In September, Purdue Pharma, the manufacturer of the opioid painkiller OxyContin, reached a tentative settlement for $10 to 12 billion with the 22 states and 2,000 cities and counties that sued the company over its role in the opioid crisis. According to the Associated Press, the settlement would be divided based on local impact, which means that Philadelphia would receive $6.5 million for every $1 billion for an estimated $65 to 78 million.
We asked five addiction, criminal justice, housing, and social services experts how they would spend the money Philadelphia is estimated to receive from the settlement. Here’s what they said.
Name: Rachel Dougherty
Title: Caseworker, Interim House, Inc.
- 12%: New programs
- 12%: Money to existing programs
- 15%: Expanded hospital care setting treatment
- 23%: Resources for pregnant women and parents — both mothers and fathers — to access treatment
- 38%: Transitional housing for participants with children — including men — that would include continued treatment
With this money, I would fund both existing drug treatment programs and new programs that are in the process of opening. Many existing programs need more resources for facility management, employee training, and expansion of services. New treatment programs need funding to help secure more treatment beds in the Philadelphia area. This money could fund both creating the programs and securing zoning.
I would also use some of the money to expand treatment in hospital settings, such as Penn Presbyterian and inpatient treatment settings like the Valley Forge Medical Center. A lot of patients with complicated medical histories have trouble being placed in treatment. If there were more medical settings, participants could have individualized treatment that fits their ongoing health needs.
Then, I would spend a large percentage of the funding on expanding drug treatment services for people who are pregnant and parents. Currently, there are not enough treatment programs that allow mothers to engage in parenting while attending treatment.
In conjunction with treatment services for pregnant and parenting participants, I would spend the largest portion of these funds on transitional housing for pregnant individuals and parents — both men and women. In my experience, after people complete Mommy and Me-style programs, there are virtually no resources for transitional housing for women. If women are lucky, they can get an apartment through a housing program, but it’s more likely that they end up without housing and in a shelter. Also, there are no transitional family programs for men, and there are many single fathers who are struggling to maintain recovery and parenting at the same time.
Rachel Dougherty is a caseworker at a long-term treatment facility in Philadelphia who is pursuing a bachelor’s degree in public health. She has worked in the addiction treatment field for the past four years, three of which she spent working at Mommy and Me programs.
Name: Jondhi Harrell
Title: Executive Director, The Center for Returning Citizens
I am being realistic and pragmatic; my proposal includes only 20% of the funds because that is all that would be available.
I expect that 30% of the funding will be reserved for white-led nonprofits and organizations that are providing drug intervention and opioid addiction and related services. Then, 10% may be allocated to nonprofits and for-profits led by people of color who are doing similar work.
If the city is smart, another 10% will be scheduled for violence prevention, which is a collateral effect of drug use. But I predict that 20% of the funds will be siphoned off by various city agencies as that is a Philadelphia tradition. The other 10% will evaporate, which is also a Philly tradition.
My proposal includes:
- 10%: Organizations led by returning citizens
- 10%: Entrepreneurs from Black and brown communities
Philadelphia should designate 20% of the available funds to two specific projects. The first would go to organizations led by returning citizens who are leading the movement for direct services and criminal justice reform, and against mass incarceration. There has never been any real funding in the city for services that are headed by those most impacted by mass incarceration. There also has to be a system for building a structure. The organization Compass should be given contracts to strengthen the capabilities of these organizations. If Philly is serious about creating systems that reduce crime and promote healing, it is essential to fund grassroots, street-level work.
The other 10% should go toward entrepreneurship in the community. There is no mechanism for poor, Black, and brown neighborhoods to build economic systems that combat poverty. The opioid funding is the perfect vehicle to move toward economic development that would elevate the impacted communities. The devastating effects of the war on drugs and the crack epidemic were never addressed. The opioid money is the perfect vehicle to address the past, present, and future.
J. Jondhi Harrell is a community activist, writer, lecturer, and executive director of TCRC Community Healing Center and moderator of TCRC Community News Podcast.
Name: Charito Morales
Title: Nurse, advocate, mother
- 41%: Education and outreach
- 23%: Addiction and mental health treatment
- 20%: Additional resources
- 16%: Post-recovery support
Philly has had enough of people in need who are left on the streets with few resources, and little knowledge and safety. Addiction is a serious disease, and it is our job as brothers and sisters to take care of one another and help change this behavior.
Education should receive the biggest chunk of funding because it can be a preventative step against addiction in the first place. Education and outreach go hand in hand — together, they allow the community to understand the risks involved with opioids and help them avoid using them.
Next is treatment. For those who are already struggling with addiction, treatment is the next step to recovery. Treatment should include a recovery center for people suffering from addiction, mental health issues, and other disorders like anxiety and depression. We should provide these spaces as well as access to outside resources.
We also need to provide resources, such as transportation to and from treatment, consultations with behavioral health professionals, and help reintegrating into a community or with family.
Last but not least, some of the money should fund post-recovery services to ensure that people in recovery continue to feel supported, even when they are doing well. This creates social connections and feelings of safety in their community. It also allows people to ask for help when they need it.
Charito Morales is a nurse, advocate, Philadelphian, and mother who fiercely protects those she cares for. She cares for her city, brothers, sisters, friends, family, and strangers alike. She has lost many to the opioid crisis. She believes that enough is enough and that we must put our hands together to create the change we want to see in our community against this public health issue. Each day is a day forward in this fight, and she hopes that together, we can all see the need here and work alongside each other to save lives and create healthy communities.
Name: Christine Simiriglia
Title: CEO, Pathways to Housing PA
Here’s a quick breakdown of how I would spend the money over five years:
- 50%: Providing housing-first subsidies and a full continuum of wrap-around services for 150 people
- 5%: Covering the startup and first year’s operating costs for four to five social enterprise businesses that offer transitional employment services for folks with and recovering from opioid use disorder
- 5%: Creating a three-year project that provides intensive technical assistance and training services on harm reduction strategies and systems that work for people, wherever they are in their journey, including peer and community health initiatives.
- 15%: Expanding flexible medication for opioid use disorder programs to provide street medicine
- 15%: Providing harm reduction services, including needle exchange, overdose reversal medication, vaccinations, and treatment for infections and diseases spread by the use of needles
- 5%: Establishing several overdose prevention sites in Philadelphia
- 5%: Building a space to provide safety and harm reduction supports in a congregate setting
- Priceless: Keeping for-profit hands out of the pot
Housing is a basic human right. Providing housing first is key to ensuring that everyone has a place to call home. Also, complex issues like homelessness and opioid use disorder require creativity, innovation, and constant evolution to meet the needs of those affected. Funding harm reduction strategies can empower people to make informed choices that reduce harm to themselves and others.
Overdose prevention sites and other support services need to be widely available, not kept exclusively in one, beleaguered neighborhood. And they need comprehensive services grounded in harm reduction principles to be effective. Funding and implementing a housing-first model to develop a space that merges autonomy and support services would help people with a higher level of need than we’re currently able to serve.
Christine Simiriglia, MS, is president and CEO of Pathways to Housing PA. The agency has rapidly expanded services to meet the growing and changing needs of our neighbors with disabilities experiencing homelessness since she founded the organization in 2008. Chris has worked in several service systems focused on managing non-profits, and has had several papers and tool kits published related to her work with homelessness.
Name: Jerry Stahler
Title: Professor, Department of Geography and Urban Studies at Temple University
As tempting as it may be for the city government, these funds should not offset any current spending. Instead, they should supplement current federal, state, and city funding that are targeting this crisis. Additionally, I suggest using these funds for augmenting and complementing the initiatives in progress from the Mayor’s Opioid Crisis Task Force recommendations.
I would allocate these resources into two categories — short-term and long-term spending:
- Short-term spending for meeting immediate needs in order to save lives and provide assistance for those most in need
- Long-term spending to address the root causes of the problem and help sustain progress over the long term
60%: Short-term, immediate spending
- 5%: NARCAN availability: This money should be spent ensuring that Narcan and overdose reversal training is freely available throughout the city. Narcan should be available in public places, like emergency defibrillators. Anyone with an opioid use disorder when leaving treatment, jail, prison, or any other institutional setting, should receive Narcan. So should that individual’s family and friends. College dorms, city recreation centers, and libraries should have it in stock. Also, prescriptions for any opioid painkiller should include Narcan. No one should have to die from an overdose since NARCAN should be widely available.
- 12%: Treatment on demand: We need to eliminate waitlists for people seeking treatment for a substance use disorder. Someone’s life is in danger every day or hour they are waiting for but not receiving treatment for using opioids. This money would fund increased treatment engagement, access, and capacity for people suffering from addiction, including expanded availability of medication-assisted treatment, long-term residential treatment, and other forms of treatment depending on an individual’s needs. These funds would also provide more peer support specialists to help people struggling with addiction engage with services. It should also fund programs for individuals addicted and incarcerated.
- 12%: Support for community-based harm reduction programs that address the needs of opioid users: These funds would further support the efforts of existing organizations that address the immediate needs of those struggling with addiction, including but not limited to Angels in Motion and Prevention Point. These organizations provide critical services to those most in need and serve as gateways to obtaining needed medical, social, and treatment services — but generally operate on limited budgets. These funds would also support diversion programs, through which those who are addicted are diverted to treatment rather than prison.
- 12%: Increased long-term recovery support including vocational support: One of the significant challenges concerning addiction is the difficulty in maintaining long-term, stable recovery. It is one thing to achieve sobriety while in treatment, but another to maintain long-term abstinence. Addiction is a chronic disease, and relapse is common. This money would fund aftercare and long-term recovery support programs. It would also support assistance with obtaining jobs and quality sober living housing.
- 14%: Increased housing assistance for the homeless: Housing is a critical need for people who are experiencing homelessness and have a substance use disorder. Shelters are essential as temporary housing. Still, longer-term solutions, like the stable housing and gateway to treatment offered by organizations like Pathways to Housing and other social services, are needed.
- 4%: Overdose prevention sites: Overdose prevention sites are the most controversial type of program and have not yet been implemented in the United States. How to implement such sites in a way that is sensitive to the needs of the community is critical. However, research is compelling that these sites reduce public drug use, save lives, and increase a person’s likelihood of engagement in treatment, medical care, and other services. Given the magnitude of this crisis, this funding would augment our conventional strategies of addressing this problem by opening this type of program as an emergency intervention to save lives.
- 1%: Community needs assessment and community investment planning: Kensington has been particularly adversely affected by the opioid crisis. This money would fund conducting a systematic and comprehensive community needs assessment of Kensington to identify the pressing needs of this neighborhood. Then, based on the assessment’s findings, it would develop a plan to address those needs. Strengthening the community will help prevent future problems.
40%: Long-term spending
- 20%: An endowment fund: One of the problems with allocations of large amounts of funding is that after the initial funding is spent, new programs and initiatives struggle to sustain themselves. This endowment would sustain the initial money and also serve as leverage to attract outside funding sources. For example, the Philadelphia Foundation could manage these funds, and seek additional fundraising to address the opioid crisis citywide. Also, another potential source for increasing the endowment could be a 1% tax on alcohol, cigarettes, and other addictive substances, including recreational marijuana, should it be legalized. This tax could provide sustainable funding support for the initiatives in this and other related plans.
- 5%: Evidence based school and community drug prevention programs expansion: If we want long term gains in dealing with this crisis, it is essential to invest in prevention programs in schools and the community that are effective and evidence based. Prevention can be a forgotten stepchild when dealing with any drug crisis.
- 14%: Community improvement: These funds would strengthen the Kensington community by improving infrastructure and addressing the social needs of residents. The plan should include input from all Kensington stakeholders.
- 1% Evaluation and program monitoring: This money would monitor, evaluate, and document how these services and activities are implemented and to what extent they attained their goals and objectives. It should also measure the kinds of outcomes achieved, if the programs made a difference, and how these programs and services could be improved. Conducting ongoing evaluation and monitoring of programs is important for maximizing their effectiveness and addressing the problem.
Finally, I’d like to add a few fundamental principles:
- There should be transparent management of these funding programs
- The money should not replace spending but add new funds to address the opioid crisis
- There should be mechanisms for input from various stakeholders, including individuals in recovery, their family members, community residents, and front-line community-based organizations serving these groups
- These funds should leverage money from outside sources to invest in long-term strategies that strengthen communities with the autonomy to address the social and economic problems that often lead to substance misuse, addiction, and declining neighborhoods
Jerry Stahler, Ph.D. is a professor in the Department of Geography and Urban Studies at Temple University. He has been involved in teaching about addiction, conducting research on this disease, and working with community-based organizations for 30 years. He serves on the Board of Directors of Prevention Point and served on the Mayor’s Opioid Task Force.
Editor: Claire Wolters / Story Designer: Henry Savage / Translator: Diana Cristancho