On the stretch of Kensington Avenue between the Allegheny and Somerset SEPTA stations, wound care vans, mobile drug treatment clinics, drop-in centers and harm reduction sites offer daily care to the hundreds of people who openly use drugs on the neighborhood’s sidewalks.
And still, the 19134 ZIP code sees the highest number of overdose deaths citywide as of 2022, the latest year of data available from the Department of Public Health. The total death toll there increased 14 percent from 2021.
Local providers say that’s because people who use drugs in Kensington don’t have a “health home” where they can get consistent access to physical, behavioral and substance use treatment in one place. Instead they seek services on an emergency basis and tend to fall in and out of care.
“It’s the people most at risk that need the highest touch of support,” says Sylvana Mazzella, director of Kensington health organization Prevention Point. “The low-barrier, no-wrong-door, one-stop-shop approach is what we need to keep people alive.”
That’s where a prevention and treatment program developed in Washington state could come into play.
The “health engagement hub” model creates locations where anyone, regardless of insurance status, can walk in and access primary care, infectious disease care, mental health assessments and opioid use disorder treatments such as methadone and buprenorphine. In Washington, the state pays for this care through a special fund at a cost of about $1 million per site annually. Hubs typically grow out of places where people who use drugs already access services, including harm reduction sites — which provide wound care, drug testing and sterile needle exchange — as well as community clinics and tribal clinics.
“It was just kind of like ‘they’re at a syringe exchange, they don’t want to use, they want medications. Why don’t we give them medications at the syringe exchange?’” says Caleb Banta-Green, the University of Washington School of Medicine research professor who helped launch the model in 2017.
Co-location is key
The first iteration, “Buprenorphine Pathways,” launched in partnership with Seattle and King County. Patients here can get prescriptions for methadone and buprenorphine. Research has shown these medications to be a best practice for treating addiction.
Buprenorphine Pathways is co-located with a syringe exchange program and a pharmacy, so people can begin treatment same-day. Patients are also connected to social services. Once patients are connected to the health hub, navigators can actively manage their care and arrange for other resources they may need.
In 2018, Washington state expanded Buprenorphine Pathways to five sites across the state, adding a nurse care manager and a resource navigator to each site’s team. The next round of clinics included a mental health coordinator, and the round after that layered on primary care, infectious disease care and mental health referrals and assessments.
“To have dedicated funding for a range of medical and behavioral health needs that right now are very piecemeal would be a game changer,” Mazzella says.
These sites don’t set expectations that someone will enter recovery, Banta-Green says. He says some other programs, such as traditional methadone clinics, drop people from treatment if they miss appointments or misuse opioids.
“When you fall off the wagon, you just stay off the wagon, because you know you’re going to get penalized for it anyway,” Banta-Green says of more restrictive models. “If people know they’re going to be welcomed back, no matter what, their behaviors can be different in that context.”
A study of the first site conducted by Banta-Green and local public health researchers found that the percentage of patients who were on buprenorphine jumped from 33 percent to 96 percent in a six-visit period. By the end of that time only 41 percent of those patients had other opioids in their systems (compared to 90 percent at the start.)
In a September 2024 study, a team of University of Washington researchers found a 68 percent lower mortality rate over a 12 month period, compared to a comparison group with matched demographics.
In May, Washington Democratic Senator Maria Cantwell and Louisiana Republican Senator Bill Cassidly proposed a federal version of the program, to be funded under the Fatal Overdose Reduction Act. If it moves forward passes, the federal government would distribute Medicaid funding to states, and states would certify organizations as health hubs, according to Cantwell’s staff.
“To have dedicated funding for a range of medical and behavioral health needs that right now are very piecemeal would be a game changer,” Mazzella says.
Building a system
In Philadelphia, there are few programs that provide a combination of wound care, sterile needle exchange, medications for opioid use disorder, mental health assessment and primary care. Those that exist have had to rely on grants and private donors, according to advocates and providers.
Trisha Acri, founder and director of Kensington Avenue health clinic Courage Medicine, says there needs to be a federal opioid use treatment program as robust as the Ryan White program for HIV/AIDS.
“Because during the HIV crisis, the federal government developed this funding stream for folks that didn’t have wraparound services,” she says. “Transportation, food, housing, case management, all the other services that folks need when they’re on medications.”
In the substance use world, on the other hand, government funding is limited, says Banta-Green.
“Generally, who gets paid to do stuff are doctors,” he says. “We don’t really pay for harm reduction services. We pay for harm reduction supplies. We pay for health educators and public health nurses. But we generally don’t pay for harm reduction.”
Both Acri of Courage Medicine and Mazzella of Prevention Point say becoming a “health hub” would mean they could continue co-locating harm reduction, primary care and wound care. The federal program would create a sustainable funding source for buprenorphine and other treatments, as well as supportive services that help people adhere to those medications, such as counseling and housing.
“To have dedicated funding for a range of medical and behavioral health needs that right now are very piecemeal … would be a game changer,” Mazzella says.
She would also want to use the funding to support care navigators who can do outreach in the neighborhood, building trust with people who use drugs and encouraging them to come in for care. As it stands, Prevention Point may soon have to limit its medical services because it does not have the proper permit, according to the city’s Zoning Board of Adjustment. The board rejected the nonprofit’s appeal to get the permit earlier this month.
While Washington State has had success combining harm reduction and primary care, it’s been a challenge to incorporate behavioral health, says Banta-Green, adding that many people are dealing with complex mental illnesses, and it’s difficult to get specialized providers onsite.
Instead, mental health coordinators have been doing “good old-fashioned emotional support” by talking and listening to people, he says. Once the trust is there, they might suggest a mental health assessment, which can lead to a referral.
“It’s really important for people to connect with other people and keep coming back,” he says.
Banta-Green foresees telehealth being a solution for the mental health service component going forward.
What about Philly?
Mayor Cherelle Parker has vowed since taking office to make drug use in Kensington a top priority, but her major initiatives there have centered on policing, not public health. Earlier this year she announced the city would no longer fund syringe service programs.
Parker has set aside $100 million for a treatment and health services facility in Northeast Philadelphia, which will include housing for roughly 600 people, but it’s still being built.
Multiple national studies have found the “housing first model,” which puts people in permanent supportive housing with consistent access to services, reduces chronic homelessness and substance use. For example Philadelphia’s Pathways to Housing PA uses the housing first model and maintains an 86 percent housing retention rate.
Philadelphia officials contend there are enough beds to accommodate Philadelphia’s unhoused population on a daily basis. But advocates say that’s only shelter beds, and without long-term solutions people just cycle back to the streets.
Acri, at Courage Medicine, says the housing piece would be one of the biggest barriers to implementing the health hub model in Philly.
“If they’re interested, we can work really hard to get them into a shelter … it’s just then, did they connect and did they stay?” she says. “There’s no funding to my knowledge, for substance use supportive housing. The Ryan White system provides supportive housing for patients with HIV.”
A federally funded health hub model would be a massive help to Philadelphia programs that are doing their best to serve a complex population on shoestring budgets, she says.
“We have resources to get people into at least temporary housing, we have contacts to get people into longer resources. I think the barrier is funding at the moment,” she says.
