“A Methadone Clinic? Not in My Neighborhood!”
In conservative Northeast Philly, stigma and denial combine against the opening of a local methadone clinic—even though it would be a lifesaving resource for the neighborhood's own addicted residents.
In May, the Philadelphia Department of Behavioral Health published a map showing the location of 20 deaths by overdose on fentanyl-tainted heroin in the city during a six-week period in March and April of this year. Addiction professionals weren’t surprised that more than half of the victims were clustered in the city’s Northeast section, historically the stronghold of its white working class and, more recently, where many of the city’s heroin addicts come from. Hardest hit by the spike in overdose deaths in recent months, Northeast Philly has also been locked in an epic NIMBY (Not In My Back Yard) battle to prevent the opening of the Healing Way methadone clinic in the Holmesburg neighborhood.
In their struggle against a treatment provider determined to bring critically needed services, residents have been claiming that methadone clinics bring more drug addicts and crime—even as overdosed bodies piled up around them. The press in Philly generally gave opponents of the clinic all the assistance they could muster, publishing a series of stigma-driven negative stories about methadone maintenance that cited neighborhood grievances but referenced no medical or scientific authorities on addiction treatment, even as the city’s Department of Behavioral Health embarked on a groundbreaking anti-addiction and mental health stigma campaign.
The furor kicked off in 2011, with the Philadelphia Daily News covering the proposal of the new methadone clinic as if it were an approaching plague of locusts. “’We’re not gonna tolerate the existence of this establishment,” [a Holmesburg resident] said. “No community is an appropriate place for a methadone clinic.” Residents were frequently quoted citing concern for their children, implying that methadone patients would try to get them hooked on drugs. One resident told the paper, “Imagine them seeing someone overdose here, then the kids can’t sleep for two weeks.”
The community’s struggle was ultimately unsuccessful. Healing Way is set to open in the near future, although at press time no specific date had been announced. But during the three years of opposition to the clinic, Holmesburg experienced one of the city’s worst overdose outbreaks, among drug users who could have gotten medication-assisted treatment had it been available in their neighborhood.
Even now, with overdose deaths in Northeast Philly at a fever pitch and Healing Way’s long-obstructed treatment provision on the verge, the Daily News continues its deeply stigma-imbued coverage, citing criticism of the clinic’s zoning approval by a local resident who was recently stabbed by “a man obviously high on drugs.”
“I’m worried every day now. I’m terrified,” the woman told the Daily News. “My little brother Marc, who is 12, walks to school and walks to the [Holmesburg] library right past [where the clinic will be].” Outrage that the clinic will be located across from a childcare center and a Christian church remains shrill; residents consider a methadone clinic to be no better than a liquor store and imply that methadone patients are on a par with sex offenders. The news coverage has parroted the opposition line that a methadone clinic will draw addicts to the neighborhood, rather than serve those already living there.
Almost without exception, the local news failed to print the obvious fact that members of the Holmesburg community are themselves addicted to drugs and that the section of the city has for years been plagued by pharmacy robberies. The news neglected to speak to a doctor or a public health expert or to note that methadone has long been the gold standard worldwide for treating those addicted to opioids. There was no mention that in addition to reducing arrests and the spread of infections like HIV and hepatitis C among drug users, methadone reduces the likelihood of death by overdose. People in this very neighborhood have been dying of overdoses even as reporters were working overtime to cover a story from the viewpoint of those who want to prevent opioid users from getting services that could save their lives.
Outrage that the clinic is located across from a childcare center and a Christian church remains shrill; residents consider a methadone clinic to be no better than a liquor store and imply that methadone patients are on a par with sex offenders.
While heroin addiction has been persistently miscast as an “inner-city problem,” insinuating that users are primarily poor and black, the heroin markets of North Philadelphia are fed overwhelmingly by white commuters from the Northeast and South sections of the city and the surrounding suburbs. “Going down the way,” as traveling from, say, Holmesburg in Northeast Philly to Kensington in North Philly to cop heroin is called, has been a ritual for decades. Some daily users stop by the heroin corners in North Philly on their way to work and then again on their way home; other binge users “go on a run” that finds them putting supplies in a backpack and living on the streets in Kensington for days at a time, flopping in abandoned houses when they need to sleep. When their money runs out, many return to the Northeast to get a shower and a meal from family members.
More heavily addicted users eventually stop commuting to save the transportation cost and relocate to Kensington until they go to detox, get locked up or turn up in an abandoned building, dead of an overdose. (Two of the 20 overdose deaths recorded in the city’s six-week survey were in the zip code covering the Kensington drug corners.) Philadelphia’s commuting addict phenomenon sparked a brief national controversy when a YouTube video of a nodding mother not attending to her child on the 66 bus that connects Northeast Philadelphia to Kensington went viral.
Having to commute from white sections of Philadelphia to poorer black and Latino neighborhoods for drugs is actually little changed when addicts seek medication-assisted treatment. The Healing Way will only be the second methadone clinic in all of Northeast Philadelphia, a vast tract of land whose other existing clinic is remote and difficult to reach by public transportation. Despite the region’s large number of opioid users, the bulk of methadone treatment services citywide are disproportionately located in poorer and predominantly black neighborhoods like West Philadelphia, Germantown and Olney, even though local residents do not need the services nearly as much. A map published by the City of Philadelphia demonstrates that publicly funded methadone-maintenance patients are sparsely clustered around clinics in poor black neighborhoods and more densely clustered in more affluent white neighborhoods less likely to provide the service.
For decades white, working- and middle-class Northeast Philadelphia has pointed its collective finger at poorer, ethnically mixed neighborhoods for infesting the city with drugs and crime.
Northeast Philadelphia is historically more politically conservative and Catholic than the rest of the city, though the community has diversified with white flight to the suburbs. It is the home of many local police officers who would love nothing more than to leave the city that they consider a cesspool but are stuck here because of law-enforcement residency requirements. It’s a post-industrial landscape of row houses and modest single houses, home to the city’s Fraternal Order of Police lodge and dotted with Ancient Order of Hibernians clubhouses and strip-mall sports bars. It refuses to admit in public, even reluctantly, that it has a significant heroin problem because it has so much invested in its self-image as the last bastion of order in a crime-ridden hellhole of a city. (Another fact that Northeast Philly residents ignore: Crime has fallen elsewhere in the city, while Northeast has become poorer and more dangerous.)
For decades white, working- and middle-class Northeast Philadelphia has pointed its collective finger at poorer, ethnically mixed neighborhoods for infesting the city with drugs and crime, despite the fact that their own residents drive much of the demand. Likewise, they’ve pushed methadone treatment services into poor sections of the city and force their neighbors to travel distances to receive them, while pretending that the poor black residents of those neighborhoods are the ones who really need them. Now that the Northeast is in a state of decline, it’s understandable that residents are angry about unemployment, rising poverty, crime, failing schools and other very serious problems facing the community. But scapegoating addicts and stigmatizing methadone will only make things worse, not better.
Andrew Ricciardi is familiar with the methadone stigma talk on Philly streets. “Prior to getting on methadone I heard all about ‘liquid handcuffs’ and how methadone gets in your bones so you can never get off it, how it rots your teeth and the clinics just want to milk you for money,” he recalls.
Ricciardi comes from a family with a long history of addiction, losing his mother to the disorder at an early age, and then growing up with his aunt in South Jersey. Soft-spoken with a buzz cut and built big as a bus, Ricciardi got his first taste of opiates after a college football injury. “It was the standard progression kids go through nowadays. It started with Percs, then Oxys and on to heroin.”
Like many who transition onto heroin from pain killers, Ricciardi found that heroin burns resources faster and brings a new set dangers: greater risk of arrest, needle-borne infections, the threat of street violence. “When you’re buying pills it’s usually off a friend or somebody you know. With heroin it’s a 14-year-old kid with a gun,” he says.
Ricciardi, who says he was a methadone stigma poster child before he got educated on the benefits of the medication, says that he eventually became one of the hidden miracles ignored by papers like the Daily News. “When I got to the clinic I realized it’s not liquid handcuffs. It’s about quality of life. I was homeless on heroin, my life was a wreck. After three years on methadone my life was totally turned around. My quality of life was completely different.”
After going back to school Ricciardi went to work for the clinic as a peer specialist, helping get addicts connected to medication-assisted treatment services, housing and education. He recently cofounded the Philadelphia branch of the National Alliance for Medication Assisted Recovery, where he advocates for stigma-free methadone treatment.
“We want people to know medication-assisted treatment is a legitimate form of recovery.”
A greater reliance on peer specialists in recovery has been the hallmark of the Philadelphia Department of Behavioral Health’s Recovery Transformation model, along with a high-profile campaign to destigmatize substance use and mental health disorders. Recovery Transformation seeks to build more support in communities where drug users live, including enriching the services available at methadone clinics historically considered dingy, depressing places addicts are chemically chained to.
“We’re offering a holistic approach, not just drug treatment,” Ricciardi says. “We want people to know medication-assisted treatment is a legitimate form of recovery. We’re working on education, getting people into GED programs, job training. People on methadone have been excluded from a lot of these services in the past because of the medication they were taking. So there’s a rights education piece to my work, too.”
But then, there’s the loitering issue. The public face for medication-assisted treatment has stubbornly remained the crowds of people who hang around after getting dosed, nodding out at the bus station on the corner or trading pills in the parking lot. It has shaped the opinion of opponents to the Healing Way clinic in Northeast Philly and continues to be pushed in the local press. But many don’t understand that this Methadonia-element of the clinic population is a small number of the people receiving treatment at any given facility. The majority take their medication, go to counseling sessions and then go to work, to school, home to their families.
“People benefit from methadone but outsiders don’t see it,” Ricciardi explains, because stigma against methadone is still so powerful that professional people on the medication remain reluctant to speak out about it.
“People benefit from methadone but outsiders don’t see it,” Ricciardi explains, because stigma against methadone is still so powerful that professional people on the medication remain reluctant to speak out about it. “It’s just like how people used to be embarrassed about being in AA or NA, but now people talk publicly about it a lot more frequently. I hope that as the stigma disappears more people who benefitted from the medication will be willing to share about their experience.”
Some clinics are better than others—more serious about policing their own property to make sure patients aren’t blocking foot traffic, being disruptive or engaging in illegal activity. The Northwest Human Services methadone clinic in the Germantown section of Philly has a reputation in the community for being a good citizen, unlike other facilities considered “juice bars” where patients get dosed, don’t receive very good services and spend the day hanging out in the neighborhood. Opponents of Healing Way who are so concerned about their schoolchildren being corrupted by methadone patients might be surprised to know that the Germantown clinic is across the street from the Germantown Friends School, one of the most prestigious private schools in the city.
Ricciardi comes at the criticism about bad neighborhood behavior head-on. “Look,” he says, “there are definitely people in methadone programs still getting high. Straight up. But the question is, what to do with them? Do you cut them off from services and put them back in the street to shoot heroin? I don’t think that’s the right thing to do. I think we need to keep working with that person, keep offering them good services in the hopes that they’ll come around.”
Healing Way won’t have much choice in the matter, as City Councilman Bob Henon has said publicly that he intends to hawk the clinic to keep its patients in line and take action against it if patients misbehave. The clinic is not exactly opening under perfect circumstances, but at least it’s slated to begin accepting patients soon.
“You got people dying left and right in that neighborhood due to opioid dependency and yet the community resists the best, proven medical treatment for it. It’s crazy,” Ricciardi says. “And it’s all because of stigma.”
Jeff Deeney is a Philadelphia social worker and writer who is in recovery, and a columnist at Substance.com. He contributes to The Atlantic and has written for The Daily Beast and The Nation. His previous column for Substance.com was about a corruption scandal that rocked the Philadelphia Police Department’s narcotics squad but failed to drive reform.
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