better understand how best to address the encampment problem. San Francisco is the model that looks most promising. With over 1000 tents on the streets throughout the City, they have deployed an encampment resolution team, a multi-disciplinary team that engages and helps resolve the homelessness of the residents.

They use what I will simplistically refer to as a carrot and stick approach. They first develop a by-name list of people in the encampment and assess what they need systematically. They then begin the resolution process of helping people who can go home, do so, of getting ID, access to treatment or entry into a respite which they call a Navigation Center. They go so far as to begin Medication Assisted Treatment on the street and have found that with medication like Suboxone that some people are able to think more clearly about and make better choices. Outreach teams make clear that the encampment will be closed completely at 30 days.

The Navigation Center offers a range of services with easy access. It also offers beds for people finding as we have, that a good night’s sleep, meals, safety and care enables better problem solving. Finally, within the final 72 hours the police notify people that the encampment will be permanently closed and that they will have to move. They have found that generally there are few people left at that time if the outreach and engagement has been successful.

As a result, they are seeing about a 65% success rate in people accepting safety off the street, 25% have exited homelessness and an 85% reduction in tents. To date they have resolved 23 encampments comprised of 944 people. Obviously, additional resources have been deployed to achieve this success.

We are working with our partners at DBHIDS, the police and MDO to establish an Encampment Resolution Team and deploy the new Prevention Point site as our Navigation Center.

We have a preliminary plan that we will shortly be sharing with representatives of the neighborhood associations in the area to get their input. We cannot move ahead without their being informed and involved in the plans. And, we need their help.

We will also need everyone’s help in redirecting their generous contributions away from the encampments and helping provide food, move-in kits, furniture, etc. to help people transition to more stable housing situations. We are developing a list of what our providers can use with the hope that neighbors can help. It is abundantly clear that we cannot solve this problem alone.

That concludes my testimony.  I will be available to answer any questions.


“The opioid epidemic has been taking lives, destroying families and undermining the quality of life of Philadelphians across the city.” Mayor Jim Kenney.

Read the Mayor’s Opioid Task Force Report.

The opioid epidemic appears to be driving last year’s increase in unsheltered persons, even while the total number of people experiencing homelessness decreased. See the table below from the 2017 PIT Count.

Estimated Magnitude of the Opioid Problem in Philadelphia: Type
Numbers
Fatal overdoses (2016)
Source: Medical Examiner
900
In publicly-funded treatment for opioid dependence
Source: Community Behavioral Health/ Behavioral Health Special Initiative
14,000
Misusing/abusing prescription opioids (2016)
Source: National Survey on Drug Use & Health
55,000
Using heroin (2016)
Source: NSDUH, BHSI
55,000
Adults receiving more than 1 opioid prescription in a year
Source: PA DHS, Aetna, US Census
150,000

City’s Behavioral Health Department Offering Free Narcan Trainings to the General Public in Effort to Curb Skyrocketing Opioid Overdose Deaths

With the city on pace to record more than 1,200 drug overdose deaths this year – far surpassing last year’s count of 907 – and with an estimated 70,000 people in Philadelphia currently using heroin daily while thousands more are abusing other opioids, the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) is offering free trainings to the general public on how to administer the life-saving opioid overdose antidote Narcan (Naloxone).

The DBHIDS Narcan overdose prevention trainings will take place at 801 Market Street from 10:00 am to Noon on September 20th, October 18th, November 15th and December 13th. Registration is required. Download Free Narcan Trainings Flyer.


The opioid crisis increases the risk of homelessness for many Philadelphians. The following article in the philadelphiaweekly details what is happening in the Kensington neighborhood.

Highlights of Progress in Kensington/Fairhill

Read “Responses to Gurney Street

Addressing the Opioid Epidemic – How the Opioid Crisis Affects Homeless Populations

National Health Care for the Homeless Council – Fact Sheet | August 2017
America is facing an opioid epidemic that has reached nationally recognized crisis levels. Currently the Center for Disease Control and Prevention cites that 142 Americans die from opioid overdose every day. Since 2000, deaths due to drug overdose in general have been steadily increasing. Read the Fact Sheet

Hank’s Take: Down and out on Market Street

Fox29 Hank Flynn

Philadelphia’s homeless numbers are on the rise, thanks to opioid abuse …. Read the story

What happens when Kensington’s hidden heroin camps close?

Max Marin  June 28, 2017 

Gabby Dean .  . . . under the Emerald Street bridge, was living on the streets until she recently secured a bed at a women’s shelter. On the 2700 block of Emerald Street, a gaunt, bone-thin man named Michael sweeps the sidewalk under the railroad tracks where he’s been sleeping on and off for two years. He tugs at his sweatpants to show that he’s not wearing any underwear or socks.

Two days ago, the Streets Department came through and cleared out the belongings of the homeless drug addicts who had claimed space under the bridge. “They took all my clothes,” Michael says.

In Kensington, the opioid crisis and homelessness go hand in hand. The neighborhood has the largest homeless population outside of Center City, and the dozen people huddled in this tunnel, most of whom asked for their last names to be withheld, are just a fraction of the whole.

Before the Streets Department cleaned out the underpass, about 40 others had set up camp there.

Just a few blocks away, the city and railroad giant Conrail have agreed to clean up and fence off  a far more notorious encampment, which stretches bleakly along the same train line that traverses Emerald Street.

For more than two decades, thousands of addicts have been frequenting the out-of-site injection space known as “El Campamento.” Dozens currently live in squalid conditions at the site. With impending closure, many are concerned about where the unstably housed denizens of Kensington will go to continue fueling their addictions.

“If we looked at a map, people are going to continue their behavior,” says Casey O’Donnell, a psychologist and CEO of Impact Services, a Kensington nonprofit that provides housing assistance. “They’re going to find more bridges, more vacant homes, and the people that want to be out in the open because they feel safer, like at McPherson [Square], they’re going to find more open space.”

Once a month, the Streets Department clears out the tent city that begins to appear under Emerald Street between Lehigh and Somerset.

Locales such as El Campamento and McPherson Square park, where librarians are trained to administer overdose-reversing medicine, have garnered national attention in recent months. The city has stepped up its response. Harm-reduction advocates have been pitching to bring a safe injection site to the neighborhood.

Meanwhile, lesser-discussed places such as the Emerald Street tunnel underscore the sheer scope of problem.

When the warm weather strikes, this thoroughfare north of Lehigh Avenue evolves from a small refuge for regular mainstays like Michael into a full-blown shantytown, packed with mattresses and battered furniture and makeshift shelters.

Once a month, the Streets Department comes in and clears off the sidewalks during what are called “service days,” which are coordinated with the city’s Office of Homeless Services.

Lisa, whose last name is being withheld, leans against the grafittied concrete wall next to two other women. These thirty-somethings are regulars on Emerald Street. Sleeping and getting high in close quarters out in the open is far safer than staying inside a vacant house, they say. Save for when people throw objects at them from moving cars, Lisa says they feel more secure here. They can look out for each other.

“Whether you call it a community or not … whether it’s adaptive or maladaptive, there is a network and a community of people that are in their addiction,” O’Donnell says. “And they haven’t stopped being human just because they use drugs to manage pain.”

In a few weeks time, dozens of others will likely join the crowd. Complaints will arise from neighbors. Cleaning crews and police officers will disperse the burgeoning tent city once again before it gets out of control.

“There’s a core group of us,” Lisa says. “We do our best to try to keep it clean and safe, but then it gets to be too many people.”

The Streets Department gives the homeless and addicted a chance to move their belongings before they service the underpass. (Some, like Michael, say they missed that opportunity last week.) An outreach team from the Department of Behavioral Health and Disability Services also intervenes to offer pathways to social services and housing.

“And when they say yes, we move heaven and earth” to help them, says Liz Hersch, director of the city’s Office of Homeless Services.

But the city’s emergency housing facilities operate at 90 to 120 percent of capacity most of the time, Hersch added, and there are not enough permanent housing units to meet the need for the at-risk homeless population. “We have kind of a clogged pipe system,” she said. “People come in but we don’t have the housing on the other end for them to get to.”

Michael sweeps up the remaining debris and used needles on Emerald Street.

At least 241 street homeless or unstably housed individuals reside on the streets Kensington, according to a 2015 survey conducted by multiple neighborhood organizations. Some who work in the neighborhood believe the number to be much higher. Under Emerald Street bridge, they hail from as close as Fishtown and as far as Florida.

Access to treatment remains the most daunting problem in Philly, especially coming off a year that saw 907 fatal drug overdoses. In the last 18 months, the city has expanded publicly funded outpatient and residential substance abuse treatment slots from 500 to 1,000, said a spokesman for DBHIDS. For those under Emerald Street, however, it’s not always as simple as wanting help. One woman, who declined to give her name, said she couldn’t get into treatment because she doesn’t have the proper identification. Others said they have gone into treatment programs, but they wound up back on the streets where they inevitably relapsed. Non-English speaking addicts, many of whom come to Philly from Puerto Rico for drug treatment through a practice known as “air bridge,” face even more hurdles.

In a matter of weeks, those living and using drugs in the railroad gulch at El Campamento may be searching for new surroundings — whether in treatment or in a new part of the neighborhood.

To stymie displacement, outreach teams are providing on-the-ground intervention near the site to connect drug users with social services, whether it be referring them to Prevention Point for medical care or to rehab facilities for longer-term treatment.

Since May, outreach teams have engaged 259 individuals near El Campamento, says DBHIDs, which is orchestrating the effort with neighborhood organizations like Impact Services and Prevention Point. Nine people have since been placed in treatment, one woman in a Safe Haven, a woman’s shelter. Two people are now being processed for by Pathways to Housing, which connects at-risk homeless to permanent housing.

Back on Emerald Street, Lisa wonders who’s next from her crew to leave the streets for help or housing. Inevitably though, some will continue to find places to sustain their drug habit, whether in a vacant lot, an abandoned house or under I-95.

Michael is still sweeping up a stretch of the sidewalk, using his broom to unclog trash from sewer drain. There are crumpled beer cans, cigarette butts, and food wrappers, but he’s more concerned about the used hypodermic needles. Every time he talks to neighbors, he says he offers an apology and promises to keep the sidewalk clean.

“I may shoot dope, but if it was my kid who got poked with a needle I’d want to kill every addict down here,” he said.