At the corner of Frankstown and Homewood avenues, the war on drugs continues in full view. Police regularly arrest people looking for drugs here; sometimes they’re repeat offenders. Pittsburgh police say local residents have complained about open-air drug sales.
Violence comes with the territory. There were multiple shootings on the block last year, including in June when police found a 6-year-old girl with a critical gunshot wound to her chest.
This block in Homewood has also become a symbol of a different approach to the country’s problem with drug addiction disorders: harm reduction — i.e. treating people suffering from addiction like they would any other disease. To advocates, that means giving them effective health care rather than continuing to cycle them through the criminal justice system.
Keith Richardson, who says he is homeless, was at the corner of Frankstown and Homewood on a recent Friday in December and pointed to an example of the harm reduction approach in the trees across the street. Naloxone is kept in the branches to revive anyone who overdoses. In April, Pittsburgh Police Chief Scott Schubert watched one of his officers, who had been flagged down a block away from the intersection, revive a man with naloxone given to the officer by a resident.
In a nearby parking lot, Prevention Point Pittsburgh hands out clean needles, helping to prevent the spread of infections. A year ago in the same lot, Prevention Point started a program where people suffering from opioid addiction can get a prescription for buprenorphine — a medicine that some studies have shown cut the likelihood of dying from an overdose in half.
These community-based programs are a response to the fact that life-saving medicine can be difficult to obtain for people suffering from addiction. If a person sustains a gunshot wound, they are typically given the best care possible on their way to the hospital. But harm reduction advocates say for people suffering from addiction, it’s hard for them to receive medicine that can prevent them from dying of an overdose. The challenges include long wait times to get into treatment facilities, burdensome regulations on how the medicine can be administered, underutilized local programs and additional personal challenges people face who are dealing with addiction.
In response to a record number of overdose deaths during the COVID pandemic, the harm reduction approach is gaining momentum locally and nationally. In November, three ambulances in the City of Pittsburgh were equipped with buprenorphine for the first time. In December, the federal government opened up its first grant program targeted at harm reduction work. Gov. Tom Wolf’s administration has promised to increase its harm reduction efforts in the new year.
Graphic: Allegheny County overdose deaths
The changes are needed, according to Richardson, who sees the impact of more powerful opioids every day on the corner in Homewood. “The thing is they have synthetic drugs like fentanyl, not only in heroin but in coke and pills. They are putting it in everything and people are dying,” he said. “A lot of times people don’t know there is fentanyl. And some do know and just don’t care. And they take a little bit, and it takes them out.”
But many drug and alcohol treatment providers who still only take patients who quit drugs cold turkey and kick people out after a relapse. People who suffer from diabetes don’t have their medicine taken away if they buy fast food, but people who suffer from opioid addiction often lose access to their medicine if they have a single relapse, said Divya Venkat, a primary care doctor at the Allegheny Health Network who works in one of Prevention Point’s mobile addiction clinics.
“We never expect them to go from eating McDonald’s on a daily basis to not eating McDonald’s at all,” she said. “That’s not the human condition.”
Not doing enough
There was hope that the widespread availability of naloxone, a drug that reverses opioid overdoses, was having a dramatic impact: In 2018, Allegheny County health authorities suggested the increased availability of naloxone helped bring about a 40% decline in overdose deaths that year. The decline in deaths nationally was more modest but it was the first decline in three decades.
The number of overdose deaths started increasing again in late 2019 and then, after the start of the COVID pandemic, spun even further out of control. More than 100,000 people in the United States died of an overdose between April 2020 and April 2021. People younger than 50 in Allegheny County were more than seven times as likely to die of a drug overdose than of COVID-19 over the past two years. Gov. Wolf told WESA this month that his administration will try to bring the epidemic back out of the shadow of the COVID pandemic.
“The opioid epidemic is something that did not get the priority it should have, and we’re moving back to that.”Gov. Tom Wolf
“The opioid epidemic is something that did not get the priority it should have, and we’re moving back to that,” he said.
Deaths have a growing racial disparity. The spike in overdose deaths between 2015 and 2018 happened to white and Black residents at roughly the same rate in Allegheny County, even though it was perceived as predominantly a problem among white people. The increase in deaths in the last three years has happened largely among Black residents. In 2020, Black residents were almost twice as likely to die of an overdose as white residents.
The dramatic increase in overdose deaths largely reflects a change in the potency of opioids available on the street, not a change in how many people are addicted. The biggest survey of drug use in the country found that the number of people addicted to opioids actually decreased between 2015 and 2019, a period when overdose deaths were increasing rapidly.
For the first time, the federal Substance Abuse and Mental Health Services Administration is accepting applications for $30 million in funding that will go toward harm reduction strategies like needle exchanges, which can make it safer for people to inject drugs without hurting themselves. Although the new program is limited to only 25 grants, its existence marks a shift in federal policy.
Overdoses from fentanyl are now the leading cause of death for people 18-45 in the country. Since 2020, Allegheny County residents younger than 50 were more than seven times as likely to die of an overdose than of COVID-19.
The grants could also be used to make buprenorphine more widely available, a treatment that a number of advocates and doctors in Pittsburgh referred to as “the gold standard.” The medicine prevents withdrawal and stabilizes chemical dependencies.
Josh Schneider, who was appointed the City of Pittsburgh’s first overdose prevention coordinator, noticed about 30% of patients who overdose in Pittsburgh refuse transportation to the hospital. Some of them overdose again later when they return to street drugs to deal with their withdrawal symptoms. Buprenorphine can prevent their bodies from going into withdrawal. But in many cases, those overdose patients were not being offered the drug.
Mobile clinics
On a recent Friday, Dade Humphries, a social worker with Prevention Point, set up a white van that doubles as a patient waiting room. Inside the van there’s a medical bed, like the ones in a traditional doctor’s office, and a small bathroom where patients can take a drug test to see if they have opioids in their system. Humphries works with uninsured patients to get insurance and use it to pay for future doses of medicine.
Earlier this year, Prevention Point began parking a second white van in the same parking lot as its five needle injection sites in Pittsburgh. When residents come for safe needles on Friday afternoons in Homewood, if they are ready, they can also meet with a physician who can prescribe them buprenorphine.
Making addiction treatment more convenient is also more effective, said Michael Lynch, the director of the Pittsburgh Poison Center. A 2020 study in the Journal of Substance Abuse Treatment found that patients were seven times more likely to show up for treatment if their appointment was on the same day as they were reaching out for help.
“There is a window of time when that person is interested. We don’t know how long that window will be, so it’s important to be available to that individual at that moment in time or as close to it as possible,” he said. Lynch set up a telehealth clinic through UPMC during the COVID pandemic through which patients can receive buprenorphine on the same day they are referred.
Prevention Point prioritizes its existing five needle-exchange sites – in Homewood, the Hill District, Carrick and Perry Hilltop – even though the need is much greater. “Honestly we could stick a free, low-barrier buprenorphine program anywhere in the city and would have just as good of a response,” said Aaron Arnold, the executive director of Prevention Point. “But with this model we wanted to deliver that service directly to people who had the most barriers otherwise and were likely most at risk of the negative consequences of an unregulated drug supply.”
Victor Noble, a physician’s assistant who works in the mobile clinic in Homewood, said the needle exchange site had been hearing from patients who said they wanted to be on buprenorphine but were having a hard time getting into a clinic.
Noble said the patients have various reasons for saying they are ready for treatment, though most of the patients they see at this point have experienced some kind of overdose. They said it’s inspiring to see people who are trying to get help with addiction.
“I’m glad to be able to help people along with something that they’re basically doing for themselves,” they said.
Between January and November, providers at Prevention Point’s five new mobile clinics met with 277 people. About a third of those people have had an appointment within the last three months, a sign they were still engaged in treatment, according to the nonprofit.
Brittany, who asked to be identified only by her first name, said she has used Prevention Point’s services before to get clean needles. She also received a prescription to buprenorphine earlier this year, though she didn’t end up picking it up at the pharmacy.
“It’s like a safety net, when I’m ready or sick, I’ll go get it,” Brittany said. “I’m ready but I’m not ready… But there are some people that want to, are ready and are using it every day.”
One of her close friends recently died of an overdose. Brittany said she was considering going back to get a new buprenorphine prescription. “I’m ready, but I’m not ready.” she said.
Oliver Morrison is PublicSource’s K-12 education reporter. He can be reached at oliver@publicsource.org or on Twitter @ORMorrison.
