Living on the Edge
Gov. Corbett's budget, if enacted, could push thousands of drug addicts out onto Philly streets.
Daniel Denvir
City Paper
Neal Santos
CLEAN HOUSE: Anthony Grasso runs Next Step, a Frankford recovery house that serves addicts who don't qualify for city-funded care.
[ DEVASTATION ]
For an estimated 1,000 to 4,500 recovering addicts in the city on any given day, the only option for getting clean in Philadelphia is checking into one of more than 300 informal recovery houses scattered across Kensington, Frankford and North Philly. It's a fragile network, administered mostly by former addicts and funded largely through residents' welfare dollars, in particular the nine-month, one-time General Assistance (GA) payments offered by the Commonwealth.
In Gov. Tom Corbett's proposed budget for the coming fiscal year, GA is eliminated altogether. Advocates say the impact could be devastating, affecting 34,843 Philadelphians who receive GA money (including people with disabilities and survivors of domestic violence) and pushing thousands of addicts out onto the street.
"If you cut all this, the bottom line is that the streets are going to overflow with people," says Anthony Grasso, co-owner of the Next Step recovery house in Frankford. "Do you know how many people are going to commit more crimes to get what they need?"
Recovering addicts are typically awarded medical insurance and food stamps; the rest of their benefits come via GA. It's not much: $205 monthly, unchanged and unadjusted for inflation since 1990.
"When looking at this year's budget, the state is facing significant challenges," says Corbett spokeswoman Kelli Roberts, who argued that the governor made "tough decisions" to "preserve core services." In this case, Roberts says that eliminating GA — cash assistance she says only 19 states provide — allowed the commonwealth to preserve the Medical Assistance available to the same groups. But Corbett's budget also cuts $170.3 million from that program.
Media attention has focused on Corbett's proposed 20 percent cut to Philly's social services, disguised by a new "block grant" that rolls seven line items — funding programs for the homeless and those with mental illnesses and intellectual disabilities — into one. But while that would amount to a $41 million loss in Philly, cutting GA would drain $87.5 million from the neediest Philadelphians.
GA also provides cash assistance to people who do not qualify for federal Temporary Assistance for Needy Families, and those with pending applications for Social Security Disability Insurance. The backlogged Social Security Administration can take months to approve applications; appeals can take years. GA covers applicants in the interim, and if they are approved, the state is reimbursed. For these populations, losing GA would be a severe hardship; for recovery houses, it could be fatal.
Almost 10 years ago, Grasso walked in the door of the recovery house he co-owns today, high on speedballs, oxycontin, heroin — whatever he could get his hands on. "I had never heard about no recovery house," he says. "I know today it was God who sent me here."
His office walls are lined with treatment certificates. Some of the men have recovered, others are now dead. GA provides between 60 percent and 75 percent of the revenue at Next Step. If houses like this one close, the city cannot fill the gap.
"A good portion of the population comes through the uninsured door," says Roland Lamb, director of Philadelphia's Office of Addiction Services. "That means you will have a lot of people who will not be able to be sustained in our system."
The city has 24 recovery houses under contract to provide services, he says. These must meet Department of Licenses & Inspections requirements and have staff complete training programs. The city cannot, however, afford to fund most recovery houses — and so they are, by and large, unregulated.
That can result in a broad range of issues. Some, says Lamb, are "more flophouses than they are recovery programs." Others have been accused of exploiting addicts for cash, or requiring them to perform questionable "volunteer" labor — including at election time. Neighbors complain that most are concentrated in just a handful of zip codes, taking advantage of the abundant cheap and sometimes vacant row homes. Even good houses, Lamb says, are underfunded and thus pose "some definite problems insofar as safety issues are concerned."
"It's all of the above, really," says Paul Yabor, who lives in a recovery house in Frankford.
Most recovery houses follow the 12-step model; others, like the Adonai House on Frankford Avenue, take different, faith-based approaches. Adonai's Bob Beck, like many people who run houses, is a recovering addict you would not have liked to meet when he was using.
"I rode on the wrong side of the tracks," the tattooed, muscular former bike-gang member tells City Paper. Now Beck goes down to Kensington and Somerset avenues most days to pray with addicts. Other times, men come to his door straight from prison: Admission to a recovery house is frequently a condition of an addict's parole or probation.
Everyone — service providers, the city — says recovery houses are indispensable.
"I have no idea how the system would continue if they eliminate General Assistance," says Mimi McNichol, director of social services at the AIDS service organization Philadelphia FIGHT. "These places fill a huge gap not just in terms of recovery, but also homelessness."
Recovery houses also help addicts deal with other medical issues like HIV, which Yabor, an activist with ACT UP, has survived since 1990.
Philly's recovery-house movement began in the 1980s during the crack-cocaine epidemic. A recovering drug addict named Rev. Henry Wells — everyone just calls him "the Rev" — opened one of the first, inviting people to recover at his home. One Day At a Time — or ODAAT, as people call it — is now a sprawling recovery empire with its main facilities at the corner of 25th Street and Lehigh Avenue in North Philly. Over the years, Wells graduates took over ODAAT houses or simply opened their own. And so it grew. "This is the grandfather of all recovery houses," says Mel Wells, the Rev's son and ODAAT president.
Though worried about the cuts, Wells won't speak ill of Corbett.
"We've been trying not to get caught up in the politics," he says.
Nonetheless, he pledges that ODAAT will "raise some hell" to defend GA. On April 3, they're taking buses of recovering addicts to Harrisburg and mobilizing local political support.
Sharif Street, son of former Mayor John Street, sits on ODAAT's board. The recovery house was in John Street's City Council district, and the councilman defended them when the Department of Licenses & Inspections came poking around. (In 1999, hundreds of ODAAT volunteers returned the favor, campaigning for Street.) It is unclear whether local connections will provide sufficient leverage in Philly-hostile Harrisburg. Plus, says Street, "this is a population that, for a lot of folks, is easy to dismiss."
Philadelphia is home to one of the nation's most thriving markets for cocaine and heroin in the nation. People from the suburbs come here to buy drugs, and then move on to places like ODAAT to recover. Indeed, recovery houses are full of people from elsewhere — including from Baltimore, New York, New Jersey and Puerto Rico. Recovery houses, like the Kensington and Frankford neighborhoods where the open-air drug trade flourishes, are extraordinarily diverse.
PRO-ACT Honors Its Volunteers in April during National Volunteer Week
PRO-ACT is celebrating the profound impact our volunteers have had on our Recovery Community. April 15 - 21, we are joining the rest of America in recognizing the 63 million volunteers who have given themselves through service. PRO-ACT thanks our many volunteers who dedicate themselves to service every day. To honor them we are holding events in all of our Recovery Community Centers.
The Council of Southeast Pennsylvania, Inc. is spearheading an initiative focused on overdose prevention and education. Nationwide the number of deaths due to prescription and non-prescription drugs out numbers the deaths related to motor vehicle accidents. This number has continually increased over the years and Bucks County is not immune to the nationwide trend.
According to 2010 information from the Bucks County Coroner’s Office, of all deaths that involved toxicology, 65.8% were directly related to drugs. 37.2% of those deaths were of people under the age of 30. This number reported by the coroner’s office has almost doubled in the past four years. Oxycodone, Xanax, Heroin, Codeine and Morphine were among the highest reported drugs found at the time of death.
There have been initiatives of varying levels in other states from education and awareness, to passing laws giving immunity to those responding to an overdose by calling 911 and establishing programs that distribute a lifesaving antidote to an opioid overdose. Bucks County needs to take action.
This site will include information on the progress of the newly formed Overdose Prevention and Education Advisory Board’s presentations, steps taking place in other communities, legislative actions that are initiated, education and information on drugs and overdose, and resources and references.
If you would like to become involved in this initiative please click on the Advisory Board link and check the calendar or contact Valerie Fahie, Overdose Prevention Coordinator at 215-230-8218 x 3158 orvfahie@councilsepa.org.
By Dr. Stuart Gitlow | March 30, 2012 | 23 Comments | Filed in Addiction &Healthcare
Think about a patient with addiction. He seeks attention for his illness and would like treatment. Should he go to a counselor, a nurse practitioner or a physician? How would his treatment differ in each case? If you’d like to shake things up further, please add psychologists and social workers to the mixture.
If our hypothetical patient is seen by a nurse practitioner in an ambulatory setting yet fails to improve with respect to his addiction, has he failed medical treatment? Would the next step be for the patient to see a physician? Or would it be to enter a more intensive treatment setting?
Our nation is moving quickly toward an environment in which a greater quantity of medical care will be delivered by clinicians who have not attended medical school. Interestingly, we already have that environment in the field of addiction, and have had that scenario for decades. What we do not know, however, is whether this approach is efficacious for the treatment of patients.
Take a simple research study: 200 patients with newly diagnosed addictive disease are divided into two groups matched by age, sex and socioeconomic background, as well as by drug of choice. One group is seen by addiction specialist physicians, the other by addiction specialists who are not physicians, and both are seen with the same frequency and intensity. At 12 months, determine whether there is a difference between the two groups in terms of recovery rate as defined by abstinence and functional improvement.
The study has never been performed.
No one has ever bothered to determine whether social workers are better than physicians at treating addictive illness, or whether physicians are better than psychologists. And though no one has ever bothered to determine if surgical nurses could perform appendectomies successfully, or if counselors can treat life-threatening illnesses like cancer, there has not been a need to answer those questions. So addiction is in an odd place: there is no proof that non-MD/DO care has sufficient quality to be utilized as a replacement for physician-based treatment, yet non-physician treatment already represents the standard in many locations. And of course, there is no proof that non-MD/DO care does not have sufficient quality either.
In the vast majority of patients coming to my practice, prior misdiagnosis or mistreatment reigns high on the problem list on initial intake. Patients treated incorrectly for depressive illness when they have sedative-induced depression, patients treated with combinations of sedatives and stimulants for alleged anxiety accompanying ADHD, patients with known alcoholism prescribed benzodiazepines for mild insomnia or anxiety: the list goes on and on, with physicians in my community being as much to blame as other clinicians.
Addiction is a complex lifelong disease which, if unaddressed, commonly results in death of the patient. Shouldn’t we have some research to determine to whom these patients should be referred?
Stuart Gitlow, MD, MPH, MBA, is Executive Director of the Annenberg Physician Training Program in Addictive Disease and Associate Clinical Professor at the Mount Sinai School of Medicine. He is Acting President of the American Society of Addiction Medicine.
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Are you feeling overwhelmed, stressed or have a specific question about your child’s drug or alcohol use? Our Parents Toll-Free Helpline is anationwide support service that offers assistance to parents and other primary caregivers of children who want to talk to someone about their child’s drug use and drinking. Our trained and caring parent specialists will:
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Our Helpline is open Monday through Friday, 10:00 am to 6:00 pm ET. We are closed on weekends and holidays. The Helpline is not a crisis line. If you do not connect with a parent specialist, please leave a message and we will make every effort to get back to you by the next business day. If you are in need of immediate or emergency services please call 911 or a 24 hour crisis hotline.
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