Long wait times and a toxic drug supply make it difficult for Philadelphia patients to get addiction treatment

Navigating Philadelphia’s fragmented array of drug treatment programs deters many people with opioid addiction from getting the care they need, a new report from Thomas Jefferson University has found.

The city has 60 programs outside of hospitals designed for drug users who are relatively stable, and more than 1,800 beds in residential rehabs. Hospitals and psychiatric hospitals have at least another 150 inpatient beds for those with more intense medical needs.

But securing a spot in these programs can be difficult, time-consuming, and physically painful, people in addiction told researchers in a series of focus groups.

The report’s authors recommended a series of reforms to Philadelphia’s treatment system that they said health officials should consider, including:

The report was released in mid-February, before Mayor Cherelle Parker announced a $100 million plan to open throughout the city several “triage and wellness centers” for people in addiction. She has not yet shared details about what services those centers would provide.

A group of city council members who represent Kensington in February proposed that police and outreach workers could take people using drugs openly to “triage centers,” where they would be offered treatment or, if they refused, arrested. But Parker has not explicitly endorsed this, and it’s not clear what role law enforcement would play in her plan for the centers.

Long wait times can make even starting treatment a challenge. People with addiction must undergo assessments that can take hours before being placed into specific programs.

These waits can cause intense suffering for people who are physically dependent on substances like fentanyl and xylazine. Withdrawing from fentanyl, a synthetic opioid now common in illicit drugs sold on the street, can result in symptoms that patients describe as akin to a severe flu within just a few hours.

And withdrawal from xylazine, a horse tranquilizer that has contaminated most of the city’s illicit opioid supply, produces symptoms that include intense chills, sweating, anxiety, and agitation ― which many doctors in Philadelphia are only just learning to treat.

For some patients, the assessment process doesn’t even result in getting a placement: Several patients told Jefferson researchers that they had waited to be assessed for more than 15 hours only to be told there were no inpatient beds available.

“To even be able to be considered for an available bed in the city of Philadelphia is grueling, to say the least,” a certified recovery specialist who helps patients navigate the treatment system told researchers.

One woman told researchers that she was shuttled between an emergency department, an assessment center, and an inpatient treatment facility for a full day while withdrawing from opioids, just to be told there were no available beds until the next morning. She spent the night at a friend’s house in pain. “I was sick as a dog,” she told a Jefferson focus group.

Other patients cited a lack of housing as a particular challenge for getting into treatment. A woman in one focus group had recently lost a friend to an overdose. The friend had been living in a tent, and taking the opioid treatment medication buprenorphine.

Then her tent was burglarized and her buprenorphine stolen.

“She overdosed and died after losing her medication,” said Megan Reed, an assistant professor of emergency medicine at Jefferson and one of the report’s authors. “Housing is just a giant barrier to so many things, both directly and indirectly.”

The rise of xylazine in the city’s illicit opioid supply also makes it harder for unhoused people to access treatment, Reed said. People who use xylazine often develop serious wounds that are difficult to treat, especially on the street. But many addiction treatment centers don’t have the medical capacity to treat severe wounds — and, conversely, many long-term care facilities that could treat such wounds are often wary of treating people with addiction.

“If you have substance use disorder stamped on your chart, nobody wants to deal with you. And a lot of these patients wind up being discharged back to shelters, back to the flop house, back to the streets,” one certified recovery specialist told researchers.

Geography can also prevent people from getting care, especially as the demographics of the overdose crisis shift, said Erin Kelly, an assistant professor at Jefferson’s Department of Family and Community Medicine and one of the report’s authors.

In recent years, more Black Philadelphians have died of overdoses than their white counterparts.

Most treatment centers in the city are located in predominantly Black neighborhoods, but people who need treatment don’t always want to get it in their neighborhood, Kelly said. Some might worry about their neighbors discovering they have an addiction. Others want to avoid places where they’ve used drugs before.

All neighborhoods in Philadelphia should have easily accessible drug treatment so residents can choose where they’re most comfortable receiving care, the report said.

Staff writers Anna Orso and Max Marin contributed to this report.