Anyone who mistakenly believes the opioid crisis is over or even waning should take a two-hour drive east and visit the raw heartache of Philadelphia’s Kensington neighborhood.
We discovered recently there were few good places to rest your eyes in Kensington. We saw doorways crowded with semi-conscious drug users; people passed out on benches and against parked cars; open-air drug bazaars; folks injecting drugs into each other’s necks; women and men selling their bodies for five dollars and a hit of drugs. All out on the main streets, in public, in the middle of the day.
It's strikingly clear through our work producing a podcast on drug treatment that the opioid addiction crisis is not over, not in Kensington, and not in Lancaster County — where 80 people have already died this year from overdose — and certainly not in Pennsylvania, where fatal drug overdoses continue to claim lives, now at the rate of 12 people a day.
If we ever hope to stop this devastation, we need to better use the tools of treatment we have available and stop stigmatizing the people and families who need our help and support.
Kensington, in northeast Philadelphia, has been rocked by hard economic times. But the opioid crisis is the ultimate equalizer. As in Lancaster, Kensington saw record-high overdose deaths drop over the last two years through an aggressive dispersal of naloxone or Narcan, the overdose reversal drug.
But traditional heroin is all but gone in most places, replaced by more deadly synthetic drugs such as fentanyl, which make reviving someone from an opioid overdose more uncertain. For now, naloxone is saving lives, but it's not a solution for substance use disorder — evidence-based treatment is. With the proper treatment and support, recovery is not only possible but highly probable.
One option for recovery is a medically assisted treatment plan, often referred to as MAT, using methadone, buprenorphine (Suboxone) or naltrexone (Vivatrol). A MAT regimen can block the horrific withdrawal symptoms that keep many people in addiction. Moreover, a MAT program usually diminishes cravings for opioids while the person is working on recovery.
MAT can drastically reduce overdose deaths by up to 60%, according to the latest study of nearly 20,000 people in active addiction, from the National Institutes of Health. Yet the same study found that in the first year following an overdose, which is arguably the most critical time in recovery, only 17% of people, at most, were enrolled in a medically assisted treatment plan. Which, by the way, mandates counseling as part of treatment.
We found in our interviews a widespread misconception of what MAT is. Some people say it’s just substituting one drug for another. Even though MAT medications work on the same receptors in the brain that opioids do, their job is to block the craving that comes from opioid dependency. Without cravings, many people can concentrate on their recovery, rather than the monkey on their back. Medications like daily aspirin for heart disease and insulin for diabetes were designed to help those with a chronic disease. Substance use disorder is a disease.
And then there are some in recovery who feel MAT was not the treatment they used to reach sobriety, so they disparage people who are using a different path. In all of Lancaster County, there is just one Narcotics Anonymous meeting specifically for people on MAT; it was started by Project Lazarus, a grassroots organization fighting the opioid epidemic across Lancaster County. Even more perplexing is that there are very few recovery houses in this county who admit women on a MAT plan, even if they have stabilized their lives with the treatment.
MAT is not a magic pill by any means, and not all are successful on it. But for many people it works very well and those who adhere to it can lead normal lives, have jobs, take care of their families and plan for a future. It makes no sense to underutilize the treatment that has been proven to be the most successful so far.
As Dr. Nora Volkow, director of the National Institute on Drug Abuse, recently wrote, “A great part of the tragedy of this opioid crisis is that ... we now possess effective treatment strategies that could address it and save many lives, yet tens of thousands of people die each year because they have not received these treatments. Ending the crisis will require changing policies to make these medications more accessible and educating primary care and emergency providers, among others, that opioid addiction is a medical illness that must be treated aggressively with the effective tools that are available.”
Although Kensington’s drug problem foreshadows hardships yet to come for other communities, it is also shining the light on some innovative solutions. Prevention Point Philadelphia in Kensington does not wait for those in active addiction to come for treatment; its caring staff take Suboxone out to the streets in the organization’s “bupe” (or buprenorphine) bus and get people stabilized on the medication so they can make clear-headed choices about treatment and recovery. This has helped reduce overdose deaths in that community.
Now it’s our turn to make decisions in our community.
We can continue to blame those in the throes of addiction and their families or we can decide to be vigilant about treatment. We can love our neighbor who is struggling with drug use.
And we can decide to embrace what works.
Susan Baldrige is executive director of the nonprofit Partnership for Public Health and a former LNP staff writer. She co-wrote this with Zerubabbel Asfaw, with whom she created “Jonesing,” a podcast on the science behind medically assisted treatment. Listen at apple.co/35gs4pJ or at spoti.fi/2ota1Mv. Baldrige’s email: Susan.Baldrige@lanchc.org.