Trapped by the ‘Walmart of Heroin’

A Philadelphia neighborhood is the largest open-air narcotics market for heroin on the East Coast. Addicts come from all over, and many never leave.

Comments: 262

  1. Listen to TSOP (The Sound of Philadelphia) while you read this and try to remember, as I can, the city before it turned into an ugly cesspit of drugs and used needles. Bet you can't...

  2. I hate that the entire city of Philadelphia is being portrayed as a cesspit of drugs and poverty. This is a terrible problem but it is only one neighborhood in a city of great neighborhoods. I moved here 25 years ago and wouldn’t want to live anywhere else.

  3. I don’t think the author painted the city with a broad brush. She took pains to pinpoint the problem. This isn’t a story about Philadelphia; it is a story about a small area and the complexities of tackling an immense crisis. She repeatedly wrote about the administration's efforts to find solutions and to help people.

  4. Your pictures make this look like it is an overwhelmingly White population addicted to drugs. Is this true? If so can it be explained? Were they targeted or do they have some social or biological similarity which explains the demographics? Drugs should be decriminalized including heroin and cocaine. The law should only limit the quantity an individual can sell to less than $100,000 a year. Corporations should be banned from trading in recreational drugs. We should punish large drug syndicates and only allow mom and pop operations. The punishment for large operations should be draconian. Take the massive profit out of recreational drugs.

  5. @Mike: it is easily explained.. The road to heroin addiction doesn't go through the weed dealer but (only in the US) through the doctors office.. Most other countries ban opioid prescription for people who are not on the verge of death.. It's called terminal care and should be the only acceptable time a doctor prescribes opiods! USA; please wake up, ban prescriptions to anyone who is not on their death bed.. You'd still be stuck with the current addicts but the problem will not grow anymore or at least as fast as it is now! No way that's going to happen as the drug makers pay millions to politicians to prevent just that!

  6. @Mike
    When strong opioids became common practice for routine surgeries, POC were for the most part, denied pain management due to the belief that POC had a higher rate of addiction. So largely, the black population in particular has been spared the big pharma opioid crisis. However, it needs to be noted the black population has been struggling with an opioid crisis since the 40's, with white America largely ignoring it. A scene from the movie "The Godfather", tells of the beginning of this crisis best: the heads of the five families came together for a truce and one don stood up and declared "In my territory, we would keep the trade in the dark communities, the coloreds. Their animals anyway, so let them loose their soul."

  7. @Mike: please go find and read the book "Dreamland" by Sam Quinones.

    It explains the whole thing. It is not that "white people are more immoral and addiction prone."

    White customers were TARGETED very deliberately -- first by Purude Pharma -- then by very sophisticated drug dealers working out of a particular district in Mexico -- they did not want to deal with blacks due to the fear of violence and rival black dealers. They knew whites were polite & passive customers. THEY TARGETED WHITE PEOPLE with laser-like precision. Most of the dealers are illegal aliens from MEXICO.

  8. I feel so bad for the people who live there and cannot move. It always amazes me how people like these addicts (although their quality of life is shot) can go on and on and on, bodies ravaged, health deteriorating, skeletal, disease-ridden, and we have people with legitimate ailments and diseases, trying to fight them proper medical care who don't survive and die. drug addicts live forever, ordinary citizens die from the flu. go figure. TSOP days forever.

  9. @nyc2char
    The belief that addicts live forever is way off. Not sure where you got that line of thinking. There is no doubt that addicts tend to take a lot of people down with them but there are answers but they are big answers.

  10. @nyc2char
    How can you say "drug addicts live forever"? Their mortality rate is at bubonic plague levels. For ordinary citizens, our life span is actually increasing; cancer is yielding to new treatments; ordinary people with decent insurance, which is a high hurdle, can have acceptable, if not leading-edge health care.

    As long as the Republican right wing is in the driver's seat, our society will not ascribe any value to the lives of addicts or the poor. In fact, to these plutocrats, anybody not in their income range is dispensable.

    So we "ordinary citizens" have more in common with addicts than we are willing to admit. If we truly valued these people as fellow human beings --- the children, brothers and sisters of somebody; the mothers and fathers of somebody, we would treat them as the Portuguese model does. Now they and those who love them have no way out.

    Treating the agonies of withdrawal, and assuring that addicts don't poison themselves should be a national priority. (I can almost hear the sarcastic scoffing at that.) People will scoff untl one of their own loved ones falls into the pitiless iron grip of addiction.

  11. @nyc2char I love Philly. Always will.

  12. My mom grew up in Port Richmond and my aunt still lives there. It's crazy knowing about "The Badlands" since you were a kid and now reading an article where you can recognize the street names and know exactly where these camps are. This story isn't new and it is still a story after decades because there is no easy fix to this endless cycle. At the same time not doing anything and just blaming it on people's "character" and "choice" is not a solution. Decriminalization works for Portugal and is the only fix we haven't tried yet. Just need to get the political will to do it. How long we will wait for that? Decades more probably. :(

  13. @Brett: Portugal is a tiny nation of 10 million. And their problem was vastly smaller and did not involve the same level of lethal drugs.

    It is worth studying their approach, but I do not see other countries EVEN IN EUROPE copying Portugal.

  14. Not to worry. Trump has promised to fix this.

  15. @A. Stanton: this problem is DECADES old and you know it.

    How did OBAMA fix this? please be specific.

    Obama had 8 years -- Trump has had 20 months.

  16. I thought Trump was going to do something about the opoiod problem. Just like he was going to do something about the Chicago crime problem. Thanks Trump.

  17. @Angel this has nothing to do with Trump. Listen, I cant stand him, but this has been going on down in that neighborhood since Reagan. Lets be real, it will take an army of people & agencies to even begin to curb this epidemic. You can really thank the Senators, Boarder Patrol, the pharmaceutical industry, and city council for allowing this to happen. It doesnt get this bad by chance. Read up on the FDA passing Oxycontin without doing clinical trials, resulting in "no known side-affects", although the Chinese have know for 5000 years that opiates are addictive.

  18. Google opium war, half of the Chinese population were addicted to opium, forced sales by the biggest drug dealer ever existed, UK.

  19. Jeff Stockbridge, congratulations on being recognized for your striking and tireless portrayal of Kensington Blues.

  20. @cwhy check-out his book, Kensington Blues. Its a collection of pictures, and short stories written by individuals who are/were stuck in Kensington. He donated a percentage of the proceeds to Prevention Point, the clean needle exchange.

  21. Reading version after version of this story, set in city after city, rural area after suburb, year after year after year, one could get the idea that no one, anywhere, has a clue how to effectively address the problem.

    It's almost as if we didn't have, among other examples, nearly two decades of history in Portugal to point the way for us.

    It couldn't be that some of the massive resistance to changing our societal approach arises from attachment to the $30 billion or so we spend on abysmally-failed *old* approaches, could it?

    "It is difficult to get a man to understand something when his salary depends upon his not understanding it."

    ~Upton Sinclair

  22. There are other models, and some of them work. When reading this article, it reminded me of the open drug scene I witnessed as a young person growing up in Switzerland in the 80s. There were many parallels, from shutting down areas where dealers and users congregated followed by everyone spreading out into the adjacent neighborhoods and scaring residents, all the way to the city installing "blue lights" to prevent users from finding their veins. All of this happened on a smaller scale but it was terrifying and the government learned its lesson: now there are safe places to inject heroine with medical staff present, prescribed methadone AND heroine, etc, and it's gotten a lot better. Harm reduction is the key, abstinence and willpower are mostly wishful thinking held by those who have never experienced a serious addiction.

  23. We lost the war on drugs 20 years ago. But the government and police must reap financial benefits otherwise the open street selling would cease.

  24. @Douglas are people in these areas actually being arrested for drug possession? My impression is that they are not and that drug use is done in the open with little fear of law enforcement. Thus it is unclear how Portugal style decriminalization would resolve these issues. I actually favor decriminalization, but do not think it is a panacea for the sorts of issues detailed in the article.

  25. After reading the article I have a new appreciation for how complex and difficult this problem is for cities, health professionals, and community activists. I applaud Mayor Kenney for forming a task force to tackle the problem head on. I also applaud his realism--that finding solutions will take years. But no one living in America's birthplace, Philadelphia, should live in such abject despair--not the addicts or the residents who must witness the suffering and blight that addiction brings.

  26. @GK

    I beg to differ about the success of Mr. Kenney's 'task force'. A better moniker might be 'design committee'.

    The results seem to have been a mishmash of stale ideas brought to the table by the various participants, with no overall strategy and highly dubious results.

    That's not leadership.

  27. What? It sounds like exactly the right group of experts worked hard to develop evidence-based solutions to an exquisitely complex problem. If you have better ideas, by all means please share.

  28. The removal of the law from all of this is the first step to a solution but there are so many interests that would object.

  29. @JH3 Removing the law from the sale and use of fentanyl would be devastating to our society. That's not even debatable.

  30. This is so depressing!

    You have to wonder if the prolonged stay in the Middle East has anything to do with it. After all, that tightened environment can forever change a person's psyche. Life is not as precious and people need more kicks to feel alive.

    And the synthetics just blow everything away. Your brain may get rewired permanently. This is not just behavioral, it may really be neurochemical. Even with Suboxone, blocking the craving might not be enough.

    So, without even understanding the basic science, how are you going to cure a disease, man-made it may be

  31. @Bos: That prolonged and failed involvement in Middle Eastern as well as Far Eastern power struggles has diverted our attention and resources from dealling sensibly with our own problems at home -- no coubt about that!

  32. How about enacting and enforcing vagrancy and drug laws and just trying incarcerating these young people. Enforced professional rehab with multi-disciplinary treatment teams? Prison or jail vs rehab? I know it is expensive and unpopular but really this sort of behavior ought to be illegal and come with significant consequences.

  33. You mean doing the same thing we've been doing and hoping for different results? That's the definition of insanity.

  34. I was 23 and working in a psychiatric facility in Albuerque. A patient there was a young woman who'd signed herself in to detox from Methadone. She was charming and I was completely taken in -- advocated for her to get shots of Valium for her symptoms. But after a while, I was disenchanted. She told horrific stories. Her sister was a piano teacher but she sold her sister's piano to buy drugs. She'd trained her 3 year old daughter to "look for ties for mommy." I later learned that she'd signed herself into the hospital for methadone detox because heroin was more fun. I think about her when I read stories like this. This article captures the complexities, but my heart is with the residents of the neighborhood who are trying to survive and raise children in these terrible neighborhoods.

  35. Susan: your story is horrific but there is one line that does not track. The addict you spoke of indicated that heroin was”more fun” than methadone. Most addicts feel that the drug they are addicted to are more like a ball and chain that they are unable to extricate themselves from. No real addict are having fun. The fun ends after getting high has caused a major upheaval in the user’s life. How many high I had ask have you seen smiling, dancing and generally enjoying life?

  36. Before there is desire to inject, there is extreme despair. Do these people have a "good reason" to be so much in despair that the only way "out" is thru blanking out. While homelessness and basic necessities are important, many addicts (as the woman says she has two children who are addicts) are losing hope for reasons that have lttle to do with resources: Recall the addict who said she finds here belonging even if it's a dysfunctional family. We need a multipronged approach and it starts with school and basic sense of what s good. No wonder USA is near the bottom in PISA!

  37. Just yesterday I attended the funeral of a 52 year old friend, a long time addict, who thought he was buying coke (!) but instead got a deadly dose of heroin laced with Fentanyl.

    It feels like the AIDS epidemic when a generation was wiped out. Now, as then, we’ll never know what those people could have become or accomplished. We’re incredibly smart and talented people. We have to find a solution before we lose any more of our families, friends and neighbors.

  38. @Rmski77

    Ouch!! Sorry about the loss of your friend, Rmski77. It must've been extremely painful for you to have to deal with. Take care...all the best.

  39. @Rmski77

    No. A generation was not wiped out. Not even close.
    The AIDS epidemic, officially counted as beginning in 1981, has killed 675,000 people. In 37 years, that comes to 18,243 people a year IN THE U.S.

    In contrast, the flu epidemic of 1918-1920 killed somewhere between 50 million - 100 million people worldwide, with 500,000 people dying in the US in a two year period.

    Yes, HIV/AIDS is a tragic virus, whose mortality has largely been controlled by the great antiviral cocktails that science has researched and tested.

    This is a situation that is worsening from so many factors -- availability, cost, and others notwithstanding, the pushers are very good at what they do.
    Please do not equate HIV/AIDS with this.

  40. Doctors need to stop using opioids for every procedure and sending patients home with prescriptions that addict them. Shame on the medical community of doctors and big pharma that created these drugs and continue to use them. My daughter was prescribed oxy when she had her wisdom teeth out, how ridiculous! Everyone needs to accept a little pain for a short term issue such as that, to avoid the chance of a lifetime of addiction. Extreme chronic pain is another story, but these drugs are prescribed after nearly every surgery. Reform and regulation of opioid prescriptions is long overdue.

  41. I agree. But in the same breath, people will claim the opioid crisis is due to the difficulty some people have getting opioids from physicians

  42. I agree. There are effective and much safer options for pain relief after having a wisdom tooth out, like anti inflammatories.

  43. I'll be sure to run my prescriptions past you next time. Forgive me

  44. This scourge is growing, its unreal how many do drugs. Basically to escape reality, or pain, or dysfunction, social ills like housing that is too expensive. Vicious cycle impossible to break.
    In beautiful supernatural BC we got the same problem and its growing we have had hundreds and hundreds and hundreds more die in the last 2 years fentanyl related, we have burgeoning homeless camps with people of the same ilk like one of the addicts said in the article "one big dysfunctional family" they feel less of outcasts together. Expect more.
    Complex of course now when you let the problem get out of hand.The resources from a previous right business oriented gov't limited health care funding here, closed a major mental illness institution and support systems, and brought the compromised vulnerable to the streets. No direction home these, no hope.
    The costs are astronomical paramedics man-hours, emerg rooms full. Now everyones on the band wagon in Canada with cannabis legalization huge corporate profits the next big thing... stock in sky mode yet no support infrastructure on abuse. Well,maybe we will fund a task force.

  45. I am appalled and disgusted at the absolute lack of personal responsibility shown by the opioid addicts in this story and similar stories. No matter how many times options for recovery are provided, no many how many times Narcan is adminstered to bring them back to life from an overdose, many of these people choose the easy path of continuing to shoot-up heroin. I have no sympathy and little empathy for people who time and time again choose poorly when given options to pull themselves together.

  46. @GTM I hear you - it's maddening. What has helped me develop empathy is reading about what opioids do to the reward, long term planning and decision making centers of the brain. They are badly damaged.

    Asking an addict to plan a path out of their personal hell is like asking someone with major depression to pull themselves up by their bootstraps.

    We can make tough choices, based on actual data about what truly works, while still seeing these people as human beings who deserve empathy.

  47. @GTM
    Did you even bother to read the article? You think addicts WANT to live like this??

    You obviously understand nothing about addiction. It has a biological effect. It changes the chemistry in the brain. It's not simply a matter of "choosing" not to shoot up.

    The son of friends of ours just died from an overdose. He was 23 years old. He was the oldest of their three children. They are a solidly middle-class family. The father is an academic, in a prestigious position at a unversity. The mother is an administrator. Their other two grown kids are perfectly healthy and stable and self-sufficient.

    What went wrong with the oldest? We don't know. They don't know. They spent years suffering and god knows how much money putting him through one rehab after another.

    I had another friend -- highly educated, literate, well traveled, charming, funny, again solidly middle class -- who became addicted to crack, of all things, in his mid-50s. Mid-50s! He, too, went through rehab after rehab after rehab, over years, until he was finally able to stay clean. But because cocaine wreaks havoc with the cardiac system, he dropped dead of a heart attack only a year after coming clean.

    It's charming that you're so "appalled and disgusted." Maybe one day you'll also learn to be compassionate.

  48. @GTM: "...many of these people choose the easy path of continuing to shoot-up heroin."

    "EASY PATH?"

    So here's my brief experience with opiates: I was prescribed one to manage pain after knee replacement surgery, told to take one about every four hours or as needed. I maintained the four-hour schedule using my iPhone to remind me, keeping a careful written record to track my intake.

    After only two days of taking them as prescribed above, I noticed that three hours after taking one, I began to feel nauseated, sweaty and mildly dulled, as if I had a bad flu and intestinal bug all in one.

    I took my next one on time and the above symptoms almost immediately disappeared. Suddenly, I realized that I was suffering the pain of WITHDRAWAL -- AFTER ONLY 48 HOURS of using the opiate, and AFTER ONLY THREE hours of having taken the last one! I immediately cut my dose down to a 1/2 tab and substituted an otc anti-inflammatory as needed, stretching out the time between doses

    The supposed withdrawal symptoms immediately disappeared; a couple of hours after the first smaller dose, I felt normal again, and continued to increase the time between taking the 1/2 tab, weaning myself off over three or four days and stopping soon after. The minor post-op discomfort was nothing compared to the frightening beginning of addiction and withdrawal I had so quickly begun to experience.

    It was a never-to-be forgotten lesson about opiates and addiction: "Easy path" it is not.

  49. One of the most flawed approaches is using an opioid replacement drug like suboxone. Yes it replaces opioids but the withdrawal is just as bad coming off suboxone as the other opoids and don’t let any pharmaceutical company tell you differently. Also, many treatment centers make the addict suffer in the old school addiction approach thinking. If they suffer through withdrawal with only “comfort” meds (nausea meds, OTC pain relievers, and drugs like Gabapentin and Lyrica) they believe addicts won’t go out again. Well, they go out again when the suboxone is taken away or it leads them to get the suboxone and then increase their usage to surpass the naloxone that prevents the high. I met one young woman who was getting suboxone treatment from a rehab doc, then she bought extra suboxone on the street, plus 80 mg of oxycodone and then she started snorting heroin. Addicts need a drug that will allow their body to go through withdrawal whole blocking the body’s ability to feel and experience withdrawal. Until that is accomplished, suboxone will keep people locked into this cycle. Alcoholics and benzodiazepine abusers get weaned off using benzodiazepines. Because the medical community sees opioid withdrawal as non-life-threatening, they perpetuate the myth that suboxone treatment and painful withdrawals will help these people. There is nothing further from the truth and it’s why so many of those addicts didn’t choose treatment—which they’ve been though multiple times already.

  50. @Olderwiser
    Suboxone isn't an opioid replacement; it is a partial opioid antagonist. If used correctly, it will prevent an addict from getting high, while also lessening withdrawal symptoms and satisfying the brain's need for opioids.

    If an addict uses more drugs in an attempt to get high "over" a drug like Suboxone, then they aren't a candidate for this kind of drug, because they aren't actually ready to get clean. It should be reserved for people who sincerely want to be compliant and get their life back together. People taking Suboxone also should not drink alcohol or use other drugs, like benzodiazapenes. These combinations can be fatal.

    This woman you met was abusing Suboxone, whether she meant to or not--perhaps she did not understand how the drug worked, but she didn't actually want to be clean if she decided to take oxycodone and heroin.

    Suboxone *works* when used properly and in compliance with a knowledgeable addiction doctor and takes 3 days to wear off, which would make the use of any opioid pointless within that time frame. People demonizing it, attempting to abuse it, or failing to use it properly will result in its being taken off the market, which would be a big problem for the people who use it successfully and correctly. Please read actual medical literature on this substance before telling people what a bad drug it is.

  51. The problem is that the reward system of the brain gets permanently damaged from drug addiction. The intense cravings may be near impossible to overcome so suboxone or methadone may be required over the long term.

  52. Legalize the Drugs. Let Legal adults get prescriptions, then fill those prescriptions with seized, purified and tested drugs. The decades long "War on Drugs" is an utter failure. The only groups benefitting are the Dealers and Law Enforcement, i.e. the criminal " justice " system.
    Legalize, Tax and regulate Drugs. It's the logical solution.

  53. Like alcohol. No societal problems with that drug.

  54. "...Narcan, an overdose-reversal spray." Narcan is an overdose halting drug, not an overdose-reversal drug.

    Narcan knocks opiates from the receptors in the brain, fills them, and blocks them from opiates. After anywhere from half an hour to an hour, Narcan's effects wear off. If there are still opiates in the addict's system, they can become high again or overdose again.

  55. @Marc Erickson: Narcan is a temporary solution to a much larger problem.

    Note the woman who had gotten Narcan 9-10 times and is still out on the street getting high.

    I've read of cases where the EMTs gave ONE PERSON Narcon 4-5 times in a single day.

    There isn't enough Narcan on the planet to give to this many addicts 4-5 times a day.

    Narcan is ENABLING addicts to stay addicted. They think "it's OK if I overdose, the EMTs will just give me Narcan".

  56. Just another case of privatizing profit and socializing misery. Purdue pharmaceuticals, that sociopathic company that assiduously peddled their highly addictive drug under the pretext that is was absolutely *not* addictive should be forced to put up rehabilitation centers in hubs across America to help bring those haplessly addicted to recovery. What an absolute nightmare.

    Read Dreamland, by Sam Quinones, to get an in-depth history of how companies like Purdue have destroyed lives, towns, and actually caused untold death upon America. It's time we bring our focus to the companies that cause humanity's great scourges: tobacco, big pharma, big ag, and one can't forget--the fossil fuel industry.

  57. @Regina Valdez: I absolutely blame Purdue, but remember most of their shenanigans happened during the 8 years of the OBAMA Administration, which knew about this and did NOTHING.

    Trump did not create this opioid madness in only 20 months.

    Also: "Dreamland" by Sam Quinones is the very best book on this subject I have read -- and I believe written in 2014 -- and Quinones places the blame just as much as drug dealers who come out of a particular region in Mexico and who exploit illegal aliens to distribute the drugs, and TARGETED (!!!) white customers in a very deliberate, calculated way.

  58. Another stunning and unforgettable book, on this problem and Purdue's role in it, set in Virginia and the surrounding countryside rather than an urban one, is
    *Dopesick : dealers, doctors, and the drug company that addicted America*

  59. I lived in Center City Philadelphia, on Washington Square, for years, having moved there from Washington, D.C.

    Every word of this article is true.

  60. I knew what would happen in the first few paragraphs that described the Kensington cleanup. It is like squeezing a balloon. You squeeze one part and the balloon expands in another part. I did not read anywhere of any part of all the "programs" that there was a concerted effort aimed at the drug dealers. It seems they are instrumental in solving this problem. They are the cockroaches. They will survive a nuclear winter unless there is an intervention with them.

  61. @Janet
    From the Philly Inquirer, 10/4/18
    "An extensive Kensington-based drug trafficking organization has been dismantled with the arrests of 57 people, District Attorney Larry Krasner said Thursday.

    The arrests, targeting what is widely considered the geographic epicenter of Philadelphia's drug crisis, were for the sale of fentanyl, heroin, cocaine, crack, and other drugs, Krasner said at a news conference at his Penn Square office. The arrests include street-level dealers and leaders of the enterprise, called the Alameda Drug Trafficking Organization.

    Sixteen Alameda properties were targeted, Krasner said, and authorities confiscated about 4.5 pounds of cocaine, nearly 2.5 pounds of crack cocaine, and more than 8 pounds of heroin. In addition, investigators seized more than $285,600 in cash, 15 vehicles, and eight firearms, Krasner said."

  62. No problem. We're legalizing marijuana as an answer.

  63. @red sox 9
    Yes, cannabis. The one thing the article DID NOT mention. And it's the one thing that's not addictive or has people overdosing, living on the streets. It should be legalized. Now, alcohol on the other hand...

  64. It's a good first step.

  65. Hope this makes the employee lounge at Purdue Pharmaceutical.

  66. What a dreadful mess.

    I feel sorry for the people trying to live in that neighborhood!

    Maybe the city should buy them out & turn the whole neighborhood into a junky haven; use the whole place for their "safe" site. I understand the ravages of addiction, but the city should be doing more to help its working, tax-paying citizens.

  67. The article is full of things the city is trying to do. Did you read it?

  68. The land of the free and the home of the brave.

    One can only feel sorry for and sympathetic to the individuals caught in this human ringer. The system and its politicians all made promises to all that they can only deliver to the middle class - what's left of it - and up.

    And we act as though the money goes to the little guys who sell on the street and a few mafia thugs. What if the money goes all the way up and has for years?

    What if the CIA never dismantled its for-profit drug deals from Central America that funded its secret ops or if our love of Afghanistan is a fight for its heroin and the trips to see Aung San Suu Kyi AND the generals were to lock China out of Burmese heroin.

    Could that be why dope is so cheap in Philly? would it explain why we only denounce and catch foreigners who wholesale drugs?

    Is it really too difficult to dissect and treat or is it simply blocked by our system?

  69. Or what if deranged conspiracy theories distract from the actual causes of, and solutions to, our social problems?

  70. It is so sad. They are like the walking dead. And we seem helpless in providing long last help.

  71. Philly was always a tough town, but this...The help will come from within, not from out of touch politicians who have no idea.

  72. @Tim Moffatt: Philadelphia county is surrounded by a ring of affluent, relatively crime-free suburban communities that function as seperate worlds in themselves. In population they collectively are larger than Philadelphia proper. Most are far from "tough" but rather quiet, somewhat genteel suburbs with a high standard of living. Many, perhaps most who live in that ring of upscale communities work, shop, and socialize there as well. They rarely see much of Philadelphia beyond visits to musical concerts,sporting events or the airport. They accept none of its problems as their own. The inner city neighborhoods such as Kensington are as foreign to them as they are to you. That separation is a big part of the problem.

  73. The same is true of Baltimore. You can go fewer than 15 miles from the neighborhoods made famous by "The Wire" and find yourself in leafy suburbs of single family homes whose owners only go into the city for ballgames and shows.

  74. Kensington may be just 4 miles from the center of Philadelphia, but residents of swanky neighborhoods like Rittenhouse Square, Washington Square, or Society Hill are so well insulated from all that unpleasantness it might as well be happening on Mars... Perhaps there'd be more urgency if open drug use started cropping up in that type of area (as is the case in Seattle where one is bound to see an addict using at some point and some public bathrooms even have lower stall doors as a deterrent...)

  75. What a dystopian nightmare. Squalor, degradation, fear, desperation. Mothers using heroin, abandoning any pretense of parenting. Neighbors surrounded and afraid to go outside.

    Find some other way to deal with this, current methods are not working. Try Portugal's way. Try it! It can't be any worse and might make things better.

  76. I live roughly 20 miles from Kensington, and yet it seems as unreal to me -- although it must be real -- as something that was contrived in a horror movie. How does this come to be only a short distance from where one rarely even smells tobacco smoke or sees a discarded cigarette butt in 2018? Is this also going on around us here, and we simply are unaware that it is happening -- driving people to Kensington?
    Perhaps someone knows and knows as well how to reverse and prevent such horror. I certainly do not. That I confess.

  77. “The narrative of the opioid crisis is focused on big-pharma greed...” And it doesn’t matter how many times that narrative has been shown FALSE, the media and the CDC keep repeating it over and over, resulting in disastrous policies at huge cost to taxpayers and to millions of people who needlessly suffer because depriving them of necessary pain relief is supposed to magically prevent drug addicts from killing themselves w/the drugs in this article—drugs that killed 74,000 in the last 2 1/2 yrs; but from 2002–2016 opioid Rxs deaths ranged between 9,000–19,000 (half the # of deaths due to accidental falls. Are we having an Accidental Fall Epidemic? Why not?).

    I’ve don’t know how many times I’ve read in CDC and DEA reports: “Law enforcement strategies to reduce the illicit opioid supply must be supported” (but I read the reports, not CDC PR material), but the only “strategies” policymakers have been to come up with assumes that medical professionals are purveyors of illicit fenantyl and heroin.

    I used fentanyl patches—best tx for chronic pain—for years before the govmt concluded MY meds were hazardous to drug addicts and made sure I was unable to get MY medicine, not for pain, not even for tapering (that DIY taper was not healthful). Drug addicts must have the best lobbyists. No amount of taxpayer $ and effort—“safe sites” to shoot up w/ clean needles, nurses w/Narcan—even when it imposes suffering on others, is too great to ensure their wellbeing.

  78. @Lee: I agree wholeheartedly. 85% of those who need pain meds legitimately are not at risk of addiction. i took vicodin, oxycontin and tramadol after knee surgery and I can't even imagine dealing with that level of pain without appropriate meds.

    However, I hated the feeling of being "out of it" and had awful nightmares the whole time. In under 10 days, I had tapered MYSELF off of the drugs, and only used OTC stuff like Aleeve the rest of my recovery. I never got addicted, and I was given HUGE quantities of pain meds -- like 180 Vicodin at a time, REFILLABLE.

    The difference? I'm not morally superior to anyone. I just didn't want to be high in a stupor all day, and i had a life I loved and wanted to get back to.

  79. I remember when publicly shooting up Heroin was not socially accepted, and mainly a problem of the black community. So the answer was put them in jail. Lock the door and throw away the key. Now that "respectable people" are shooting up publicly we have some of these blue light bulbs for the front porch as a deterrent , and then say there is nothing much more we can do .

  80. @Robert: jail is an extremely expensive solution. And BTW, I don't see a racial element here.

    I'm against drug abuse and drug dealers. I don't care what race they are. They need a heavy dose of "tough love" and not this constant pandering (free needles, injection facilities, etc.).

    They clearly want to die. Let them.

  81. I just finished Beth Macy's "Dopesick" in which she examines the horror that is our country's opioid epidemic. Addiction is hell for the users, but also for the traumatized communities forced to witness this grotesque scourge.

  82. Exactly. I really feel for the first responders, like the guy quoted, who “save” the same people night after night, often multiple times in the same night. It really shakes your humanity to provide Narcan to people who clearly, and selfishly, expect other people to save them from themselves. So is that then enabling the addiction? That is the million dollar question.. and if so then what?

  83. I worked in the Shipyards in the San Francisco bay area for decades, beginning in the mid-1970s, and I knew dozens of high-functioning heroin addicts. Though their lives outside of work seemed perpetually disorganised, on the job, virtually all were thoroughly competent and professional, indeed, several who were amongst the hardest workers on the graveyard shift machinery repair gang I supervised. I don’t kid myself by imagining “it all worked out fine” for these guys, with the disappearance of industrial America, those jobs are long gone, along with the pay checks that supported their habits, but my point I guess, is that drug use, even addiction, in and of itself doesn’t mean an individual is only fit to live under a railroad viaduct.

  84. @Glenn Baldwin: is there one person here who strikes you as a "hard worker"? Whom you'd trust around your loved ones -- or around heavy machinery?

    I can't explain your friends 45 years ago, but maybe the heroin was not as strong? or laced with fentanyl?

  85. @Glenn Baldwin I was stationed in Germany in the US Army April 1973 to October 1974. Heroin use was rampant in my unit, and was so cheap most users just snorted it rather than injecting it. We were an armored combat battalion and at least 1/2 of the soldiers used illegal drugs, and many others were abusers of alcohol. The Army regularly sent people to dry out in a Frankfurt hospital but never succeeded in stopping it. Very few soldiers were ever punished for it, and many of the users were "lifers".

  86. The time to stop a problem like this is before it begins. That takes eyes (and feet) on the street to nip it in the bud. Instead of continuing to militarize our police, going back to foot patrols and engaging in community outreach could have a huge effect. Only by familiarizing oneself with the territory can one understand how this scourge is allowed to spread. Citizens are no less to blame in our alienated society where the cocoon comfort of the automobile has become the primary tool for disengagement from the physical environment. It's no wonder that people are heedless of the the impending climate catastrophe, the space outside their doors is of little concern. Someone else is taking care of it, in their minds. As long as a problem is shunted out of sight, it's not a problem for them. Strongman tactics and vigilantism will solve this homeless problem if it is left to fester. What else are people to do? The ones with money needn't worry, their communities are protected.

  87. The War on drugs has been raging for years now and it seems to be a lost cause. Clearly we have not hit upon the answer. Blaming Drs and pharmaceutical companies who’s greed surly added to the mix is one aspect to think about. But throwing the baby out with the bath water is no answer. Incarceration has proven to be foolish. No I believe we still are looking in the wrong direction. No answer here.

  88. @J Clark

    The only trouble is, however, that because heroin is illegal, addicts can and often enough do resort to crimes, including violent crimes, in order to get it. When people commit crimes, especially violent crimes, such as muggings, beatings, burglaries, and murders to get their fix, they can expect to serve a jail sentence, as a consequence.

  89. What is the National Guard for if not situations like this? Surround the area, clear the camps, arrest the dealers and institutionalize the addicts. Ship those from out of the area to the places whence they came. Keep troops deployed until the neighborhood isn’t a center of gravity for this behavior anymore. Above all, legalize drugs and spend the money we’ve been wasting on a Sisyphean effort to eliminate drug traffic to treat and prevent instead.

  90. @Hapax Legomenon

    "What is the National Guard for if not situations like this?"

    As a Superstorm Sandy victim, I can attest that sealing off Cities to protect residents from looters and violence, patrolling a decimated, darkened City for weeks in order to protect residents from violence in the wake of a natural disaster, &distributing bottled water and blankets are some of the functions that the National Guard performs.

  91. The saddest line here is that heroin is cheaper than painkillers for someone suffering from an IED-related injury.

  92. For vets with PTSD marijuana is an approved treatment in NY.

  93. @orangecat
    That would be sad except the decision to use heroin requires such enormous willing and active stupidity. Is there anyone using who can claim they didn't know what heroin is? No. They all know and they use it anyway. Maybe they think they are so exceptional that addiction won't happen to them.

  94. @orangecat
    If you think that’s purely by chance, then I’ve got a bridge to nowhere for sale...

  95. We lost the war on drugs, time to declare victory and use the law enforcement money to set up medically supervised safe clinics where users can get proper medical treatment. If that means they stay on the drug with managed care, so be it. It is better than what's going on now, plus the prison population could be greatly diminished with additional taxpayer savings.

  96. I live a mere block away from this scene. Not mentioned here is the increase in property value, brand new houses being built in empty lots, and thriving restaurants/bars that extend from Fishtown along Frankford Avenue down to Lehigh Avenue, where a long awaited food co-op is expected to open. Lehigh intersects all encampments areas mentioned in this article. Both sides of the tracks suffer from this epidemic on a daily basis. I think it's worth mentioning here that both sides of the tracks suffer daily as witnesses to this epidemic. The hopes of improvement is stifled on one side and poverty is seemingly ignored on the other.

  97. @JnCh So glad you mentioned this. I've lived in this area for almost 20 years now. The line of development (half million dollar houses) now runs right up to these encampments. It's one of the big reasons we are now seeing these exposes and hearing talk of safe injection sites. Big money urban revitalization is crashing into the opioid epidemic in a raging pitch battle of American copious consumption. Who wins out?

  98. How about going after the cause instead of treating the effects?

  99. @Kurt Pickard

    We are listening - please elaborate.

  100. @Kurt Pickard

    There are many more causes than one, as to why people turn to and become addicted to drugs, especially heroin and drugs like that. Familial upbringing can be a cause, and so can growing up in poverty, people with learning and/or developmental delays, lack of social and academic skills, loneliness, and lack of parental guidance while growing up, as well as physical and mental trauma. Yet, at the same time, people who become addicted don't have to come from low-to-moderate income backgrounds, or from run-down urban areas. Addicts come from all walks of life.

    Having said all of the above, various emotional problems can and often enough will result in addiction. The people who end up being rehabilitated end up doing so by themselves.

  101. Why isn’t the issue of mental health and homelessness even mentioned here? This is a sad, sad situation for every human being involved. It reads like a nightmare.

  102. One notable detail about Philly is how it has been in an economic boom for years with little sign of letting up. The city, well parts of it anyway, are revitalized and flush with investment, jobs, growth and new construction. Despite this, the stark contrast between signs of wealth and prosperity and human squalor cannot be missed. It is a complicated problem, but the City is never going to be able fix it. The city's economic structure is crippled and failed through decades of mismanagement and grift. Jobs are filled with incompetent political appointees just trying to get rich. The schools are broken, the police are broken, the jails are broken, there are hoards of homeless and addicts creating a public health crisis on a daily basis. If it weren't for all the "Ed's and Med's" and commercial investment, the whole city would resemble Kensington.

  103. @Ricky Isn't the last sentence true of most cities. Take away Eds, Meds, and commercial investment, and you have a failed city.

  104. The reason people are dying is that the product is often adulterated so they don't know what they are injecting. As horrible as addiction is, might it not be better to make it legal so that addicts could buy products of known purity and thus avoid accidental overdose? We let adults drink and smoke despite the known harm they are doing to themselves. Why not let them shoot up?

  105. Yeah, legalize opium, they can smoke it. and fall to sleep, it won't kill them as fast as fentanyl.

  106. @Andrew Terhune: adults who smoke and drink, even to excess, RARELY end up living in squalor like this, on the streets and defecating in public. (In fact, I think I can say that SMOKERS never end up like this.)

    This is really serious hardcore addiction, not a "bad habit" you can manage if someone gives you free housing, free food, free medical care, free needles and generally panders to your addiction.

  107. @Andrew Terhune Everyone is a potential addict. Legalizing heroin, making using it easier and less socially unacceptable for people who wouldn't be disposed to go to places like Kensington would create millions of new addicts, destroying that many more lives.

  108. Looking at Google Street Map, Kensington Avenue under pass, in the picture taken by Google Map in August 2016, the fire hydrant was not yet leaning, and there was no camping ground. This drug camp is fairly recent.

  109. @Avi It might have moved blocks but when I lived in Philly 6 years ago this was the reputation of Kensington.

  110. @Avie The article describes how the city cleared the railroad gulch in 2017, shifting drug users to other parts of the neighborhood.

  111. This article is quite sad, but I am still unclear why targeting the dealers isn’t a strategy in play. The article mentions that more pop up, but how are you ever going to make the area less of a hotspot if people from around the country know you can score heroin within moments of getting off the train? If it’s so easy to find a dealer every hour of every day, shouldn’t it be easy to arrest a dealer at the same rate?

  112. @Liz

    If you really go hard and arrest all the dealers and such, the drug circus will just move to another location - and you start all over.

  113. @Liz Sweeping up street dealers is like playing whack-a-mole. Most of them deal to support their own using. The ones we really want found and caught are their suppliers and the bosses of those suppliers. Those are much harder to find and catch. I sometimes wonder if the re-orientation of the FBI and massive reallocation of federal law enforcement resources to anything "anti-terrorism" didn't set us up for this tidal wave of illegal hard drugs getting imported and sold in the US with such ease. When heroin is cheaper than oxy pills on the street, heroin supply is clearly not a limiting factor.

  114. If a certain percentage of those who try an drug become addicted, then you need to intervene before people try the drug. What misery is driving this crisis? Surely some of it is from poor prescription practices, but just as surely there are other things driving the use of these narcotics. Where is the investment in these communities, these schools, the mental healthcare...If the focus on the end state problems is futile, there needs to be a focus on the days before the first use of these drugs.

  115. The article’s purpose seems aimed at shocking via anecdote, and is filled with assumptions and assertions that are unsupported. A mayor is “progressive”. The areas problems exist because of a lack of investment in the city, etc. These are assertions that belie a specific predisposition of the author and really take this piece away from being an unbiased account of the state of affairs in Kensington, which is clearly tragic.

  116. America...

    40K dead a year to opiods
    30K dead a year to guns
    Slashing funding for schools and healthcare

    It's a modern day dystopia.

  117. Sadly, I think you're correct.

  118. @Chris

    40k is sad, but it's a tiny percentage of the US population. What percentage of the Irish develop alcohol-related liver problems?

  119. @Chris
    400,000 Americans die every year from smoking cigarettes. Complicated does not begin to describe the depth of the problems in our society. However, a real sustained investment in Healthcare, education and families and PEOPLE (corporations don’t count) could get us to a better place, in time.

  120. Why can't the source be stopped? These people need help, not just a clearing of camps.

  121. @Liz watkins there are laws to prevent people from being picked up and committed to a hospital for treatment. What needs to happen is to reopen the mental health institutions, expand them to include drug treatment, and then just picking up and hospitalizing people.

  122. Another big city controlled by Democrats who refuse to deal with the exploding homeless and addicted population. The same thing is happening in New York City, Los Angeles, San Francisco, and Chicago. What do these liberal enclaves propose to do to protect law abiding citizens from the scourge of the drug addled and the aggressive homeless? Nothing. Absolutely nothing.

  123. Because drug addiction is not a "big city" problem. It is as bad if not worse in rural areas. I practiced worker's' compensation in two flyover states for 30 years. Those of us who spent a lot of time reading medical records could have told you opioids were a problem 20 years ago. Doctors would routinely authorize refills after two weeks when they were supposed to last a month. This happened with regularity and random drug testing following work accidents more often than not showed drug usage. It was a vicious cycle exacerbated by the recession/depression a decade ago. Comp claims, pain clinics, opioid use and social security disability claims all skyrocketed simultaneously in all populations including wealthy enclaves of cities and rural farm towns where soybeans are grown.

  124. Just stop it! Ohio is a bastion of Republican politicians as is Kentucky, Tennessee, and West Virginia. They are having no better success at ending the opioid epidemic. This is a problem of people, not politics. Taking cheap shots at Democrats isn’t going to help one person or community come out from under this.

  125. @paul Good that you've offered a meaningless political perspective. Addiction doesn't have a party affinity.

  126. “This is America” where denial is reigns.

    Here in wealthy Orange County, CA, drug abuse is rampant, and even seniors are dying of opioid abuse:

    Center for Health Journalism Fellowships Blog
    Why are Orange County retirees dying of opioid overdoses?

    By Jill Louise Replogle
    October 26, 2017

    "The city of Laguna Woods, a retirement community in Orange County where the median age is 77, has the highest drug and alcohol death rate in Orange County. Accidental prescription opioid overdoses account for the majority of those deaths.

    Orange County as a whole has more than twice the rate of opioid-related deaths as neighboring Los Angeles County. The epidemic is hitting hardest among people in their golden years. And yet the causes and consequences of Orange County’s opioid problem remain largely out of the public eye."

  127. @Oceanviewer, Perhaps some of these elders are intentionally checking out? Getting old can be a painful experience, especially in this country.

  128. How can people whose started on pain killers end up shooting up, and a so called solution that is even more expensive is available but the cost is out of reach for so many? I have a child with mental health issues who could easily be one of the homeless addicts portrayed here. It cost 1000$ a month for insurance. Insurance doesn’t want to pay for suboxone after paying almost 500$ a month for 60 8 mg strips, it was approved for 50$ but then the doctor wants $150 a visit. So after initial intake or short term treatment whose following up to see if this solution is available longer term? Do you think any of these people have the thousands to spend on treatment? Seems like insurance companies and doctors are greedier then dealers.

  129. @Cathy: What "mental health issues" require oxycontin?

  130. Self medicated became addicted to Roxie 200mg daily,

  131. I've paid over $24,000 for suboxone over the last 5 years. You just gotta pay if you want care in America. I have good insurance and I still had to pay. Insurance wont pay for the strips, only pills.

  132. A progressive Mayor? A sanctuary city? A model for America? The city used to be a place of family residences, row homes, neatly maintained and populated by working people. Those people are fleeing to North Jersey and the Philadelphia suburbs. What amazes me is that they are bringing with them the same failed brand of city liberalism (Progressive) that failed the city in the first place. They left the city for a reason. Why change back to the political system from which they are fleeing? As long as the addicts are receiving freebies they will remain. I seriously doubt most are vets or in pain from illness. With all the safety nets now available by government and nonprofits there is no excuse to be on the streets and addicted. There is a limit to what the population can afford to accommodate and support these people. Chasing them from one place to another or fleeing to the suburbs is not the answer.

  133. @Eddie It couldn’t be any clearer as to the cause of addiction, degradation, and homelessness like that described in this article. It isn’t liberalism--it isn’t any “ism” at all (although, as a liberal, I would prefer to blame conservatism gone wrong)--it is our policy of criminalizing drugs.

    We need to take Portugal’s approach, de-criminalize drugs, and treat all addiction as an illness.

    I agree with you that chasing people from one place to another is not the answer. The answer is treating people as we would wish to be treated, were we in their circumstances. And yes, drug use starts, for most people, medically, and yes, many are veterans, particularly of Afghanistan and Iraq.

  134. @Eddie

    "What amazes me is that they are bringing with them the same failed brand of city liberalism (Progressive) that failed the city in the first place. They left the city for a reason. Why change back to the political system from which they are fleeing?"

    Many are coming South and doing the same thing to us. Don't they understand cause and effect?

  135. @Eddie Uum, what safety nets? More like the lack of education or safety net is driving more and more people into poverty and addiction... And by the way, these days most people fleeing Philly (or Manhattan, or Boston, or Seattle, or DC) are doing so because the suburbs, bland as they may be, are much cheaper...

  136. It's difficult to comprehend how a part of Philly less than 2 miles from my home is so different from where I am. We've frequently remarked on how our privilege has gotten us into a more safe, clean, and quiet neighborhood, but I frankly didn't realize just how different the situation was such a short distance away. I appreciate that Philly is willing to try just about anything at this point, because it's impossible to know what's going to work and everybody has to just keep trying.

  137. @Lindsey,

    Your privilege? You live in a safe neighborhood because you, and your neighbors, make the conscious decision not be commit crimes or to become addicted to drugs.

  138. @Lindsey

    In Manhattan, a neighborhood can change in 5 blocks

  139. There's one place on the planet that has successfully dealt with a drug epidemic. Before 2001, Portugal had soaring addiction rates - one percent of its population was addicted to heroin (one of the highest rates in the world) and HIV rates were soaring.
    In 2001, all drugs were decriminalized. Addiction was treated as a health crisis rather than a criminal offense. And in the 17 years since, addiction rates have dropped 75% and HIV rates by 95%.
    Astonishing to me, given those stats, that Portugal, by nature a conservative country, may have come up with a long-term solution to a seemingly insoluble problem while the rest of us are still arguing about who to blame.

  140. They did a lot more than decriminalize - although they did do that - they also created a mandatory registry of drug addicts and aggressively expanded treatment and outreach and pushed people in. And they still have a lot of regulation - some of which is stricter than many cities here. They don’t allow open air drug markets or encampments. They ban addicts from associating with other addicts and from visiting certain places where drug use is prevelant. People can lose public benefits. Drug dealing is still illegal. They have free health care, including for treatment.

    As you can see by this article, decriminalizing on its own doesn’t do much, especially at the neighborhood level. As a fellow Seattle resident, you should already know this though.

  141. It looks like Philadelphia has effectively decriminalized heroin, by this article. None of these people seem particularly worried about being arrested for possession. So why isn’t the problem getting better.

  142. @jrsherrard I agree. I believe Portugal's approach could well be described as rational and realistic. And, yes, if a conservative and historically very catholic country like Portugal was able to do this, maybe there is hope for us here in the US! As for our evangelical conservatives, may I suggest reading the New Testament again? Jesus was quite clear about compassion for the less fortunate and downfallen as a key quality for his followers.

  143. I am not a lifelong resident of my adopted city, just 19 years now, and am certainly not an authority - speaking just from my heart. Those of us who live here know that Kensington Ave under the El is a drug-ridden, dangerous place where very little light shines even on a sunny day. The writer of this article fails to mention that the neighborhood turns nicer a few blocks in each direction and that the El is probably the root cause for this location's problems. The drug addicts won't get cured if the El is torn down/turned into a tunnel/removed in some fashion but Kensington Ave could be given a chance to succeed. Anyone who has ever been to this area will agree with me that the El is a blight to the area and no program of change to Kensington can begin without some change to it. Blaming the drug problem on Democrats won't get us anywhere. I'm not sure how the Republican politicians differ from the Democrats on how to treat addicts, they should probably just stop talking and listen to the doctors, treatment specialists and people on the street.

  144. I don’t think you can blame the El for the drug epidemic in Kensington. It’s a confluence of events and conditions that have led it to become ground zero for the heroin epidemic. That said, it doesn’t seem like the proposed solutions are going to work, either. But tearing down the El won’t take away the problem.

  145. I doubt that removing public transportation would fix anything. It would only make it harder for working class residents to get to jobs they have elsewhere.

  146. Let's review. When anyone of any age living anywhere can get any drug they want any time they want it, the system is broken. Not only does decriminalization address this issue, but it also would have a huge impact on the incidence of petty crime, incarceration rates and prison costs that currently run taxpayers billions upon billions every year. And speaking of wasted money, how's that War On Drugs going? How about putting the cartels out of business? Would that be a bad thing?
    People have to begin looking at the bigger picture and realize that this country's current approach to drugs is the very definition of insanity.

  147. For what it’s worth, addiction has long been with us. My mother-in-law, now long dead, used to talk about taking the long way around walking home from school to avoid an encampment by a bridge where men drank sterno. The canned-heaters.

    Pearl S. Buck spoke of the opium addict as a hollow reed. Fannie Hurst wrote about the ostensibly respectable morphine addict in the early twentieth century.

    Among my friends, co-workers, and acquaintances I don’t know anyone not touched by this horror in recent years. I see it everywhere walking around the city, the train station, by the museums and tourist areas.

    It makes one a slave. I don’t know the answer. What can people do when they are in legitimate pain, physical or mental, which is often the gateway to addiction? For those who enter addiction recreationally, I’m sure it’s initially not very different from other youthful risk-taking behaviors.

    Both legal and illegal substances entrap equally. I just don’t know the answer. These are people, but in the throes if this slavery are hardly recognizable as such.

  148. Of course you "don't know". Literature is ill-prepared to deal with this situation, and romanticizing these junkies serves no purpose here.

    Youthful risk-taking behavior involving opioid abuse should not be condoned or tolerated. Over prescribing addictive medication should not be condoned and punished. There are alternate medications that do not lead to zombification, and our medical establishment needs to wake-up and mimic the procedures in countries that do not have this scourge.

    Yes, we will have self-medicating, mentally ill addicts.

    The ubiquitous anecdote of the patient whose pain medication leads to life on the street and/or death is too compelling to brush off as a continuous part of society.

    Yes, I do know the answer. It is the competent, responsible prescription of pain medication.

  149. This is now a multi generational problem facing all communities in the US. Fueled by the cheap availability of prescription pain killers (oxycontin, oxycodone, ), availability of cheap heroin and now heroin mixed with deadly fentanyl the problem is an epidemic. It is a challenge that needs to be addressed with a full blown, multi faceted approach: shelters, sanitation, food, mental health care, and long term followup for those who can be convinced to take advantage of the services. We wiped out polio and measles and need to wipe out this scourge is the new public health crisis facing us. The cure for addiction should not be a slow process of rotting in the damp, filthy tent under an overpass until an addict dies....

  150. "Department of Public Health announced that the city would encourage organizations to develop supervised-injection sites, where people can bring their own drugs without fear of arrest…" "The city wanted to respond to the needs of the residents."
    “They have no reason to go when everyone is giving them absolutely everything.”

    These quotes are revealing. Who are the demented policy makers who have enabled this toxic situation to continue? The situation has gotten worse over the years with no solution in sight because of lack of enforcement and lack of insight into the situation. What happened to the concept of personal responsibility? Why are theses addicts and dealers portrayed as victims rather than criminals? Do the policy makes actually think that the existing situation is better for all concerned than clearing the area and imprisoning the dealers?

  151. [[Elvis Campos said “I didn’t know about the drugs when I came. I found the house, and it was cheap.” No one on his block used or sold drugs, he said, and his neighbors worked hard to keep it clean. But dealers were always around their homes trying to sell.]]

    Before buying or renting a place to live, always talk to the mailman who has that route. He can tell you which properties have constant turnover of tenants, which are likely drug houses, and the general direction in which the area is heading...which properties have recently been renovated, etc.

    Also, drive through the neighborhood at morning and evening rush hours to see which houses are active. And drive through at night to see which houses are blasting loud music or ave drug traffic.

    And talk to the old timers who want to move but can't sell their homes at a decent price. They'll know exactly which buildings are drug houses.

  152. @Third.coast

    When low income people are often working two or more jobs in order to simply afford housing, they often don't have time or money to do this kind of time-consuming due diligence.

  153. Sorry to say this - but the only conclusion I can reach here is no Narcan. I'd love to see any statistics on addicts who are brought back to life with Narcan and later go on to get clean. Likely impossible to gather data on this.

    I'm politically moderate, sensible, with a big heart. This is a terrible epidemic but individuals and families should bear the brunt of the responsibility - not the government and residents. I sound like a heartless person but enough is enough. Agree with comments on dystopia.

  154. @Liz
    What is sensible about letting addicts die in the streets. Does the individual and the family clean that up too? No. The government and the communities do. Get real, Liz.

  155. While addiction is obviously a very complex issue, it’s nevertheless frustrating to see people who struggle with addiction refuse help repeatedly. It’s very selfish to keep refusing help when it’s offered on a silver platter when the alternative is to be a burden to everyone (I know the phrasing is harsh, but I believe it to be true). I suppose drug addiction must override the normal impulses of the brain and the social norms that would discourage that selfishness, but in the meantime, it’s grossly unfair to the residents of Philly who have to live in this squalor they’re not causing.

  156. Maybe some current or former Purdue Pharma execs should be required to camp out here for a week.

  157. More than ten years ago, I recall viewing a televised documentary about the baffling resurgence of heroine, and Philadelphia being its gateway to the East coast. It was quite troubling then, and the fact that policing and political authorities did not take heed, hence, enabling the issue to envelope to this degree is equally troubling. It truly makes you wonder who's in the pockets of the Cartel, and aiding them in getting these narcotics from South America all the way to Philly.

  158. As an actual resident of the City of Philadelphia—who is taxed eights ways ‘til Sunday—this article left me seething. Even though my property taxes have increased 40% in ONE YEAR and Philadelphia assesses its own capital gains and wage taxes, neither I, nor my fellow Philadelphians have seen any incremental improvements in our lives. In fact, our quality of life has deteriorated significantly over the last 2 years. And yes, I think it’s important to highlight how much revenue my family and others generate for the city because the mayor and the city council have failed to protect all of us. Drug dealers and suppliers are not arrested. If they are, lengthy sentences are not doled out. Philadelphia does not have a sustainable economy with any industry to support it. There is no job creation and the city has lagged the broad-based economic recovery in the U.S. These factors have created the perfect storm for what is happening today. I realize the complexity of this socioeconomic issue and public health crisis; however, please do not express sympathy toward Mayor Kenney. He and his shambolic policies have inflicted irreparable damage to this city. I also assign blame to the federal government which continues to deregulate the pharma industry, encourages corporations to run leaner, fails to protect its vets, and ignores a nationwide health crisis.

  159. @Carpetbagger Yikes... 40%! As someone who has lived in and now lives near Chicago, I feel your pain when it comes to the lack of job creation. No easy answers in solving the epidemic, but not having jobs available just leads more people down the path of addiction.

  160. @Carpetbagger
    Well,maybe if every state and city weren't bending over backwards to lure the big corporations with tax "incentives" ,abatements, and so-called "enterprise grants", your taxes might not be rising as quickly. I assume though, you don't mind that your home value has risen, do you?

  161. @MIB, thanks for your commiseration, and although Chicago and IL have their own set of problems, I still love the city dearly. Your sales and property taxes are no joke though.

    @TimLynch, I agree there are deleterious effects from these race-to-the-bottom policies, though please don’t forget the residential property tax abatements, which are partly responsible for the upward pressure on Philadelphia real estate prices. I purchased my home in 2015 without one. Has it appreciated in price? Sure. 40% in one year? I don’t think so. Have inflation, wages, and interest rates gained 40% in those time frames? Nope. Not even the S&P500 has generated anywhere near a 40% return during the current bull market. We are 10 years out of a financial crisis and I remain highly skeptical of all inflated asset prices in this country, including the Philadelphia housing market. Perhaps you should ask the Chinese how they are enjoying their sky-high real estate values now, and also again a year from now. What’s happening in Kensington reflects years and years of booms and busts in economic cycles, with absolutely no recovery from the previous one. Thanks for trying to imply there was latent hypocrisy in my initial statement, though.

  162. I hate when politicians are referred to as "progressive." I especially hate when a mayor is referred to as progressive but who cannot get the most basic government functions to work (trash collection, street cleanup, snow removal, property tax collection, etc) let alone do anything about a national epidemic that seems to have its epicenter in their city. Also, there is nothing progressive about filling libraries with narcan instead of books and having the largest poverty rate of any big city in the country!

  163. "Gentrification is genocide." It is very poignant that someone was astute to paint that on a wall in Kensington. As the writer noted, this has been an ignored problem for decades in Kensington. It has its roots in the 60s actually. It is a microcosm of the evolution of the United States. Like many neighborhoods in Philly, it was almost like a small town in itself. Like many old cities in the country, Philly is a quilt made up of distinct neighborhoods. Kensington was a bustling,thriving place well into the the twentieth century.
    For decades this problem existed, it used to be known as the meth capitol of the United States. Bikers and the Mob controlled it and then coke and crack...and there was always heroin. No one seemed to notice,or care.
    The difference now is there is valuable land to be scoffed up by developers and the junkies are now white kids from the burbs. Suddenly, it is all hands on deck. The developers love highlighting the real estate tax abatements to prospective buyers so now the junkies are an inconvenient obstacle in their marketing brochures. Yeah, the drug market and their customers will move on to another neighborhood and in another thirty or forty years, we'll be reading about this again. So it goes.

  164. Why is this happening in Philadelphia and not in Singapore? Aren´t the Basic Needs of humans all over the world not the same?
    Who cares about the families living in these places protecting the kids and clean up the mess?

  165. I know a heroin addict. All the money and the best facilities in the world couldn’t cure him. He stopped when the guilt and shame were too great to bear.

    The disease model of addiction is pseudoscience.

  166. Huh, I did too. Did because he's off H and doesn't need to get Methadone from the gov't anymore. He works s full time job now and helps support his grandma. He was in very deep. My experience isn't everybody's.. but honestly all I did was hang out with him for at least a few minutes every day, and offered to be a reliable source of transportation to the clinic. In the event of crazy weather or otherwise. I had the time for him. as I already said, my experience is probably rare. But I do feel the world would be a little different if people spent more time doing things they feel is right, rather than just typing or voting a certain way.

  167. @Mr. Grieves

    I'm inclined to accept the Trainspotting model of addiction as being the most accurate.

  168. With two opiate addicts in my family, I also tried every approach in the book. Change only comes when the addict wants to change. Providing them with opportunities to do so is key, but so is protecting the innocent people they hurt when they - repeatedly - reject help and allow the inherent selfishness of addiction to take over.

    I have deep sympathy for these addicts but the nearby residents are truly the victims here. Shoving the consequences of your own addiction into someone else's life - especially when they don't have the means to escape - is truly cruel.

  169. It is great that you did an article about all these privileged white people- along side the article using the extremely rich and privileged DT and Bret Kavanaugh as "representative of all the white men who feel they are losing ground". Something is being lost in translation. I think maybe it is that "white people" are not a monolithic group of similarly situated and motivated people and that narrative is degrading democratic voting.

  170. 2 thoughts:

    1) The girl who turned to heroin after being raped in college may be the saddest thing I've ever read.

    2) Putting this on the local government is ridiculous. Local governments will have conflicting interests: be humane to the addicts but not so humane as to attract addicts from their neighboring towns. More drug fatalities yearly than the entirety of the Vietnam War. It would be nice if the federal government was working to fix this issue.

  171. @Bob

    I know several addicts and alcoholics well enough to have talked deeply about their lives. All of them have major trauma history, often dating back to early childhood. Childhood physical and sexual abuse are incredibly common among addicts. The day to day might be not good, but what they are really trying to 'escape' by getting drunk/high is the pain and shame of being abused.

    I also know a several woman from solid families who have become addicts. Each one of them was raped.

    I don't want homeless addicts in my neighborhood, but when I see them, I know that someone hurt these people VERY badly. The addict has certainly made bad choices about how to manage this pain, but as a society, we don't provide a lot of other options.

    I think our best hopes of dealing with addiction are:

    1. Encouraging addicts to get long term birth control (vasectomies/tubal ligration, IUDs). We don't need more children born into unstable situations.
    2. Making long term birth control available to everyone for free. We need people choosing to have children when they are in stable relationships - not accidentally having children in unstable or volatile situations (almost half of pregnancies in the US are unintended).
    3. Investing in mental heath care for children.
    4. Investigating and punishing rapists and child abusers.
    5. Investing in mental health care for the victims of rape and abuse.

    We have to prevent the next generation of people from being so hurt that they turn to drugs.

  172. Yet another example of how our government serves its people (cough cough hack hack). When we put social services front and center and the well-being of US citizens first, then the situation will change. Until our moral compass changes as a nation and its politicians regain morals and values that concern humanity, nothing will change. Hope is lost when others regard you as worthless. The only thing that matters is money. When we put people first, recovery from heroin addiction has a chance of success.

  173. @Joanne Sorry. Drug addiction has been around forever so I'm not sure about your moral compass changing anything.

  174. We have got to get a handle on this.

    Once addicted these folks are a lost cause. We have got to intervene before people become addicted.

  175. Why are all the photos of individuals in this piece photos of women when homelessness and drug addiction are issues that primarily effect men?

  176. @Asks Questions

    It's all about women.

  177. @Asks Questions Maybe the men didn't agree to be photographed, outside of the lead photo.

  178. @Asks Questions - I was once homeless and can answer that question. Society feels that men are more capable of dealing with serious problems like war and they ignore the men. They focus on the poor women who have children and need help! And the women play it to their advantage. Just have a baby and suddenly DSHS bends over backwards to help you with food stamps and housing, with temp shelter, and counselors. Men? To the back of the line.

  179. One has to have sympathy for the Marks of the world, but I feel much more for the Dawns- and their kids.

    Without compassion, we humans would turn into monsters faster than you can push a plunger down a tube, but at some point compassion becomes enabling. Who wants to become an EMT just to "save" the same person from the same self-inflicted wound over and over and over again?

    There is rising disgust with the enabling of the drug addict camps, wherever they are. A Republican is within a point or two of being elected governor of Oregon, despite a 20-point registration gap (and everything else), and a major factor is that even the ultra-liberal residents of Portland have had just about enough of the needles, feces and theft.

    My question is, if Mark had known that he wouldn't be given food and Narcan, would he have landed in Kensington at all?

  180. @Eric - A better question would be would Mark have landed in Kensington if he couldn't Google heroin markets on the east coast and get Siri to give him directions.

    We have an "open-air drug market" like Kensington here in Seattle. It is literally a few blocks away from the Pike Place Market. The police know its going on in broad daylight on the downtown streets and they literally look the other way.

  181. [[“There is one girl down there with blond hair,” Nancy said. “I literally see her go to the bathroom at least four times a day right there. She walks 10 steps out from the tunnel, with her back facing us, pulls her pants down and goes.]]

    Once, I saw a woman perform this maneuver. Midday, major road, she squatted on top of a little berm in front of a fast food joint and left a steaming pile for someone else to clean up. Clearly she was an addict and homeless. Ironically, even thought the sign on the door said "Restrooms for customers only," I'm sure they would have made an exception in this case.

  182. @Third.coast No they wouldn't. And that is part of the problem. Try dressing shabby and see if you can find a bathroom, much less a shower.

    Everyone knows this, everyone fears it (having to look for themselves) and everyone knows the most effective solution would be to provide liberal accommodations.

    That won't happen. Go figure.

  183. So we keep out immigrants that want to work but we subsidize drug users who cycle repeatedly in and out of expensive rehabs that obviously have low success rates? These people are the true scourge of society, blame it on drugs but they are weak. They suck up money, time and community goodwill, ruining areas where hard working citizens are trying to make an honest living. Let the users die, eventually their numbers will be reduced (natural selection if you will) and eventually the laws of nature will curb the epidemic ( on1ly the strongest will survive). Also they should all be spayed/neutered to prevent unwanted pregnancies and the continuation of weak willed people in society. Yes this sounds like a novel or Nazi program but if getting off heroin is that difficult then why even try to help? It’s like trying to help people with late stage cancer, 99% of them will die so offer a place where they can inject a big one and peacefully not be in pain any longer. We need to start thinking of the “whole” in this county vs the individual.

  184. I live 1 block away from the Frankford Ave encampment. This article glosses over the fact that large pockets of Kensington are gentrifying quickly and they're selling brand new homes for $400,000+ within 100 yards of people shooting heroin on the street in the middle of the day. Kensington Courts is a 150-unit new housing structure with units "starting in the 200's" being built literally around the corner. All of this money pouring into the neighborhood, property taxes skyrocketing, but where's the money to help get these people off the street? To get the drugs off the street? To fix these incredibly complex problems?

    A couple years ago when the gentrification was just taking off, these addicts were hidden away up on the old Conrail tracks-- out of sight, out of mind. The city decided it would be a good idea to clear out the tracks, but honestly where did they think these people would go? Now they're out in the open and cannot be ignored. Maybe it was necessary to see this horrible problem up close & force the residents of the neighborhood to pressure the city into finally doing something about it. Get these people help! Or at least get them bathrooms. I'm open to safe injection sites--they can be the first step to opening someone up to treatment. Find the major drug suppliers & get this stuff off the street. It's already a real-life Hampsterdam. Do some real police work & cut the head off the snake, and make the community safer for EVERYONE in it (homeless included)

  185. @Chris

    What size for 400k? In NYC, a 3BR for 400k is low income housing. Many studios are 500k-800k. If I heard someone in NYC bought a 3BR for 400k, I'd assume ghetto. In my zip, 3BR will run you 2.25mil minimum.

  186. @Chris The article mentions a few times the many efforts to get them off the street, including providing treatment and shelter, but most refuse it.

  187. The gentrification of Kensington is quite amazing when you look at all these expensive houses, yoga studios and hipster joints sitting RIGHT NEXT to the heroin junkies shooting up in the open.

  188. I used to be an addict. I know what those places are like. They are where you see what humanity at it's most animalistic looks like. When you are an addict you are also an animal. You are an animal whose life revolves around opiates.

    You will do anything and everything to get drugs. You will live without morality. You will live without friends.

    I've been sober for 6 years now. I thank God I missed the fentanyl, that would have probably killed me. I went to rehab one time and then stayed in the rehab outpatient program for another 10 months. I was put on suboxone. I got my life together but it took me years and years. I'm grateful for how lucky I am to have insurance. In the end though it all comes down to willpower. You have to really really want to quit in order to even have a chance. You have to have a catharsis.

  189. Thank you for telling your story. Can you shed light on why the homeless addicts in this article reject free treatment?

  190. It's a Gift!

  191. Jacqueline,
    What a powerful message.
    Thank you for sharing your past experience.

    Welcome back!

  192. We can learn a lot from other countries: Singapore, Taiwan, China, Malaysia, Indonesia, etc.

    They have very efficient policies towards people who sell hard drugs like heroin: the death penalty.

    As a result, far fewer people are being destroyed by the poison of drugs!

  193. This is absolutely not the way to go. The history of prohibition is soaked in blood around the world. I highly recommend Johann Hari’s “Chasing The Scream.” Use of drugs and mind altering substances is so deeply ingrained in the human experience that the law will never win this battle.

  194. @Peter

    Ah yes. The death penalty will stop drug dealing, just as capital punishment has stopped all other capital crimes, right? The death penalty is not a deterrent to any kind of crime.

  195. @Peter Those are the very countries that supply most of the worlds drugs!

    I will cite China, they supply most of the world's fentanyl, repeatedly cited in this article as a major scourge.

    The scale of these drug shipments is evidence of clear corruption and political protection extended from government authorities in China.

    Rather, the existence of a death penalty for drug use is a good indication of a severe, ongoing and endemic drug problem in that society.

  196. Tragic tale but not surprising.

    Humans like to get 'high' and one drug after another becomes the means: rum, gin, whiskey, opium ... the 1950s saw heroin overrun & destroy city neighborhoods such as Harlem like Bubonic Plague. 1960s saw relatively harmless marijuana and LSD, then speed, in short order PCP, then cocaine, then crack, then meth, oxycodone, spice, now heroin again, fentanyl ... the lessons of drug abuse were generational and will likely be so again: younger children watch their older siblings enter the streets and die, they learn to avoid the drugs altogether. Policing, rehab, reviving over-dosed users, none of these really make a dent.

    Meanwhile, the most dangerous drugs are alcohol and tobacco, which together kill hundreds of thousands of Americans quietly, in the background. Humans like to get high ...

    Bigger question is what is there to live for? To be a 'consumer', in corporate America; a kind of mindless, fleshy robot to be used once then discarded as trash, to live nowhere in particular, with no chance to contribute anything, to learn, to be a part of something bigger than themselves, to have a future. To kill an elephant or a bee or another human, the idea of these things has to be destroyed first; to justify, to eliminate the individual identities, to dehumanize, to introduce the profit motive and distill everything to figures on a screen.

    These addicts died a long time before they found themselves on Kensington Avenue = not worth enough.

  197. I just don’t feel sympathy for anyone who thinks life will get better if they inject heroin. Your choice. Your consequences.

  198. @M
    Yes, thanks for your perspective, M. Except it’s not their consequences. Can’t you see?! Did you read the article? It’s the librarians’ consequence who watches people od’ing from across the street. It’s the children who watch addicts pooping on the corner and the kids parents who clean up needles every day, and watch as their neighborhood becomes less safe for their families. Get real, M.

  199. @M Ah, so righteous! Do you live in the United States? If so, the problems described here and the humans who are engaged in these addictions, and their consequences, are also residents. Do nothing? Let cities degenerate to the point where nowhere is safe? You need not feel sympathy for any addict, but the reality is that their actions do affect you and much like the need for policing to protect others, the problem of adults addicted to narcotics and the behaviors associated do not just go away. Government exists in part to deal with problems in society and whether you have any sympathy for anyone with this particular problem, actual concerted actions are needed. Do you question this?

  200. Hopeless drug addicts. I couldn't possibly care less about them. Not a penny of tax dollars should be spent on them except to lock them up.

  201. @Matt And what of the drug manufacturers who actually are responsible for this opioid crisis? They've profiteered by creating these addicts, in the first place. No different than the street drug dealers.

  202. @Matt Well, if your tax dollars are spent on jailing addicts instead of treating them then a lot more of your tax dollars are going to be spent.

  203. @Matt Locking them up is spending tax payer dollars. Do you think jails and prisons are free?

  204. We have our own "Methadone Mile", located around the hospitals, here in Boston. It's unbelievable. I went to BMC for an appt. and when sitting in traffic was surrounded by intoxicated people in the streets, openly shooting up, defecating on the sidewalk, etc. I was fearful somebody was going to fall into the path of my moving car. It was un-nerving. As was parking and walking in the vicinity. Surreal area.

  205. So this is what America has become. I don't have a clue as to what the answer is but obviously neither does anyone in authority.

  206. @Steve

    So we need new people in authority.

  207. Great story. I grew up in "the Far Northeast" as we call it, and remember hearing about The Badlands even as far back as two decades ago. That being said, for accuracy, Philly is separated into sections of neighborhoods, and Port Richmond and Kensington are most definitely not part of the Northeast Section. Kensington is technically it's own neighborhood as well as its own "section" (which includes Port Richmond and Bridesburg).

  208. I worked in Port Richmind. They were quick to tell you that they were not Kensington.

  209. I wonder how much it costs society to deal with this problem ( police, rehabilitation programs, social workers, medical workers, etc. ). I read that some people overdose regularly and have to be revived over and over again. It sounds cold, but why not make it clear to those people that they get 3 strikes and then that's it. I read that some will do anything to get high. If they're so hard core, then ship them off to a camp somewhere away from civilization and give them all the drugs they want for free. Why should the rest of us be prey to those who already gave up on themselves?

    I'm all for helping those that want to help themselves, but not the rest.

  210. It's shocking to read about a country that has so much but whose people are suffering so badly by their own hands. How can one explain it? Maybe the United States will have to become an undeveloped country and start all over again. Perhaps the philosophy of individualism was wrong, that your political compass led you to this reality, that the idea that everyone needs to take care of themselves - results in a country where the only sober people are the muslim immigrants and extended families who support each other. This article describes the failure of America.

  211. @june Like Europe and every other country doesn’t have these problems too.


  212. Maybe one approach not mentioned would be for a collection of states to open a class-action lawsuit against the Sackler family for lying to doctors and hospitals about the addictive qualities of OxyContin, for starters. Make the Sacklers finance addiction recovery centers in all 50 states.

  213. @kladinvt If only! Such addiction treatment centers would certainly be more aptly named than some museum wings around here.

  214. This is what happens to neighborhoods when you send all your factory jobs to countries where the work can be done with slave labor. The underpass in the photos is a half block from where I used to get off the el and wait for the bus that would take me to my teaching job in a class of developmentally delayed students. When I started to wait there in1967 the corner would be full of people waiting for buses that would take them to their jobs in the factories in the area. I would run into former students who, even with problems that kept them from a regular classroom, were able to get jobs running a sewing machine doing piecework, assembly work, or packing. Some of my alums would be on their way to day programs for special needs adults, As with the factories and jobs, those programs don't exist anymore either.

    This had been a blue collar neighborhood. Many voted Republican. When I retired 16 years ago people had not yet begun to camp on the sidewalks. However almost every corner in the area had a young and wasted young woman soliciting to raise money for her next fix. Older people who had lived on the streets in the neighborhood for years sold their houses cheap to people with dreams of gentrification, or they just walked away from them.

    Plenty of financial breaks for the billionaire donor class. No money for education, medical care or other human services. Your vote matters so think before you vote. This show could be coming to a neighborhood near you.

  215. It would be less expensive to legalize drugs and limit the distribution to local health agencies. Drug addicts will take drugs regardless if they are legal or not. I’m not advocating for the use of these drugs, but after experiencing the death of a friend’s son from fentanyl laced heroin and the subsequent anguish it’s time to change the approach to drug addiction. If we don’t change then we face this darwininian experience of addicts dying in the streets, Police and EMT wasting time trying to clean up areas like Kensington.

  216. In some of the comments here, there is little appreciation for the reality that change takes time. I believe Mayor Kenney is to be applauded for addressing the complexity of the challenge -- a challenge that, as many people here note, has been part of the fabric of the city for decades. It is a fantasy to expect such a major problem to be completely solved in two years. The mayor's assembly of a task force, including experts, and the fact that he is actually pursuing informed solutions, represents progress.

    It seems to be a tendency to point to Democrat-led efforts at reform as "failed" when they do not solve decades-old problems within a year or two. I wish more people would acknowledge that it takes years of effort, inevitably with some trial and error, and with a lot of cooperation and good faith, to accomplish what has not been accomplished before.

  217. Einstein’s definition of insanity : doing the same things over and over and expecting a different response.

    Perhaps it is about time to change the dynamic on the drug wars. Perhaps we need to reclassify addiction as a health problem and treat it accordingly versus continuing to treat it as a criminal problem.

    Perhaps we need to shift the money spent on chasing drug dealers and reinvest I’m addicted patients.

  218. @FDNYMom

    Perhaps we need to stop seeing it as a problem. What defines "problem?" Death? Dysfunction? maybe some people are born to be junkies. As far as I know William S Burroughs was a high functioning junky.

    I was a cigarette addict. I quit, but people failed for a decade to get me to quit. I quit just before I turned forty. Addicts gonna use.

  219. That’s exactly what Philadelphia is trying to do.

  220. @FDNYMom Why are we the world's biggest user? How do other nations handle this, what works?

  221. Too many people wander into this life after getting hooked on painkillers. The FDA needs to up their game and do faster evaluations and approvals on any promising therapies that alleviate pain without getting the patient high or hooked.

  222. It is time to enforce personal responsibility and the consequences that accompany it. It is time to protect the rest of society from those who drag it down by their life-choice of addition.

    If an emergency worker is called to respond to a person experiencing an overdose - check behind the right ear, then:
    - If it is clear, administer a dose of Narcan. Place a small tattoo behind the right ear.
    - If there is a tattoo behind the right ear, move on.

  223. @George whitney I don't think you could find one addict who would say he or she started out in life to make addiction a "life style choice" because living under a bridge and nodding out all day was so enticing.

  224. two strikes and you're out?

  225. @George whitney

    You did read that Mark in the article is a veteran who got addicted by taking prescription pain medication for a war injury. Is that the way you want to treat our veterans?

  226. Need to lower the price of prescription Oxy.

  227. @loyd eskildson: great question. I am a masters trained nurse, also in public health with a focus on comparative health care policy. Which is to say I know a little bit, but not nearly enough. First, other countries prioritize addiction as a health problem, not a criminal one. Second, in America (and this was clearly borne out in this article), most addictions stem from accidents and injuries and the way we dole out medication for the downstream effects of those. Other countries (dare I say where health care is a human right, not a privilege) spend more time with these same patients and utilize other treatment modalities with less negative downstream, addictive effects. Think: massage; meditation; toggling anti-inflammatory meds with anti-pain meds, rather than opiates. Lots of psycho-social support to manage low-level, ongoing pain, etc.
    There is a place for opioids, but in the time crunch of caring for patients in America, coupled with huge gaps in follow-up care and a ‘take a pill so I don’t feel anything’ culture, we have so much to learn from other countries.
    Unfortunately, even understanding that we don’t have all the answers is a skill we haven’t mastered.

  228. @Lissa Addiction is not considered a crime in the US. An addict who is involved in criminal behavior would be arrested for the crime, not for the addiction. If it is a non-violent crime the addict may be steered into Drug Treatment Courts which research has shown to be very effective. Also, many of the tx modalities you mentioned have been utilized here for years. Methadone, needle exchange, acupuncture are also provided. I disagree that we have much to learn from others. The UK has a monstrous alcohol problem. So, does Russian. Heroin addiction is a big problem in France. What we have here is a failure to legalize addictive drugs and dispense them through government clinics where addicts can be steered into case management.

  229. Untrue. First, only 3% of hospitals receiving federal dollars (read those hospitals who disproportionately treat acute overdoses) use ANY of the above treatment modalities. They are simply too overwhelmed and understaffed for the kind of time required.
    Second: criminalizing addiction IS prioritized over treating and managing in this country and is demonstrated by the numbers of non-criminal offenders currently in our prison system; lack of federalized needle exchanges. Additionally, methadone is not covered by Medicare; because Medicaid is a mix of state and federal funding—coverage of maintenance methadone treatment through Medicaid varies by state and not all insurance, for those who have it, cover it al all.
    I appreciate your perspective on other addiction issues that other countries have, but we still have much to learn.

  230. i was a community organizer in Kensington and North Philly in the mid-late 70s. this article doesn't surprise me.

    the area was characterized, even then, by extreme poverty, more extreme than i had ever seen in NYC, even in the South Bronx. you can't talk about the current drug situation without addressing such extreme poverty, lack of jobs, lack of hope.

    in the late 70s, there were young men on almost every street corner who were known as "huffers." they sniffed and were addicted to a cheap cleaning solvent known as "Ty-wool." I'm sure i'm spelling that wrong, i don't know what it really was. it would totally burn out their brains and bodies, they were emaciated walking zombies, and very dangerous.

    Kensington was once a thriving industrial area, the center of the textile industry, filled with factories. By the 70s, these were almost all gone. the area was in-bred, people lived there for generations. the area was known as K&A (Kensington Avenue and Alleghany Avenue) and actually had its own dialect.

  231. @bruce bernstein

    So where do all these men get the money for drugs?

  232. Bruce, you are so right. I was born and raised in Philadelphia, and lived there for 50 years. When the factories started moving to cheaper labor states, Philadelphia was dealt a death blow. (The city used to be the leading manufacturing city in the world about 120 years ago. Hard to believe, isn't it?) Then banks and insurance companies started merging and relocating. Because the school system was turning out non functional illiterates, many businesses relocated to the suburbs. Now I believe the Federal govt and U of P are the major employers. I know this first hand because I tried to teach remedial reading in the early 70s to high school sophomores who were reading at a 3rd grade level then. There's plenty of great PR for Center City while many areas look like bombed out cities of the Middle East.

  233. My brother was a drug addict briefly in the late 60s. He was sentenced to a year in a prison-like hospital, where he managed to get clean, get therapy, and stay off the streets for a reasonable length of time. He came out and never used again. We have to find some type of long-term rehab solutions that get people clean and well away from these environments. Rehab facilities in drug neighborhoods is not a good idea. Prosecuting high-level dealers would be a good start too.

  234. Separate the addicts from society.
    Use drug/homeless program budgets to create huge addict settlements in remote rural areas.
    Compell addicts to live in these settlements.
    (Send the addiction/homeless program administrators to them too.)
    Treat the treatable, but force them to stay until they’re clean for a long minimum period.
    The street dealers will probably follow the customers.
    The neighbors will thank you.

  235. @Melvin
    In addition to what you said:

    Make the drugs in the US and give it to the addicts for free--unless they want to be treated. This would get rid of the dealers and ultimately the cartels.

    I think this would still be cheaper then the war on drugs.

  236. What is striking in this piece is the number of veterans who have returned from duty overseas only to become addicts in the country for which they risked life and limb.

    Our fighters deserve better than this.

  237. I am wondering where are these people supposed to live?? Sleep? In many ways we are a very cruel nation. (Peopel snoozing off get kicked out of libraries. A cup of coffee costs usually 1$. WHERE CAN THESE PEOPLE GO? Personally, I like the idea of 18 hour libraries, some kind of center -- with activities of various sorts. Making. Exercising. "Camp" so to speak.... and in an odd way with the tent encampments that is what they had.

    Yes, making sure that money made money did result in jobs going bye-bye.... and along with the jobs ... that community. Nothing replaced it. Tax the rich plenty -- and a luxury tax but what do we have inflation in the price of housing, food, gasoline.... etc. I blame them all starting with Ronnie Reagan.

  238. I was a heroin addict in Philly almost ten years ago. Kensington was bad then and it's bad now. It's sick that it took a crazy political climate to get people to even talk about the Badlands, but if addicts are seen as voters, maybe that makes a difference.

    I tried to get off heroin several times. Cold turkey. Methadone. Leaving the state. Etc. I cannot stress the importance of Suboxone. The minute I took the medication it was as if someone hit the reset button. I called my family, moved out of state and in with them and have been clean for many years.

    Why aren't we pumping shelters with Suboxone? I know it's expensive, but this can't be a better solution. Narcan is nice, but that's only preventing death.

  239. I applaud Mayor Kenney for taking the initiative to try to clean up the area with a multidisciplinary approach, trying to help those who want help, and trying to convince those who don't want help to seek it anyway.
    That said, it becomes clear eventually that a certain segment of these folks simply do not want help, do not want to be clean, and simply want this as their life. They refuse help. At that point, it becomes abusive to constantly offend their personal agency, forcing them to live how they don't want to live. At the same time, continuing to enable their personal choice (not to become addicted, but to remain addicted with no effort to change) becomes a lesson in insanity. These are adults. They have agency. If they choose to decline help, let them live with the repercussions, and concentrate instead on the needs of the innocent hardworking people in the town whose lives are being shattered by these selfish people.
    Stop caring more for people than they bother to care for themselves.

  240. @Abc123
    I really do not think that people dealing with this hellish problem are being "cared for too much."

  241. Injection sites and plenty of public restrooms are the answers. Those few amenities aren't going to drive people to suddenly give up everything and settle down to become heroin addicts. How is this so hard for government employees to understand? Not all fights are winnable and the drug war certainly isn't.

  242. Maybe this "problem" is not solvable -- God knows, many communities have been battling the toxic combination of drug addiction + homelessness + mental illness for decades.

    Maybe the best we can do is manage these encampments and try to make these people's lives a little less miserable. Put military-style logistics in place -- set up bathrooms, laundry facilities, showers, and food distribution onsite. Have a clean team pick up trash on a daily basis. Have a clean injection site. Put a mental-health counselor onsite 24/7.

    And life sentences for selling drugs should be part of the discussion. These are the people who are profiting off of others' misery.

  243. How unforgivably sad that so many of our veterans can’t afford the pain meds they need because they don’t have adequate medical insurance, and so they turn to heroin and get stuck in this cycle. Our gov’t and messed up health care system is to blame most of all. No one WANTS to become a homeless addict.

  244. Pharmaceutical Corporations made billions of dollars encoraging doctors to overprescribe highly-addictive opiods. They even claimed that these drugs were LESS addictive than their predecessors, when actually the opposite was true.

    Many of these addicts started using street drugs after becoming addicted to these prescribed opiods, so why shouldn't we hold Big Pharma accountable for some of this clean-up? They certainly have the money.

  245. @Sarah

    Exactly and not on pharma executive is doing a day of time. The US values the rule of law the rule is if you have money you are above the law

  246. Why do we have a prohibition program that doesn't work and fills the taxpayer funded prisons, often run by foreign prison contractors, full of non-violent sick people with addiction problems.

    Are we trying to set ourselves up to be taken advantage of?

    We are being re-colonized by the foreign prison companies, like G4S, drug cartels,and foreign oil companies, like Saudi Aramco and Royal Dutch Shell that took over our largest oil refinery; BP that returned to Iraq in 2003 after a 45 year absence when our troops cleared the way for them and our taxpayers paid trillions to make this possible.

    In places like Portugal where they treat drug problems but don't prosecute them, drug use has fallen below 20% of what it once was.

    In Switzerland, you can walk into a clinic and get heroin, assured of the ingredients of the product. The Swiss do this because they do not want the gangs and cartels that make places like Chicago, the murder capital of the nation, in their country.

    Tax and regulate drugs, provide treatment for addicts, so we can get beyond this unfortunate period in our history.

    By the way, in 2001, no heroin was produced in Afghanistan; Myanmar was the world's leading producer of heroin. But from 2002 forward, Afghanistan was the world's leading producer of heroin and hashish, producing over 14 trillion dollars worth since 2002.

    So who actually had motive to bring down the towers and start a war in Afghanistan and Iraq?

    And why does no one ask this question?

  247. @jan We DO NOT put people in prison for addiction. That is a myth.

  248. You know that Afghanistan was a major opium producer prior to 2001. There was only a small blip for a couple of years when it was not a major opium/heroin producer. The Taliban prior to 2000 had no issue with opium. Why are you not telling the whole truth?

  249. It's like an episode of the Walking Dead. Problem: it's not entertainment. Really telling about about the range of those desolate -hearted people who've just given up... it's exhausting and overwhelming to read about, nevermind to figure out a solution..

  250. So is this an illegal drug crime wave or a drug health care epidemic or a capitalist business opportunity?

    Is the solution prison, drug rehab or cheers for Making America Great Again?

  251. “In the early 2000s, Dominican gangs started bringing in Colombian heroin that was not only purer but much cheaper than heroin imported from Asia, which historically predominated.”

    This is the ‘truth’ that we’re going with? How many places in the world can actually produce enough poppy straw to accommodate America’s opioid crisis?


  252. @ubique

    It's infinite. as much as is "needed" or pushed can be produced.

  253. I can't help but think how much money the pharmaceutical industry is now making off of narcan when they were the ones pushing opiates to begin's quite ridiculous. Pain management in the US is completely flawed. In Europe you'll receive some ibuprofen 800s post-op and be told to rest. It's time for big pharma to take some responsibility for the products they push and the way they incentivize doctors. Where is the FDA when you actually need them?

  254. This is a fantastic piece of journalism, a crystal-clear window onto a tragedy.

  255. We used to live in Olney northwest of Kensington off 5th street and it was bad news then in the 1980’s. Crack vials everywhere and even in the school yards and sidewalks nearby. Grade schools! Most all of the street people then had mental problems, and not all of them took drugs either. They preferred their world vs the side effects of psychotropic medications, and lived on handouts mostly. Or scrounging , panhandling or being creative by standing at intersections squirting a soapy liquid on windshields then “ demanding” change to quickly squeegee it off. The poor will always be with us says the good book. (Amen.)

  256. That may be Afghanistan's response to US foreign policy.

  257. @juanfran

    US foreign policy in Afghanistan was to protect the poppy fields for friendly warlords. Obama mentioned the US would do something about Afghanistan heroin, of course it was a talk

  258. Depressing for sure. Humans eith seemingly no way out.

    Overall this conflagration of drugs seems greater in the US than anywhere in the world. Deaths, addiction numbers , crime.

    Try reading “Chasing the scream” by Johann Hari, while I am not 100% convinced it does make a very cogent argument for what one might call a modified legalization of these drugs. ( the addiction centers government to supply drugs and needles under controlled circumstances. Expanded methadone.
    The compelling part is the removal of profit financial incentive for both the drug dealers and the police. Its a huge money pit with only the addicts losing. Suppliers and law enforcement lapping up billions. Would like to see the option debated. Portugal and parts of Canada etc have been successful with various plans from what Hari lays out??

  259. Stories about zombie addicts have been written for decades. There is nothing new here. The US has moved away from criminalizing drug addiction to treating it which was a positive move. Unfortunately, the result is that a monstrous mainly non-profit recovery industry has grown to combat addiction but for the most part it is a vast expensive failure as people churn through it over and over and over. One addict churning through treatment can cost in the hundreds of thousands, even millions, of dollars. We have come to the point where legalizing addictive drugs and making them only available through government controlled clinics is an alternative worth considering. The clinics would be a gateway to appropriate treatment and overall case management. There would still be addicts who prefer living under a bridge and being knocked out 24/7 but it is also the right of citizens to push them out of their neighborhoods. Drug addiction, by the way, is not a Democratic or Republican issue, so don't go there.

  260. @BB Fernandez
    Yes, legalize all drugs, control them, tax,them and oversee their distribution. Cigarettes have killed millions of people ad cost trillions in healthcare costs.

  261. The longer I live, the more amazed and sickened I am by the hypocrisy of rich Caucasian apologists and politicians.

    When heroin was confined to poor black neighborhoods and poor black people, addiction was treated as evidence of the helplessness and depravity of the Negro race. Now, since whites have discovered the joys of smack, addiction has magically morphed into an illness that demands treatment and compassion from all. But the rich don't need to worry, because - if this article is correct - all the solutions put forth by our leaders still put their biggest burdens on people who are brown and/or poor. Civic life and civic solutions to our nation's problems are dead. All that's left is to wait for our toe tags.

  262. Thank you so much for this article. It has been long time since I read something this good in the NYT! It was paingul to read but certainly is neccesary to expose the misery these people are suffering. Thanks!