Opioid Crisis

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.

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.