Philadelphia is home to the worst urban opioid crisis in America. More than 3,000 people have died of drug overdoses here in the last three years, and the city health department estimates that tens of thousands of Philadelphians are addicted to opioids. As the epidemic has worsened, city officials, hospitals, and outreach workers have scrambled to address a complicated public health crisis with few easy answers.

The city has spent more than a year pouring resources and initiatives into Kensington, the neighborhood at the epicenter of the crisis. Two years after fatal overdoses hit an all-time high—claiming 1,217 people in 2017—it appears that the 2019 toll will be similar to 2018’s, when 1,116 people died.

“The numbers haven’t been finalized, but the preliminary numbers—I’m not particularly pleased,” said Brian Abernathy, the city managing director. “It’s about the same as last year. But I’m not happy with that. The amount of devastation that’s happening on so many different levels is just not something we as a city should think is okay.”

Getting that still-staggering number to budge in 2020 will mean much more work, especially outside Kensington, in areas like South Philly, where drug use usually happens behind closed doors, away from the reach of health workers.

Here’s what the city—and its partners in local hospitals and outreach organizations—have planned for the year ahead.

More peer specialists in and out of hospitals. People who are in recovery from addiction have long been part of the treatment industry. But “peer specialists,” as those who have gone through a state certification process are called, are taking on bigger roles in Philadelphia hospitals, connecting with patients in ways physicians and nurses say they cannot. They are meeting patients in emergency rooms, helping people with addiction navigate the days of early treatment and doing street outreach around the city. Since Penn Medicine began sending peer specialists into its emergency rooms in 2018, seven in 10 of the department’s patients with opioid use disorder have stuck with treatment for at least 30 days. Other hospitals are eager to replicate that success and are looking to expand their peer programs in the new year. The city is trying to hire nearly four dozen peer specialists, as it helps hospitals improve their “warm handoffs” of patients directly into long-term treatment.

The Temple hub. With help from a large state grant, Temple University Health System has expanded its treatment programs and referrals, acting as a “hub” that sends patients to community treatment programs. This is especially key at Temple, because the health system’s Episcopal Hospital in Kensington deals with more overdoses than any other hospital in the city. Temple increased its buprenorphine prescribing—medication-assisted treatment proven to yield more lasting recovery—by 70% and increased its outpatient treatment slots from 11 new patients a month to 116.

The next generation. At Jefferson Health, MATER, the long-running treatment program for pregnant women with addiction, is incorporating women’s families into their treatment. Instead of requiring a 30-day “blackout” from all contact with the outside world, like many treatment centers do, MATER is hosting family dinners twice a month, offering family therapy, and helping mothers plan to reunite with their extended families, said Kim McLaughlin, the program’s director.

Bending the rules to keep people in treatment. In the past, if someone missed three treatment appointments in a row at Jefferson, they were out of the program, said McLaughlin. But now, for example, if someone is missing fewer appointments than they used to, that’s considered an improvement, and not a reason for punishment. She says it’s a key change in the middle of a crisis where leaving treatment can mean death.

Getting naloxone where it’s needed. Last year, when Penn Medicine launched large-scale, staff-wide giveaways of Narcan, the overdose antidote, employees from around the system came by to pick some up, said Jeanmarie Perrone, the director of the division of medical toxicology in the University of Pennsylvania’s emergency department. Often, she said, staffers knew family and friends in their communities who might need a dose of Narcan. “They were really personally affected and wanted to be better prepared for their community,” she said.

Better leadership in neighborhoods. Kensington is no longer under the emergency declaration prompted by chronic public drug use and homelessness that had people in addiction living in encampments under bridges. But some programs used during the declaration will continue there and in other parts of the city. Some examples: More mobile addiction treatments in neighborhoods without many treatment options, like the van that prescribes medication-assisted treatment in South Philly. The city is also looking to add more supportive housing for the chronically homeless. Former deputy director of emergency management Noelle Foizen will lead an “opioid cabinet,” where the officials who oversaw the emergency declaration will meet regularly to address opioid-related issues all over the city.

Work to earn. This month, the city launched a program where people can help clean streets in Kensington, and be paid the same day. Two days a week, 10 people will be selected by lottery to earn $50 for about four hours of work. “The goal is to provide people with a more productive way to earn money rather than petty theft or panhandling,” said Abernathy. (People who aren’t selected in the lottery will be offered treatment, other help finding jobs, and links to social services.)

Protecting schoolchildren. Despite all the work that’s been done in Kensington, open-air drug use and dealing continue, and smaller encampments remain on Kensington Avenue. Schoolchildren often have encountered dealers, needles, and people injecting heroin on their way to school, so one of the most popular improvements has been “safe corridors.” These neighborhood volunteers help children get to school safely. “I greet them, and say good morning, and kind of get between them and any negative aspects in the community,” volunteer Mike Noton said.

Stemming gun violence. For police officers who patrol Kensington, the biggest challenge is getting drug-related shootings under control, said Inspector Michael Cram, who commands the department’s East Division. Cram said intense demand for drugs in the neighborhood has prompted dealers from other parts of the city to “rent” corners to cash in on the highest profits. These outsiders carry guns for protection—and to keep up, Kensington dealers are doing the same. All those guns, he said, lead to more violence.

Treatment, not arrest. The city hopes to expand a police diversion program in Kensington and North Philly, where people with addiction are offered treatment and social services, instead of being arrested. In all, 951 people were referred to the program from Kensington alone in 2019, the city says.

Keeping a closer eye on pill sales. The city plans to create a local data reporting system for pharmacies, because it’s often hard for local entities to access statewide and national data on pill sales. The system, aimed at monitoring sales of prescription opioids to spot illicit use, should be in place within three to six months, city officials say.

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