Leslie Glass's Blog, page 327

Cannabis Withdrawal Can Be ‘Highly Disabling’

From Medical News Today:

Authorities are legalizing cannabis, particularly for medicinal use, in an increasing number of states. Many people stand by its alleged benefits, but new research warns that frequent use may lead to the “disabling” symptoms of cannabis withdrawal syndrome.

A recent study — led by the Columbia University Mailman School of Public Health and Columbia University Irving Medical Center, both in New York City, NY — set out to investigate what percentage of people who frequently use cannabis may experience cannabis withdrawal syndrome.

This condition is included in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which was published in 2013.

According to the DSM-5, a formerly frequent user of the drug has cannabis withdrawal syndrome when they experience at least three of the following symptoms within a week from cessation:

irritability or hostility
nervousness or anxiety
poor sleep
loss of appetite
restlessness
feelings of depression
shakiness or tremors
sweating
fever
headaches

“In a rapidly changing landscape of marijuana laws and attitudes,” notes study author Prof. Deborah Hasin, “cannabis use continues to increase among American adults.”

“As a result,” she adds, “more information on the prevalence and correlates of clinical withdrawal in the general population is of critical importance.”

Withdrawal linked with psychiatric disorders

The researchers started from interviews with 36,309 participants who registered for the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a national survey that takes into consideration clinically diagnosed cannabis withdrawal syndrome.

For the study analysis, the investigators used data collected from 1,527 participants who identified as frequent cannabis users. This means that they used cannabis at least three times per week for 12 months before they took part in the interview.

In their study paper, which appears in the journal Drug and Alcohol Dependence, the researchers report that, according to their analysis, 12 percent of people who frequently smoke marijuana experience cannabis withdrawal syndrome.

The researchers also note that cannabis withdrawal symptoms appeared to be linked with mental disability and a family history of depression.

Also, these symptoms were associated with a number of psychiatric disorders, including mood disorders, anxiety disorders (social phobia, agoraphobia, and panic disorder), personality disorders, and post-traumatic stress disorder.

Of all the possible withdrawal symptoms, most frequently, the participants reported experiencing nervousness or anxiety (76 percent of the respondents), hostility (72 percent), sleep problems (68 percent), and depressed mood (59 percent of the respondents).

Fewer participants reported having physical symptoms of cannabis withdrawal. In cases wherein physical symptoms did appear, the most commonly encountered were headaches, tremors, and sweating.

The researchers came up with a “profile” of the person who uses cannabis frequently. Typically, they are male (66 percent of the participants), white (59 percent), young adults ages 18–29 (50 percent of the participants), college-educated (49 percent), never married (54 percent), and residing in a low-income household (45 percent).

A potentially dangerous outcome

Cannabis withdrawal syndrome was not significantly associated with how often the volunteers used cannabis over the course of a week, but the investigators found that it was significantly associated with how many joints somebody smoked per day.

A family history of drug or alcohol misuse did not appear to be linked with a person’s likelihood of developing withdrawal symptoms. A family history of depression, however, was linked with cannabis withdrawal syndrome.

“Cannabis withdrawal syndrome is a highly disabling condition.”

Prof. Deborah Hasin

She goes on to explain, “The syndrome’s shared symptoms with depressive and anxiety disorders call for clinician awareness of cannabis withdrawal symptoms and the factors associated with it to promote more effective treatment among frequent cannabis users.”

She is also particularly worried by the fact that new ways of using cannabis, such as in electronic cigarettes, may mean that users are not fully aware of just how much they are actually ingesting.

“Most users of the newer modes of administration — vaping and edibles — also smoke cannabis,” Prof. Hasin notes. “Therefore, for users in modes other than smoking, the amount of consumption could be underestimated,” she warns.

For this reason, Prof. Hasin suggests that specialists should aim to come up with a solid strategy that will allow them to better judge the impact of cannabis on an individual, depending on the concentration at which it is consumed.

“Given the increase in cannabis potency in recent decades,” she continues, “developing reliable measures to investigate the effect of cannabis concentration and mode of administration will be important in advancing our understanding of cannabis withdrawal syndrome.”

The post Cannabis Withdrawal Can Be ‘Highly Disabling’ appeared first on Reach Out Recovery.

Helping Male Survivors Of Sexual Abuse

Males survivors of sexual abuse are in the news with the #MeToo movement and the ongoing crisis in the Catholic Church about pedophile priests. Estimates show that one in six men has been sexually abused, but in reality, similar to the reality for women, is probably higher. With these high numbers, it is important not only for the survivor of abuse to understand how to cope, but also for the partner of the survivor, and we explore things that can help your male partner to not just survive the abuse, but to thrive.

10 Ways to Help Male Survivors Of Sexual Abuse

There are many things a partner can do to help. These include both female and male partners, and while the dynamics may be different, there are coping skills that can be utilized by any partner. These include:

Listen to his description of the abuse. He needs to do this on his time frame for this is a very emotional and painful subject. Listening means being compassionate and loving no matter what he tells you. While you may be overtaken with sorrow for him, realize that this is his issue to deal with in the manner that works best.
 Believe him. As therapists, we know that survivors who are believed have a better outcome of recovery, and while this has mostly been examined when the person was abused (mostly childhood abuse), belief is very powerful for an adult survivor as well.
Understand that male survivors may have a significant amount of shame not only because of being abused, but because of society’s focus on “men being men” – this could be about not being able to protect himself (from childhood abuse) or being harassed if he was abused by a female (“You should have just enjoyed it”).
Support his getting help if he engages in self-destructive behavior or has PTSD from the abuse. Symptoms may include struggling with trust, depression, nightmares, and anxiety as well as self-mutilation such as cutting and burning.
 Realize that there may be issues regarding sexual orientation such as, “If I was raped by a male, maybe he saw that I was gay even though I think I’m straight” or, “How can I ever have loving sex with my male partner when I was raped by a man?”
 Offer encouragement regarding how he’s coping with the abuse. You can continue to be a support, but do not try to take on the role of his therapist.
 Let him know it’s not his fault that this happened. He was a victim. But also relate that he can become a healthy survivor instead of staying a victim.
 Understand that he may be concerned that he might be a sexual perpetrator. Let him know that abuse doesn’t cause one to be a perpetrator.
 Also, he may feel guilty if he orgasmed during the abuse; this is not uncommon. It doesn’t mean he enjoyed the abuse, it just means that the body responded to sexual stimulation.
 Recognize that he may struggle with intimacy and sexual relationships. This in an important area to discuss – when you are not having sex. Participate in intimate actions that don’t always lead to sex.
 Support him in seeking a survivor’s support group and/or therapy.
 Focus on how he has coped with the abuse with a survivor’s mentality and honor his recovery.
 If you’re a survivor, make sure that you are dealing with your own abuse issues.
 Take care of yourself and seek support as needed. You may also want to attend a support group and/or counseling.

There’s hope with connection and acceptance and compassion. The survivor and you, his partner, can do a lot to help along the healing path. Abuse is horrific but with healthy coping, it can be turned not only into surviving, but thriving on the path of life.

 

The post Helping Male Survivors Of Sexual Abuse appeared first on Reach Out Recovery.

Alcohol Math For Girls 1=2

Did you know when it comes to alcohol math: 1=2?  You probably do know that the drinking culture in high school and colleges has been creating dangerous environments for your children for decades. I know because I was a Public Member of the Middle States Commission of Higher Education for six years back in the early 2000s. Alcohol affects the behavior of your boys. For boys, drinking is just a rite of passage and all too often a way to get laid without getting in trouble. For girls the adverse consequences are lasting. Do you know the alcohol math?

More kids die on college campuses as a result of alcohol or substances every year than in the military.
One in four college students is sexually assaulted as the result of drinking.
If fun in high school or college is drinking, your daughter is not going to tell you about the adverse consequences.
If your daughter, sister, friend has been assaulted in high school or college as the result of drinking, she is not likely to tell you, or the faculty, or seek help.
For girls, drinking and adverse alcohol experiences are not a just a rite of passage as they are experienced by boys.
If your daughter dares to talk, she will be blamed.
If she keeps the secret, the trauma and shame of adverse alcohol experiences in high school and college are lasting and life-changing.

Girls Don’t Know 1=2

Girls, especially in high school, know that their parents don’t want them drinking. They know bad things can happen, but they want to have fun and be grown up. Young adults in college are encouraged to drink not just one, but to drink heavily. Girls and young women know they get drunk and feel sick. They know they act stupid and reckless. When they get assaulted, they blame themselves. Girls are taught that they can have fun and drink with the boys. They are taught to blame themselves for the adverse alcohol experiences that lead to assault.

Girls don’t know that no level of alcohol consumption is safe for them

It isn’t just pregnant women who can’t drink without consequences.

Why Girls Can’t Drink Safely

Girls get drunk quicker and stay drunk longer. The simple reason for this is biology. Males have more water and enzymes in their bodies that allow them absorb alcohol more efficiently than women. A few drinks for a male will make them reckless and aggressive; even one drink for a girl renders her incapable of protecting herself.

Let’s Do The Alcohol Math

If you’ve ever seen a BAC (Blood Alcohol Content) card, you will know that girls’ blood alcohol content rises at a faster rate than boys. But BAC cards have not caught on in the seven years we’re been writing about alcohol. What do the numbers on the BAC cards really mean? When girls have just one drink, brain function is impaired. Reflexes are impaired. Judgement is impaired. They are no longer able to say no. Is this new information for you?

One Drink For a Boy Equals Two For A Girl

You may have to see the math to understand how extreme the imbalance is between males and females and how little alcohol it takes to incapacitate girls.

1 drink for a boy = 2 drinks for a girl

2 drinks for a boy = 4 drinks for a girl

3 drinks for a boy = 6 drinks for a girl

The simple fact is your daughters, sisters, friends are at risk for sexual exploitation after just one drink. But how many girls know that? How many girls and women are taught to think that the fun has to stop after one drink. Girls are taught to play the drinking games and to keep up with the boys.

Now You Know The Alcohol Math

Now you know that when your daughter, sister, friends, have two drinks it’s the same as a male having four. And when they have three drinks, it’s the same as a boy having six. It’s time for a change. #notmetoo, #knowyourlimit

The post Alcohol Math For Girls 1=2 appeared first on Reach Out Recovery.

Are Your Boundaries Strong Enough

From Darlene Lancer @ Psychology Today: Love can’t exist without boundaries, even with your children. It’s easy to understand external boundaries as your bottom line. Think of rules and principles you live by when you say what you will or won’t do or allow. If you have difficulty saying no, override your needs to please others, or are bothered by someone who is demanding, controlling, criticizing, pushy, abusive, invasive, pleading, or even smothering you with kindness, it’s your responsibility to speak-up. Boundaries also are also internal, discussed below.

Types of boundaries

There are several areas where boundaries apply:

Material boundaries determine whether you give or loan things, such as your money, car, clothes, books, food, or toothbrush.
Physical boundaries pertain to your personal space, privacy, and body. Do you give a handshake or a hug – to whom and when? How do you feel about loud music, nudity, and locked doors?
Mental boundaries apply to your thoughts, values, and opinions. Are you easily suggestible? Do you know what you believe, and can you hold onto your opinions? Can you open-mindedly to listen to someone else’s, without becoming rigid? If you become highly emotional, argumentative, or defensive, you may have weak emotional boundaries.
Emotional boundaries distinguish separating your emotions and responsibility for them from someone else’s. It’s like an imaginary line or force field that separates you and others. Healthy boundaries prevent you from giving advice, blaming or accepting blame. They protect you from feeling guilty for someone else’s negative feelings or problems and taking others’ comments personally. High reactivity suggests weak emotional boundaries. Healthy emotional boundaries require clear internal boundaries – knowing your feelings and your responsibilities to yourself and others.
Sexual boundaries protect your comfort level with sexual touch and activity – what, where, when, and with whom.
Spiritual boundaries relate to your beliefs and experiences in connection with God and a higher power.

Why It’s Hard

It’s hard for codependents to set boundaries because: 1) They put others’ needs and feelings first; 2) They don’t know themselves; 3) They don’t feel they have rights; 4) They believe setting boundaries jeopardizes the relationship; and 5) They never learned to have healthy boundaries.

Boundaries are learned. You didn’t learn you had rights or boundaries, if yours weren’t valued growing up. Any kind of abuse violates personal boundaries, including teasing. For example, my brother ignored my pleas for him to stop tickling me until I could barely breathe. This made me feel powerless and that I didn’t have a right to say “Stop” when I was uncomfortable. In recovery, I gained the capacity to tell a masseuse to Stop and use less pressure. In some cases, boundary violations affect a child’s ability to mature into an independent, responsible adult.

You Have Rights

You may not believe you have any rights if yours weren’t respected growing up. For example, you have a right to privacy, to say “No,” to be addressed with courtesy and respect, to change your mind or cancel commitments, to ask people you hire to work the way you want, to ask for help, to be left alone, to conserve your energy, and to not answer a question, the phone, or an email.

Think about all the situations where these rights apply:

How often do you say “Yes,” when you’d like to say, “No?”
Write want you want to happen.
List your personal bill of rights. What prevents you from asserting them?
Write statements expressing your bottom line. Be kind. For example, “Please don’t criticize (or call) me (or borrow my . . .),” and “Thank you for thinking of me, but I regret I won’t be joining (or able to help) you . . .”

Internal Boundaries

Internal boundaries involve regulate your relationship with yourself. Think of them as self-discipline and healthy management of time, thoughts, emotions, behavior and impulses. If you’re procrastinating, doing things you neither have to nor want to do, or overdoing and not getting enough rest, recreation, or balanced meals, you may be neglecting internal physical boundaries. Learning to manage negative thoughts and feelings empowers you, as does the ability to follow through on goals and commitments to yourself.

Healthy emotional and mental internal boundaries help you not assume responsibility for, or obsess about, other people’s feelings and problems – something codependents commonly do, followed by violating others’ emotional boundaries with unwanted advice. Strong internal boundaries curb suggestibility. You think about yourself, rather than automatically agreeing with others’ criticism or advice. You’re then empowered to set external emotional boundaries if you choose. Similarly, since you’re accountable for your feelings and actions, you don’t blame others. When you’re blamed, if you don’t feel responsible, instead of defending yourself or apologizing, you can say, “I don’t take responsibility for that.”

Guilt And Resentment

Anger is often a signal that action is required. If you feel resentful or victimized and are blaming someone or something, it might mean that you haven’t been setting boundaries. If you feel anxious or guilty about setting boundaries, remember, your relationship suffers when you’re unhappy. Once you get practice setting boundaries, you feel empowered and less anxiety, resentment, and guilt. Generally, you receive more respect from others and your relationships improve.

Setting Effective Boundaries

People often say they set a boundary, but it didn’t help. There’s an art to setting boundaries. If it’s done in anger or by nagging – “I’ve told you 100 times . . .,” you won’t be heard. Boundaries are not meant to punish, but are for your well-being and protection. They’re more effective when you’re assertive, calm, firm, and courteous. If that doesn’t work, you may need to communicate consequences to encourage compliance. It’s essential, however, that you never threaten a consequence you’re not fully prepared to carry out.

The post Are Your Boundaries Strong Enough appeared first on Reach Out Recovery.

Employees And Execs Are Failing Drug Tests At Shocking Rates

From The New York Post:

New York City employers are squarely blaming a raging drug epidemic for much of the trouble they have filling jobs in one of the tightest labor markets in a generation.

More local prospective workers are testing positive for substance abuse, or showing up stoned for work, according to industry analysts.And even as weed is legalized in some places, or viewed as more socially acceptable, it’s not just marijuana’s job-impairing side effects that bother these hiring managers. The abuse of hard drugs, such as cocaine and methamphetamine, has exploded, and further threatens productivity.

Many jobs in New York City now take 60 days or more to fill. Thirty percent of the openings in New York City for registered nurses, bartenders, delivery drivers, program managers and machine operators that are posted on professional job websites go unfilled for 60 days or more, according to the employment portals.

A 2018 report by Quest Diagnostics reveals a 150 percent increase from 2013 to 2017 of methamphetamine positivity rates for workers tested in the wider New York region, which covers New Jersey and Pennsylvania.

Drug abuse rates overall for workers tested in New York state were at 3.5 percent in 2017, compared with 3.2 percent a decade earlier, the Quest data analysis shows.

The drug crisis comes as the local job market is very tight, with the New York City unemployment rate at 4.1 percent.

And the Labor Department said job openings in August topped a record 7 million nationwide — with the number of openings exceeding job seekers by 902,000 — as the national unemployment rate stands at a 49-year low of 3.7 percent.

Analysts believe there is a direct connection between drug-impaired workers and employers’ inability to fill open slots.

“Now that the economic considerations of this are real, it is time for a fresh look at what is happening in this area of drug testing,” said Peter C. Earle, an economist at the American Institute for Economic Research.

Today, some analysts believe as many as 25 percent or more of applicants for some jobs in New York City are failing drug testing, reflecting a broader national pattern. Analysts estimate that tests are conducted by as many as 50 percent of New York City employers.

“It’s a huge issue,” said Earle, adding that though changing attitudes toward marijuana complicate perspectives on that substance, abuse of hard drugs by workers should be a no-no for employers.

“These changing patterns and geographical variations may challenge the ability of employers to anticipate the drug of choice for their workforce, or where to best focus their drug prevention efforts to ensure a safe and healthy work environment,” said Barry Sample, a senior director at Quest Diagnostics.

Substance abuse cuts a wide swath. New York’s hospitality sector is an example.

Andrew Rigie, executive director of the NYC Hospitality Alliance, said some employees can slip up in the high-pressure, alcohol-fueled atmosphere of bars and restaurants.

No-shows at work, or staff turning up on the job strung out or high on pot, are not uncommon in the industry.

“We have people in the business who certainly struggle,” Rigie told The Post.

The post Employees And Execs Are Failing Drug Tests At Shocking Rates appeared first on Reach Out Recovery.

Philly Dope Market

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.

The first time Mark shot up “Philly dope” was in the summer of 2017, with his girlfriend, Sarah. They had been on their way from Massachusetts to South Carolina, hoping to get clean there and find someplace cheap to live. The plan was to detox slowly on the way. In New Jersey, they needed to buy more drugs, just enough to make it to Myrtle Beach. Mark got out his phone and Googled “really bad drug areas.” A neighborhood in Philadelphia came up: Kensington.

Mark had never heard of it, but it was easy to find, not too far off I-95. The streetlights were broken or dim, and the alleyways were dark. Most of the blocks were lined with two-story rowhouses, abandoned factories and vacant lots. Kensington Avenue, the neighborhood’s main drag, was a congested mess of Chinese takeouts, pawn shops, check-cashing joints and Irish pubs. Missing-person posters hung from storefront windows. The dealers were all out in the open, calling out brand names, even handing out free samples. Many people smoked crack or meth or injected heroin. They stuck needles in their arms, necks and the skin between toes. They were limp and nodding off. Some people lay on the ground looking dead.

Mark got addicted to oxycodone after he was injured by an I.E.D. while on deployment in Iraq. A friend taught him to shoot up heroin because it was a lot cheaper than taking painkillers. And the heroin in Kensington was very cheap. As little as $5 a bag. Mark was used to the high he got from drugs in Massachusetts, but this was different. “We thought it was real dope,” he said. But the heroin had been cut with fentanyl, a synthetic opioid that the couple had never taken before. The withdrawal was the worst Mark and Sarah had ever gone through.

“I’ve never been so sick in my life,” Mark said. “It was like the alien in the movie was going to pop out of my chest, things I’ve never experienced going through detox before.” They tried dosing themselves with Suboxone, a synthetic opioid that eases the pain of withdrawal. They had used it before to get sober. Now it wasn’t helping. The addiction was too powerful and the withdrawal too excruciating. “I knew then that I wasn’t going to leave,” he said. “That we couldn’t leave.”

From The New York Times:

In the summer of 2017, when I first toured the area with Patrick Trainor, a special agent for the Drug Enforcement Administration, he called Kensington the largest open-air narcotics market for heroin on the East Coast. It’s known for having both the cheapest and purest heroin in the region and is a major supplier for dealers in Delaware, New Jersey and Maryland. For years, the heroin being sold in Kensington was pure enough to snort, but that summer, it was mixed with unpredictable amounts of fentanyl. In Philadelphia, deaths related to fentanyl had increased by 95 percent in the past year.

Philadelphia County has the highest overdose rate of any of the 10 most populous counties in America. The city’s Department of Health estimates that 75,000 residents are addicted to heroin and other opioids, and each day, many of them commute to Kensington to buy drugs. The neighborhood is part of the largest cluster of overdose deaths in the city. In 2017, 236 people fatally overdosed there.

“We have not only people from other parts of the state,” Trainor said, “we have people from other parts of the country who come here.” Every year, “drug tourists” from all over the United States visit Kensington for the heroin. Eunice Sanchez, a local pastor, put it more succinctly: the area, she said, was the “Walmart of heroin.”

Once a blue-collar factory neighborhood, Kensington was especially devastated when deindustrialization swept through the area in the 1950s. (Philadelphia neighborhoods don’t have officially designated boundaries, and the northeast section of the city, including West Kensington, East Kensington, Fairhill, Port Richmond and Olde Richmond, is often referred to as “Kensington.”) As the white population fled for the suburbs, Hispanic and African-American people moved in, and with few investments from the city, the drug market filled the economic vacuum. Houses transformed into drug dens, factories into spaces to shoot up, rail yards into homeless encampments. Most residents, many of them immigrant families who had come to Kensington for a better life, did not have the means to move.

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. Kensington’s decentralized market kept competition high and prices low. Most corners were run by small, unaffiliated groups of dealers, making the area difficult to police; if a dealer was arrested, there was always someone there to replace him. The Philadelphia prison system has become the largest provider of drug treatment in the city. The police have realized that they can’t arrest the problem away, and they spend many of their calls reviving drug addicts with Narcan, an overdose-reversal spray. The D.E.A. focused on the high-level drug traffickers, not the guys working the streets, but the arrests did little to curb the growing demand.

“They call this the Badlands,” Elvis Campos, 47, said about Kensington. “Good people are held hostage in their homes.” Campos, who moved to the neighborhood 22 years ago, lives on a small, crumbling block next to a demolished crack house. “I didn’t know about the drugs when I came,” he said. “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. “I tell them to leave,” Campos said. “I served in Iraq, and I think that’s why I’m good at telling drug dealers to get off the block.”

Like Campos, many residents had come to Kensington simply because they couldn’t afford housing anywhere else, and though many expressed empathy for the users, they also wanted them to leave. People cleared needles off their lawns, their front steps and the sidewalks where their children played. Some wouldn’t go anywhere unless they were in a car, but a lot of families were too poor to afford a car. They organized cleanups, lobbied City Council members and state representatives and asked for help from church groups, but the problem seemed insurmountable. The drug market, institutional racism, joblessness and the ravages of the war on drugs in the ’80s left the community struggling. “You see everything here,” one female resident told me. “Overdoses, shootings, killings. We are exposed to trauma every day just living here. It’s constant.”

Dealers fought for territory and intimidated police informants. The area has one of the highest rates of shootings and murders in the city. Less than two-thirds of the residents have a high school diploma, and only a fraction have a bachelor’s degree. Nearly half the residents live below the poverty line. And yet parts of the neighborhood were solidly working-class, and the edges of the neighborhood were gentrifying. “The narrative of the opioid crisis is focused on big-pharma greed,” Zoë Van Orsdol, a public-health specialist, told me, “but in Kensington the reality is far more complicated.”

Early one morning, I found Crystal, 34, a mother of three, going into withdrawal near the intersection of East Somerset Street and Kensington Avenue, the area’s largest drug corner. Car stereos boomed, and the elevated train screeched to a stop. The train doors opened, and buyers spilled onto the walkway, heading down two flights of stairs before dispersing into the streets.

Crystal’s ankle was fractured, and her hair was damp with rainwater. She grew up just a few blocks away, and many of her relatives were addicted to heroin. Crystal started shooting up after her husband lost his job. They had split up, but she still wore her wedding ring. Narcan kept bringing her back. “It’s like playing Russian roulette with your life,” she told me. Crystal sobbed and folded her body over her knees while people walked by her.

A lot of people first came to Kensington because a car accident or surgery had left them addicted to painkillers. Later, when they could no longer afford them, they switched to heroin. Those deep in addiction were using 10 or more times a day. People cycled in and out of Kensington’s recovery houses, treatment centers and shelters. After years of this, women often ended up as prostitutes. They offered oral sex for $25 so they could buy a few bags. They had been raped, tied up and held up. They had nowhere to go to shower. They feared telling the cops about the abuse because they had already been busted on drug or prostitution charges. They slept curled with their purses between their knees and their chests.

When I met Jax, a prostitute with curly blond hair, she apologized about her appearance. She had smoked crack and scratched up her face. It was speckled with wounds. Jax started using opioids in college and ended up in Kensington shooting heroin. She had checked herself into a lot of rehab centers, but she couldn’t stay sober. Her boyfriend tried to help, but he got fed up. In 2009, she became pregnant and used heroin the whole nine months. Recently she spent 24 days in jail, then went right back to the streets and overdosed nine times in two weeks. “Sometimes I just don’t ever want to survive,” she said. “Just let me die.”

“What about your son?” I asked.

“He’s better off without me.”

At the bottom of the station steps, I met John, a 55-year-old man who lived with his parents. John was a “guide”: He guided customers from the train to the drugs. He could help you find heroin, cocaine, PCP, marijuana, Xanax, Percocet virtually any time of day or night. He could help you shop around, compare prices and quality. His own drug of choice was heroin, which he sniffed. John carried a grocery bag filled with clean needles. He got them from Prevention Point, a nonprofit on Kensington Avenue that exchanged dirty needles for clean ones. Needle exchanges helped stop the spread of H.I.V. and hepatitis C. But John was smart and made a small business out of it. He sold clean needles for $2. “You don’t come from our world,” he told me, “and we don’t come from your world.”

A few steps away, I met Shiz, a redhead dressed all in blue. Like most everyone else, Shiz was in Kensington to buy heroin. He was with his friend Kevin, a short man with a wild beard. Opioids often make people itch, and Kevin wouldn’t stop scratching his arms. There was so much dead skin it looked as if his arm were foaming.

“I only do about 20 bucks a day,” Shiz told me. He worked as a cook, making Philly cheesesteaks, and commuted into Kensington to buy drugs. Sometimes he ended up in jail and got clean. He always wanted to stay clean, but it was too hard. He tried locking himself in his house and not talking to anyone, but the boredom drove him crazy. It drove him right back to the drugs.

“Do you wish you could stop?” I asked.

He and Kevin laughed.

“Everybody wishes they could stop,” he said. “You’re always in this web. You’re in the web for the rest of your life.”

When Philadelphia’s progressive mayor, Jim Kenney, took office in 2016, he soon made it a priority to tackle the city’s opioid crisis. His administration wanted to focus on getting heroin users into treatment rather than arresting them. In late 2016, Kenney created a task force of addiction experts, doctors, social workers and agents from the D.E.A. to come up with a plan to curb overdose deaths in the city. In May 2017, they offered 18 recommendations, including a media campaign about the risks of opioids, wider distribution of Narcan and support for medically assisted treatment, which uses opioid-replacement drugs like Suboxone to help users manage withdrawal.

The first time Mark shot up “Philly dope” was in the summer of 2017, with his girlfriend, Sarah. They had been on their way from Massachusetts to South Carolina, hoping to get clean there and find someplace cheap to live. The plan was to detox slowly on the way. In New Jersey, they needed to buy more drugs, just enough to make it to Myrtle Beach. Mark got out his phone and Googled “really bad drug areas.” A neighborhood in Philadelphia came up: Kensington.

Mark had never heard of it, but it was easy to find, not too far off I-95. The streetlights were broken or dim, and the alleyways were dark. Most of the blocks were lined with two-story rowhouses, abandoned factories and vacant lots. Kensington Avenue, the neighborhood’s main drag, was a congested mess of Chinese takeouts, pawn shops, check-cashing joints and Irish pubs. Missing-person posters hung from storefront windows. The dealers were all out in the open, calling out brand names, even handing out free samples. Many people smoked crack or meth or injected heroin. They stuck needles in their arms, necks and the skin between toes. They were limp and nodding off. Some people lay on the ground looking dead.

Mark got addicted to oxycodone after he was injured by an I.E.D. while on deployment in Iraq. A friend taught him to shoot up heroin because it was a lot cheaper than taking painkillers. And the heroin in Kensington was very cheap. As little as $5 a bag. Mark was used to the high he got from drugs in Massachusetts, but this was different. “We thought it was real dope,” he said. But the heroin had been cut with fentanyl, a synthetic opioid that the couple had never taken before. The withdrawal was the worst Mark and Sarah had ever gone through.

“I’ve never been so sick in my life,” Mark said. “It was like the alien in the movie was going to pop out of my chest, things I’ve never experienced going through detox before.” They tried dosing themselves with Suboxone, a synthetic opioid that eases the pain of withdrawal. They had used it before to get sober. Now it wasn’t helping. The addiction was too powerful and the withdrawal too excruciating. “I knew then that I wasn’t going to leave,” he said. “That we couldn’t leave.”

In the summer of 2017, when I first toured the area with Patrick Trainor, a special agent for the Drug Enforcement Administration, he called Kensington the largest open-air narcotics market for heroin on the East Coast. It’s known for having both the cheapest and purest heroin in the region and is a major supplier for dealers in Delaware, New Jersey and Maryland. For years, the heroin being sold in Kensington was pure enough to snort, but that summer, it was mixed with unpredictable amounts of fentanyl. In Philadelphia, deaths related to fentanyl had increased by 95 percent in the past year.

Philadelphia County has the highest overdose rate of any of the 10 most populous counties in America. The city’s Department of Health estimates that 75,000 residents are addicted to heroin and other opioids, and each day, many of them commute to Kensington to buy drugs. The neighborhood is part of the largest cluster of overdose deaths in the city. In 2017, 236 people fatally overdosed there.

“We have not only people from other parts of the state,” Trainor said, “we have people from other parts of the country who come here.” Every year, “drug tourists” from all over the United States visit Kensington for the heroin. Eunice Sanchez, a local pastor, put it more succinctly: the area, she said, was the “Walmart of heroin.”

Once a blue-collar factory neighborhood, Kensington was especially devastated when deindustrialization swept through the area in the 1950s. (Philadelphia neighborhoods don’t have officially designated boundaries, and the northeast section of the city, including West Kensington, East Kensington, Fairhill, Port Richmond and Olde Richmond, is often referred to as “Kensington.”) As the white population fled for the suburbs, Hispanic and African-American people moved in, and with few investments from the city, the drug market filled the economic vacuum. Houses transformed into drug dens, factories into spaces to shoot up, rail yards into homeless encampments. Most residents, many of them immigrant families who had come to Kensington for a better life, did not have the means to move.

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. Kensington’s decentralized market kept competition high and prices low. Most corners were run by small, unaffiliated groups of dealers, making the area difficult to police; if a dealer was arrested, there was always someone there to replace him. The Philadelphia prison system has become the largest provider of drug treatment in the city. The police have realized that they can’t arrest the problem away, and they spend many of their calls reviving drug addicts with Narcan, an overdose-reversal spray. The D.E.A. focused on the high-level drug traffickers, not the guys working the streets, but the arrests did little to curb the growing demand.

“They call this the Badlands,” Elvis Campos, 47, said about Kensington. “Good people are held hostage in their homes.” Campos, who moved to the neighborhood 22 years ago, lives on a small, crumbling block next to a demolished crack house. “I didn’t know about the drugs when I came,” he said. “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. “I tell them to leave,” Campos said. “I served in Iraq, and I think that’s why I’m good at telling drug dealers to get off the block.”

Like Campos, many residents had come to Kensington simply because they couldn’t afford housing anywhere else, and though many expressed empathy for the users, they also wanted them to leave. People cleared needles off their lawns, their front steps and the sidewalks where their children played. Some wouldn’t go anywhere unless they were in a car, but a lot of families were too poor to afford a car. They organized cleanups, lobbied City Council members and state representatives and asked for help from church groups, but the problem seemed insurmountable. The drug market, institutional racism, joblessness and the ravages of the war on drugs in the ’80s left the community struggling. “You see everything here,” one female resident told me. “Overdoses, shootings, killings. We are exposed to trauma every day just living here. It’s constant.”

Dealers fought for territory and intimidated police informants. The area has one of the highest rates of shootings and murders in the city. Less than two-thirds of the residents have a high school diploma, and only a fraction have a bachelor’s degree. Nearly half the residents live below the poverty line. And yet parts of the neighborhood were solidly working-class, and the edges of the neighborhood were gentrifying. “The narrative of the opioid crisis is focused on big-pharma greed,” Zoë Van Orsdol, a public-health specialist, told me, “but in Kensington the reality is far more complicated.”

Early one morning, I found Crystal, 34, a mother of three, going into withdrawal near the intersection of East Somerset Street and Kensington Avenue, the area’s largest drug corner. Car stereos boomed, and the elevated train screeched to a stop. The train doors opened, and buyers spilled onto the walkway, heading down two flights of stairs before dispersing into the streets.

Crystal’s ankle was fractured, and her hair was damp with rainwater. She grew up just a few blocks away, and many of her relatives were addicted to heroin. Crystal started shooting up after her husband lost his job. They had split up, but she still wore her wedding ring. Narcan kept bringing her back. “It’s like playing Russian roulette with your life,” she told me. Crystal sobbed and folded her body over her knees while people walked by her.

A lot of people first came to Kensington because a car accident or surgery had left them addicted to painkillers. Later, when they could no longer afford them, they switched to heroin. Those deep in addiction were using 10 or more times a day. People cycled in and out of Kensington’s recovery houses, treatment centers and shelters. After years of this, women often ended up as prostitutes. They offered oral sex for $25 so they could buy a few bags. They had been raped, tied up and held up. They had nowhere to go to shower. They feared telling the cops about the abuse because they had already been busted on drug or prostitution charges. They slept curled with their purses between their knees and their chests.

When I met Jax, a prostitute with curly blond hair, she apologized about her appearance. She had smoked crack and scratched up her face. It was speckled with wounds. Jax started using opioids in college and ended up in Kensington shooting heroin. She had checked herself into a lot of rehab centers, but she couldn’t stay sober. Her boyfriend tried to help, but he got fed up. In 2009, she became pregnant and used heroin the whole nine months. Recently she spent 24 days in jail, then went right back to the streets and overdosed nine times in two weeks. “Sometimes I just don’t ever want to survive,” she said. “Just let me die.”

“What about your son?” I asked.

“He’s better off without me.”

At the bottom of the station steps, I met John, a 55-year-old man who lived with his parents. John was a “guide”: He guided customers from the train to the drugs. He could help you find heroin, cocaine, PCP, marijuana, Xanax, Percocet virtually any time of day or night. He could help you shop around, compare prices and quality. His own drug of choice was heroin, which he sniffed. John carried a grocery bag filled with clean needles. He got them from Prevention Point, a nonprofit on Kensington Avenue that exchanged dirty needles for clean ones. Needle exchanges helped stop the spread of H.I.V. and hepatitis C. But John was smart and made a small business out of it. He sold clean needles for $2. “You don’t come from our world,” he told me, “and we don’t come from your world.”

A few steps away, I met Shiz, a redhead dressed all in blue. Like most everyone else, Shiz was in Kensington to buy heroin. He was with his friend Kevin, a short man with a wild beard. Opioids often make people itch, and Kevin wouldn’t stop scratching his arms. There was so much dead skin it looked as if his arm were foaming.

“I only do about 20 bucks a day,” Shiz told me. He worked as a cook, making Philly cheesesteaks, and commuted into Kensington to buy drugs. Sometimes he ended up in jail and got clean. He always wanted to stay clean, but it was too hard. He tried locking himself in his house and not talking to anyone, but the boredom drove him crazy. It drove him right back to the drugs.

“Do you wish you could stop?” I asked.

He and Kevin laughed.

“Everybody wishes they could stop,” he said. “You’re always in this web. You’re in the web for the rest of your life.”

When Philadelphia’s progressive mayor, Jim Kenney, took office in 2016, he soon made it a priority to tackle the city’s opioid crisis. His administration wanted to focus on getting heroin users into treatment rather than arresting them. In late 2016, Kenney created a task force of addiction experts, doctors, social workers and agents from the D.E.A. to come up with a plan to curb overdose deaths in the city. In May 2017, they offered 18 recommendations, including a media campaign about the risks of opioids, wider distribution of Narcan and support for medically assisted treatment, which uses opioid-replacement drugs like Suboxone to help users manage withdrawal.

The first order of business was to clear the railroad gulch. For decades, a mile-and-a-half-long stretch of tracks in a ravine had been a magnet for heroin users, with 300 or so people using the tracks to shoot up every day. Near a bridge over the gulch, an encampment of dozens of homeless addicts had grown up. There were mattresses piled beneath the bridge, along with tables where users cut, snorted and cooked drugs together. A Hispanic addict known as the Doctor worked behind a folding table in a shack called “the hospital.” He charged a couple of dollars to shoot up those who couldn’t do it themselves. People sometimes pushed the bodies of users who had overdosed and died into the bushes instead of calling the police. Residents complained about the smell.

The plan was ambitious: El Campamento, as the encampment was known, would be bulldozed, the trees removed and the tracks sealed with fences. The cost was more than $1 million. Conrail, the company that owned the tracks, agreed to dispose of used needles, clear the vegetation from around the tracks and remove trash, including televisions, recliners, mattresses and hundreds of tires. The city would contribute funds for waste removal, some fences and security. It would also remove all the homeless heroin users from the site and offer them medical care and drug-treatment services.

Months before the official cleanup in August 2017, the Office of Homeless Services and the Department of Behavioral Health began sending daily outreach teams to the encampment. They wanted to get as many users into treatment and supportive housing as were willing to go. Kensington Hospital expanded its treatment facilities. Housing and treatment slots opened up for those removed from the encampment. Transportation was provided for those who were willing to accept treatment, and the Office of Homeless Services paid for ID cards for those who didn’t have them. Social workers and community groups set up trailers on a corner, right outside El Campamento, ready with volunteers who would help connect the homeless heroin addicts to treatment.

“It’s not an easy issue,” Kenney had told The Philadelphia Inquirer. “It’s going to take many years and a ton of money, so that may have been why it hasn’t been addressed in the past — but that’s not an excuse.”

That August, just before the demolition was scheduled to begin, I walked along the edges of the tracks and could hear people moving around in the vegetation below. Streams of users walked to and from the tracks to buy and use drugs. Two cops patrolled the area, as drug-dealing kids on trick bikes looped around to run their own surveillance. A man with thick hair and camo pants came up the street and started waving his arms. “Never see this in Texas, man,” he said. “This place is crazy.”

“Are you homeless?” I asked.

“Nah, I’m down here for the summer,” he said.

He had traveled from Texas to sniff the heroin. After two tours in Iraq and Afghanistan, he said, he started taking painkillers recreationally. He said he learned about Kensington from the National Geographic docu-series “Drugs Inc.,” in its 2013 episode “Philly Dope.” At first he threw up because the heroin was so strong. “I’m fine, I’m fine,” he said. “Don’t worry about me. I won’t end up like these people. I do other things with my life. I race dirt bikes. I do jujitsu. I take a shower every day.”

A few days later, Conrail’s team started clearing El Campamento. On a bridge overlooking the encampment, crowds of spectators gathered to watch the destruction. Machines ripped trees from the ground and pulverized them on the spot. Cars honked in celebration. An avalanche of garbage stretched from the top of the slope to the bottom of the ravine.

Two E.M.S. workers chatted about the addicts who overdosed. “If you were on the street having a heart attack and you were dying, and I left you and you died, that’s on me,” one said. “I come and wake you up from an overdose, and you walk away, and I get you again three hours later? That is insanity. I’m like: Make them go to rehab.” He nodded toward a machine that scooped up trash. “Sometimes you need to take a different approach.”

The city offered treatment, but most of the displaced heroin addicts didn’t accept it. They moved into crumbling churches, abandoned buildings, vacant lots. They pitched tents on the grass at McPherson Square, where library staff regularly rushed outside with bottles of Narcan to save the overdosed. The police told the users to be on their way. Some of them moved to the abandoned and boarded-up Ascension of Our Lord Church, on a windswept corner of Westmoreland Street about a mile northeast of the tracks. They gathered in pews, beneath light raining through stained-glass windows. They left needles in the holy-water basin.

In October, outside the Rev. Billy Cortes’s trailer church, a bin overflowed with trash, and the ground was covered with syringes. Homeless men pushed grocery carts, and addicts shuffled up and down the sidewalk. None of the neighbors were out playing dominoes as they usually did. “People are afraid to go outside,” Cortes said. He blamed the city for working too quickly to clear El Campamento. There were more drunk people, more needles in front of his house and on the street. Every day, for weeks, he saw someone overdose. Every corner of his block was littered with trash.

“Look at all these people,” he said. “Look at my neighborhood. See all this trash. Trash everywhere. It’s all dirty now! You think this is fair? This is the reality of this neighborhood. The job the city made is not good. These people don’t have a plan. The cleanup is good for the future, but at the moment it’s not a good thing.”

Winter arrived, and the addicts took shelter in four railroad underpasses beneath elevated sections of Conrail’s railroad tracks, at Kensington Avenue, Emerald Street, Frankford Avenue and Tulip Street. These new encampments were all within a half-mile corridor, just a short walk from where El Campamento had been. In general, the cleanup had pushed the market and the users east toward Olde Richmond and Port Richmond, where the population tended to be less Hispanic and more white. Areas that hadn’t seen a lot of activity in the past were now busy with drug use.

Desiree Gilman, a 34-year-old nurse with shoulder-length blond hair, lived in a rowhouse with her children about a block away from the Tulip Street underpass. Gilman was raised in the neighborhood and did everything she could to stay away from heroin. She focused on her career and raising a family. “But still,” she told me, “about 80 percent of my friends are either in jail or dead.”

Since the cleanup, her car’s battery had been stolen three times, and she had found a man sleeping in the back seat. She pointed at the tracks across the street. “I see people up there sleeping. I see clothes in the trees. You just see people crunching through the leaves. It’s creepy.” In the mornings, she got her 5-year-old son ready for school and waited with him until the school bus came. “I feel bad for them,” she said about the users. “I really do, but I can’t have them shooting up on my steps. I don’t want my kids to see it.”

At the Frankford underpass, the users were all smashed together beneath piles of blankets and clothes. The ceiling dripped. Used syringes lay in puddles and buckets. Trash was everywhere — office chairs, a pleather love seat, plastic crates, trash bags stuffed with clothes. No one slept soundly. Traffic rushed by at all hours of the night. Users were injecting one another in the neck, sometimes because their arm veins had collapsed, but also because the neck was quicker and yielded a more potent high.

A 40-year-old man who went by the nickname Country looked at me with blue eyes and droopy brows. He used to be at the Kensington underpass but moved to Frankford after people found out he had H.I.V. They didn’t want him around. Country slept on two flattened boxes. In the middle of the tunnel, where it was dark, I watched Country try to inject a man in the neck. Country was high and missed the vein. He kept going unconscious with the needle still in his hand.

A man named George sat on a soggy mattress, next to a rug with a tiger on it. He was a new arrival from South Philly. His eyes looked as if someone had scooped them out and filled them with mud. The night before, he said, two cars collided outside the underpass and a man was ejected through the windshield.

“Why come up here?” I asked.

“It’s easier to be homeless here,” George said. “You get help up here. You get food. Everything I have I was given from somebody. The drugs are here — they are closer and cheaper.” George wiped his nose with his sleeve. “People think we are having fun down here. Are you insane? I live under a bridge.”

I didn’t go to Kensington at night on Code Blue days in December, when the temperatures were dangerously cold. But the addicts were still there. They set up burn barrels to keep fires going, and the city opened emergency warming rooms. Even when the temperatures dropped to single digits, many of the addicts refused go to a shelter. For some users, opioid withdrawal was worse than the possibility of freezing to death.

This January, Gov. Tom Wolf signed a statewide disaster declaration, the first of its kind for a public-health emergency in Pennsylvania. There had been more than 1,200 overdose deaths in Philadelphia in 2017 — a 34 percent rise from 2016. Wolf pushed the state to roll back regulations that might be stopping users from getting help, like ID and sobriety requirements for shelters and treatment facilities. Instead of sending overdosed people back out onto the street, the city hired recovery specialists in the E.R. to talk to them about treatment. It handed out tens of thousands of doses of Narcan. It sent a van into the neighborhood to offer recovery services. It gave residents blue light bulbs for their porches, because the light seemed to make it harder for heroin users to find a vein.


Shanta Schachter, a community development consultant who was hired by Conrail during the cleanup as a liaison between the company and neighborhood organizations, watched the new encampments grow throughout the winter. Months before the Conrail cleanup began, she attended community meetings and chatted with neighbors. She had encouraged residents to take control of Kensington by planting trees in vacant lots, building fences, painting abandoned buildings, installing streetlights. During the cleanup, she was hopeful, but after she drove through the tunnels, she was worried about the addicts living there. “It’s just such an incredible amount of suffering,” she told me. “It’s not like people are getting better. There aren’t resources to help the people who are addicted now. I don’t think anybody really knows how to get the addicts off the streets. It can’t just be new beds, or recovery services, or anything else. It has to be everything.”

The city was willing to try almost anything. In January, the 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 and inject under the care of a medical team. There are roughly 120 of these injection sites around the world — although none in the United States — and research has shown that they reduce overdose deaths, connect addicts to long-term care and help keep neighborhoods clean of needles. There has never been a fatal overdose at an official safe-injection site. The Justice Department made it clear that it would view any such place to be in violation of federal drug laws, but Ed Rendell, the former Pennsylvania governor and Philadelphia mayor, threw his support behind a nonprofit group trying to establish one.

At one community meeting this March, city officials explained the idea to residents. The clinic would be located where the most overdose deaths occurred, and that very likely meant Kensington. Many of the overdose victims were white men, though, and some of the minority residents didn’t think it was fair. They worried that establishing a supervised-injection site in the neighborhood would condemn it to a permanent future of drug use. Brooke Feldman, a social worker, had planned to bring a homeless user named Johnny to the meeting, but when she went to the Tulip Street underpass that morning, he had already died of an overdose. “He said he would use the site and wanted to be a part of the conversation,” Feldman told me. “He didn’t even live to be able to do that.”

Dan Martino, a community organizer who put together a march for overdose awareness, had been lobbying for a supervised-injection site for years. “We already have unsafe injection sites on every street corner in the city, and it’s not working out,” he told me. “It has to be easier to get help than heroin.”

In February, on a concrete stoop on East Tusculum Street near the Kensington Avenue tunnel, two sisters, Nancy and Dawn, watched the addicts. Dawn wore a green T-shirt that read, “Dawn’s drinking club,” and her blond hair was high in a ponytail. “Almost everybody I grew up with is either an addict or dead,” she said. “I’m like the only one.”

From the stoop, the Kensington underpass looked dark, like the opening to a rat hole. “The screaming at all hours of the night is way out of control,” Dawn said. “It basically sounds like they are killing each other.”

Nancy’s nephew was an eighth-grade student at Visitation Blessed Virgin Mary, a Catholic school just on the other side of the tracks. Every day he walked back and forth through the tunnel, along with hundreds of other schoolchildren, while the addicts continued to shoot up beneath the dim lights. Some children avoided the tunnel by walking north to the B Street bridge and then swinging back around to Kensington Avenue.

The sisters’ family had lived on Tusculum Street for five generations, and the kids had always been able to play on the street. The underpass used to be empty, and they took care of the vacant lot to make sure it didn’t turn into a dumping site. Now they woke up to find feces and urine on their stoops. They swept needles off their steps, and they took their plants inside because the pots filled with syringes. They wouldn’t let the children play in the snow because of the buried needles.

Dawn lived one door closer to the tunnel than Nancy. “In all the years we have been here, it was never like this,” she said. “They lived on the railroad, like way up that way, where there are no houses. But you know, we don’t count, so whatever.”

“They eat, like, six times a day,” Nancy said. “They eat more than I do. They get coffee and doughnuts in the morning. They brought them tents and blankets. Their drug dealer is two blocks away.”

“They have no reason to go when everyone is giving them absolutely everything,” Dawn said. “The only thing we wish they had is a bathroom.”











“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. I can’t deal with it anymore. We were thinking about opening that fire hydrant and letting that water go. Just flood them out.” She looked east. “Tulip is already starting to fill up. If the addicts migrate to Port Richmond, the neighbors are going to riot.”

With pressure from the neighborhood, the city agreed to remove the homeless addicts from the Tulip Street and Kensington Avenue tunnels. A deadline was set for the end of May. In a news release about the removals, the city’s managing director said the camps “pose a health and safety threat to those who stay there as well as to the neighbors.” As for the other two encampments, the city didn’t have the resources. The residents would have to wait.

Liz Hersh, the director of the Office of Homeless Services in the city, described the underpass encampments as one of the most complex and challenging aspects of Philadelphia’s opioid crisis. The city wanted to respond to the needs of the residents, she told me, “in a way that was also humane for those suffering from addiction,” even when those needs were not always one and the same. The goal was to get as many people as possible into treatment or a shelter by the end of May, but a new approach was needed.



The city realized it needed to help get people into treatment more quickly. Outreach workers began evaluating people for treatment in the tunnels and on the streets, ushering them into vans for privacy. They were able to dose some users immediately with Suboxone and transport them to care. In just two weeks, more users agreed to go into treatment than had in the previous six months. “At the Conrail cleanup,” Hersh told me, “we all thought everyone should go into treatment, and it turned out that offering them homeless services, and specifically low-barrier housing, gave us better results.”

But as the city worked to clear the encampments, the drug dealers seemed to become more aggressive. On a small block off Kensington Avenue, someone threw a Molotov cocktail through a resident’s window. Dealers were looking for turf, but residents were demanding that they stay off their blocks. “That’s the level of danger and violence we face,” Eduardo Esquivel, a resident, told me. His wife was threatened by a panhandler, and his neighbor was surrounded in his car with a young child when users swarmed his block for free samples. “My worry,” Esquivel said, “is we are being asked to face this epidemic as a neighborhood, but the threat of violence is very high and very real, and it’s only getting worse.”

On the day of the removals, protesters — a mix of outreach workers and activists — marched through the streets. They plastered the underpasses in signs that read “Eviction = Death.” They wrote, “Who is human?” on the sidewalk in green chalk. Homeless Services workers carried clipboards and continued to try to get people into treatment or shelters. Police officers stood guard about every 10 feet. Volunteers handed out sanitary wipes and bottles of Gatorade. Sanitation workers threw heaps of trash into the mouth of a garbage truck.



At Tulip Street, two men dragged a tent into the trees on top of the viaduct. The younger man started popping his boils in a side mirror of a school bus while the other man called his mother. “Hey Mom, it’s Nathan,” he said.

“Just letting you know I’m alive. I love you. Bye.”

Nathan put down the phone. “I’m going to rehab,” he told me. “If there is anytime to go, then now is the time.”

“Will this be your first time?” I asked.

“No,” he said. “This is the ninth time.”

Another homeless man came out of the trees behind us. He looked down at himself. “Please don’t take my photo,” he said. “My family would be devastated.”

Nancy, Dawn and a neighbor pulled out butterfly chairs to watch the removals unfold at the Kensington Avenue tunnel. “I have two children in addiction, and this is ridiculous,” the neighbor said. “That’s a life choice.”

In a lot in front of their homes, the police dragged a shirtless man off a mattress. A young woman with a pink backpack kept going unconscious with a cigarette in her mouth. On the other side of the tunnel, people waited in line at One Pound Cheese Steaks while users shot up in the adjacent lot. Next to the counter, a man lay unconscious. “We are trying to keep it together for the community,” an employee told me, “and it’s not working out.”



Mark and Sarah, the couple who stopped in Kensington to buy drugs and never left, were being removed from the Tulip underpass. Mark wore an American-flag tank top and his sandy-colored hair curled beneath a baseball hat. “Sapper school,” he said, referring to the Army training course for combat engineers, “was probably the hardest thing I did in life. I don’t know how I did something like that but I can’t get my [expletive] together out here.” He and Sarah filled a shopping cart with damp clothes and a moldy sleeping pad tied with a bungee cord. They were going to push the shopping cart to a shelter. “It’s kind of a hike from here,” he said, “but that’s where we go to cop drugs anyway.”



Country was out wandering the avenue. He was almost unrecognizable, with thin limbs and sunken cheeks and a shaved head. “I don’t know what I’m going to do,” he said.“Where’s your stuff?” I asked.“This is my stuff.” He had a pocketful of syringes. He turned his back to me and began to cry. He cried for a minute, until the train rushed overhead and drowned him out.

By noon, the Kensington Avenue underpass was empty. Dark clouds made the early afternoon feel like twilight. Dawn waited on her stoop with her arms crossed. She pointed to the empty lot behind a factory just east of her block. “They are building a new camp right over there,” she said. “They told me they are going to come right back.”

There were already about 30 people in the lot, injecting, defecating and sleeping. One of them, Krista, 30, told me she started using heroin after she was raped in college. She was crouched over a lavender purse cleaning a crack pipe and wore a T-shirt that said “Perfect is Boring.” “If I’m a little further away, I have this nervous feeling that I need to come back to Kensington,” she said. “It’s like a big dysfunctional family. I guess this is the one place I belong.”

A portion of the factory, on the corner of East Somerset and Ruth Streets, was being converted into a $17.8 million office building with low-income housing. Residents were already living there. It was supposed to be a sign of hope. But Country had told me it was one of his new favorite places to shoot up. Someone had spray-painted “Gentrification Is Genocide” on the wall.

More than 100 people from the tunnels accepted shelter or treatment. Others were incarcerated or moved away or died. Some of them joined the encampments at Emerald Street and Frankford Avenue or pitched tents in abandoned lots. Others just disappeared.

In a single weekend over the summer, 173 people overdosed from the same bad batch of heroin. It was called Santa Muerte, or Saint Death, and witnesses said people were responding in ways they hadn’t seen when waking up from an overdose. They were agitated and scratched the air in pain.




The city plans to clear the other two encampments in the coming months. This time, activists are worried that the users will go deeper into hiding, that more of them will die alone. “We are still not done,” Devin Reaves, who participated in the mayor’s opioid task force, told me. “Until we see a decrease in overdose deaths year after year, I don’t know if you can say we have done enough,” he said. “How can we say we made an impact if people are still dying?”

Sometimes addicts died in Kensington and no one claimed the bodies. Investigators searched for loved ones, but if none could be found, the remains were buried without a funeral. Some residents mourned in their own way. They wrote the names of the dead on walls or sewed patches with portraits onto a quilt. Small memorials began appearing on land near the railroad tracks and in gardens along Kensington Avenue, close to the place the addicts had called home.

The post Philly Dope Market appeared first on Reach Out Recovery.

Trapped By The ‘Walmart Of Heroin’

From The New York Times:

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.

The first time Mark shot up “Philly dope” was in the summer of 2017, with his girlfriend, Sarah. They had been on their way from Massachusetts to South Carolina, hoping to get clean there and find someplace cheap to live. The plan was to detox slowly on the way. In New Jersey, they needed to buy more drugs, just enough to make it to Myrtle Beach. Mark got out his phone and Googled “really bad drug areas.” A neighborhood in Philadelphia came up: Kensington.

Mark had never heard of it, but it was easy to find, not too far off I-95. The streetlights were broken or dim, and the alleyways were dark. Most of the blocks were lined with two-story rowhouses, abandoned factories and vacant lots. Kensington Avenue, the neighborhood’s main drag, was a congested mess of Chinese takeouts, pawn shops, check-cashing joints and Irish pubs. Missing-person posters hung from storefront windows. The dealers were all out in the open, calling out brand names, even handing out free samples. Many people smoked crack or meth or injected heroin. They stuck needles in their arms, necks and the skin between toes. They were limp and nodding off. Some people lay on the ground looking dead.

Mark got addicted to oxycodone after he was injured by an I.E.D. while on deployment in Iraq. A friend taught him to shoot up heroin because it was a lot cheaper than taking painkillers. And the heroin in Kensington was very cheap. As little as $5 a bag. Mark was used to the high he got from drugs in Massachusetts, but this was different. “We thought it was real dope,” he said. But the heroin had been cut with fentanyl, a synthetic opioid that the couple had never taken before. The withdrawal was the worst Mark and Sarah had ever gone through.

“I’ve never been so sick in my life,” Mark said. “It was like the alien in the movie was going to pop out of my chest, things I’ve never experienced going through detox before.” They tried dosing themselves with Suboxone, a synthetic opioid that eases the pain of withdrawal. They had used it before to get sober. Now it wasn’t helping. The addiction was too powerful and the withdrawal too excruciating. “I knew then that I wasn’t going to leave,” he said. “That we couldn’t leave.”

In the summer of 2017, when I first toured the area with Patrick Trainor, a special agent for the Drug Enforcement Administration, he called Kensington the largest open-air narcotics market for heroin on the East Coast. It’s known for having both the cheapest and purest heroin in the region and is a major supplier for dealers in Delaware, New Jersey and Maryland. For years, the heroin being sold in Kensington was pure enough to snort, but that summer, it was mixed with unpredictable amounts of fentanyl. In Philadelphia, deaths related to fentanyl had increased by 95 percent in the past year.

Philadelphia County has the highest overdose rate of any of the 10 most populous counties in America. The city’s Department of Health estimates that 75,000 residents are addicted to heroin and other opioids, and each day, many of them commute to Kensington to buy drugs. The neighborhood is part of the largest cluster of overdose deaths in the city. In 2017, 236 people fatally overdosed there.

“We have not only people from other parts of the state,” Trainor said, “we have people from other parts of the country who come here.” Every year, “drug tourists” from all over the United States visit Kensington for the heroin. Eunice Sanchez, a local pastor, put it more succinctly: the area, she said, was the “Walmart of heroin.”

Once a blue-collar factory neighborhood, Kensington was especially devastated when deindustrialization swept through the area in the 1950s. (Philadelphia neighborhoods don’t have officially designated boundaries, and the northeast section of the city, including West Kensington, East Kensington, Fairhill, Port Richmond and Olde Richmond, is often referred to as “Kensington.”) As the white population fled for the suburbs, Hispanic and African-American people moved in, and with few investments from the city, the drug market filled the economic vacuum. Houses transformed into drug dens, factories into spaces to shoot up, rail yards into homeless encampments. Most residents, many of them immigrant families who had come to Kensington for a better life, did not have the means to move.

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. Kensington’s decentralized market kept competition high and prices low. Most corners were run by small, unaffiliated groups of dealers, making the area difficult to police; if a dealer was arrested, there was always someone there to replace him. The Philadelphia prison system has become the largest provider of drug treatment in the city. The police have realized that they can’t arrest the problem away, and they spend many of their calls reviving drug addicts with Narcan, an overdose-reversal spray. The D.E.A. focused on the high-level drug traffickers, not the guys working the streets, but the arrests did little to curb the growing demand.

“They call this the Badlands,” Elvis Campos, 47, said about Kensington. “Good people are held hostage in their homes.” Campos, who moved to the neighborhood 22 years ago, lives on a small, crumbling block next to a demolished crack house. “I didn’t know about the drugs when I came,” he said. “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. “I tell them to leave,” Campos said. “I served in Iraq, and I think that’s why I’m good at telling drug dealers to get off the block.”

Like Campos, many residents had come to Kensington simply because they couldn’t afford housing anywhere else, and though many expressed empathy for the users, they also wanted them to leave. People cleared needles off their lawns, their front steps and the sidewalks where their children played. Some wouldn’t go anywhere unless they were in a car, but a lot of families were too poor to afford a car. They organized cleanups, lobbied City Council members and state representatives and asked for help from church groups, but the problem seemed insurmountable. The drug market, institutional racism, joblessness and the ravages of the war on drugs in the ’80s left the community struggling. “You see everything here,” one female resident told me. “Overdoses, shootings, killings. We are exposed to trauma every day just living here. It’s constant.”

Dealers fought for territory and intimidated police informants. The area has one of the highest rates of shootings and murders in the city. Less than two-thirds of the residents have a high school diploma, and only a fraction have a bachelor’s degree. Nearly half the residents live below the poverty line. And yet parts of the neighborhood were solidly working-class, and the edges of the neighborhood were gentrifying. “The narrative of the opioid crisis is focused on big-pharma greed,” Zoë Van Orsdol, a public-health specialist, told me, “but in Kensington the reality is far more complicated.”

Early one morning, I found Crystal, 34, a mother of three, going into withdrawal near the intersection of East Somerset Street and Kensington Avenue, the area’s largest drug corner. Car stereos boomed, and the elevated train screeched to a stop. The train doors opened, and buyers spilled onto the walkway, heading down two flights of stairs before dispersing into the streets.

Crystal’s ankle was fractured, and her hair was damp with rainwater. She grew up just a few blocks away, and many of her relatives were addicted to heroin. Crystal started shooting up after her husband lost his job. They had split up, but she still wore her wedding ring. Narcan kept bringing her back. “It’s like playing Russian roulette with your life,” she told me. Crystal sobbed and folded her body over her knees while people walked by her.

A lot of people first came to Kensington because a car accident or surgery had left them addicted to painkillers. Later, when they could no longer afford them, they switched to heroin. Those deep in addiction were using 10 or more times a day. People cycled in and out of Kensington’s recovery houses, treatment centers and shelters. After years of this, women often ended up as prostitutes. They offered oral sex for $25 so they could buy a few bags. They had been raped, tied up and held up. They had nowhere to go to shower. They feared telling the cops about the abuse because they had already been busted on drug or prostitution charges. They slept curled with their purses between their knees and their chests.

When I met Jax, a prostitute with curly blond hair, she apologized about her appearance. She had smoked crack and scratched up her face. It was speckled with wounds. Jax started using opioids in college and ended up in Kensington shooting heroin. She had checked herself into a lot of rehab centers, but she couldn’t stay sober. Her boyfriend tried to help, but he got fed up. In 2009, she became pregnant and used heroin the whole nine months. Recently she spent 24 days in jail, then went right back to the streets and overdosed nine times in two weeks. “Sometimes I just don’t ever want to survive,” she said. “Just let me die.”

“What about your son?” I asked.

“He’s better off without me.”

At the bottom of the station steps, I met John, a 55-year-old man who lived with his parents. John was a “guide”: He guided customers from the train to the drugs. He could help you find heroin, cocaine, PCP, marijuana, Xanax, Percocet virtually any time of day or night. He could help you shop around, compare prices and quality. His own drug of choice was heroin, which he sniffed. John carried a grocery bag filled with clean needles. He got them from Prevention Point, a nonprofit on Kensington Avenue that exchanged dirty needles for clean ones. Needle exchanges helped stop the spread of H.I.V. and hepatitis C. But John was smart and made a small business out of it. He sold clean needles for $2. “You don’t come from our world,” he told me, “and we don’t come from your world.”

A few steps away, I met Shiz, a redhead dressed all in blue. Like most everyone else, Shiz was in Kensington to buy heroin. He was with his friend Kevin, a short man with a wild beard. Opioids often make people itch, and Kevin wouldn’t stop scratching his arms. There was so much dead skin it looked as if his arm were foaming.

“I only do about 20 bucks a day,” Shiz told me. He worked as a cook, making Philly cheesesteaks, and commuted into Kensington to buy drugs. Sometimes he ended up in jail and got clean. He always wanted to stay clean, but it was too hard. He tried locking himself in his house and not talking to anyone, but the boredom drove him crazy. It drove him right back to the drugs.

“Do you wish you could stop?” I asked.

He and Kevin laughed.

“Everybody wishes they could stop,” he said. “You’re always in this web. You’re in the web for the rest of your life.”

When Philadelphia’s progressive mayor, Jim Kenney, took office in 2016, he soon made it a priority to tackle the city’s opioid crisis. His administration wanted to focus on getting heroin users into treatment rather than arresting them. In late 2016, Kenney created a task force of addiction experts, doctors, social workers and agents from the D.E.A. to come up with a plan to curb overdose deaths in the city. In May 2017, they offered 18 recommendations, including a media campaign about the risks of opioids, wider distribution of Narcan and support for medically assisted treatment, which uses opioid-replacement drugs like Suboxone to help users manage withdrawal.

The first time Mark shot up “Philly dope” was in the summer of 2017, with his girlfriend, Sarah. They had been on their way from Massachusetts to South Carolina, hoping to get clean there and find someplace cheap to live. The plan was to detox slowly on the way. In New Jersey, they needed to buy more drugs, just enough to make it to Myrtle Beach. Mark got out his phone and Googled “really bad drug areas.” A neighborhood in Philadelphia came up: Kensington.

Mark had never heard of it, but it was easy to find, not too far off I-95. The streetlights were broken or dim, and the alleyways were dark. Most of the blocks were lined with two-story rowhouses, abandoned factories and vacant lots. Kensington Avenue, the neighborhood’s main drag, was a congested mess of Chinese takeouts, pawn shops, check-cashing joints and Irish pubs. Missing-person posters hung from storefront windows. The dealers were all out in the open, calling out brand names, even handing out free samples. Many people smoked crack or meth or injected heroin. They stuck needles in their arms, necks and the skin between toes. They were limp and nodding off. Some people lay on the ground looking dead.

Mark got addicted to oxycodone after he was injured by an I.E.D. while on deployment in Iraq. A friend taught him to shoot up heroin because it was a lot cheaper than taking painkillers. And the heroin in Kensington was very cheap. As little as $5 a bag. Mark was used to the high he got from drugs in Massachusetts, but this was different. “We thought it was real dope,” he said. But the heroin had been cut with fentanyl, a synthetic opioid that the couple had never taken before. The withdrawal was the worst Mark and Sarah had ever gone through.

“I’ve never been so sick in my life,” Mark said. “It was like the alien in the movie was going to pop out of my chest, things I’ve never experienced going through detox before.” They tried dosing themselves with Suboxone, a synthetic opioid that eases the pain of withdrawal. They had used it before to get sober. Now it wasn’t helping. The addiction was too powerful and the withdrawal too excruciating. “I knew then that I wasn’t going to leave,” he said. “That we couldn’t leave.”

In the summer of 2017, when I first toured the area with Patrick Trainor, a special agent for the Drug Enforcement Administration, he called Kensington the largest open-air narcotics market for heroin on the East Coast. It’s known for having both the cheapest and purest heroin in the region and is a major supplier for dealers in Delaware, New Jersey and Maryland. For years, the heroin being sold in Kensington was pure enough to snort, but that summer, it was mixed with unpredictable amounts of fentanyl. In Philadelphia, deaths related to fentanyl had increased by 95 percent in the past year.

Philadelphia County has the highest overdose rate of any of the 10 most populous counties in America. The city’s Department of Health estimates that 75,000 residents are addicted to heroin and other opioids, and each day, many of them commute to Kensington to buy drugs. The neighborhood is part of the largest cluster of overdose deaths in the city. In 2017, 236 people fatally overdosed there.

“We have not only people from other parts of the state,” Trainor said, “we have people from other parts of the country who come here.” Every year, “drug tourists” from all over the United States visit Kensington for the heroin. Eunice Sanchez, a local pastor, put it more succinctly: the area, she said, was the “Walmart of heroin.”

Once a blue-collar factory neighborhood, Kensington was especially devastated when deindustrialization swept through the area in the 1950s. (Philadelphia neighborhoods don’t have officially designated boundaries, and the northeast section of the city, including West Kensington, East Kensington, Fairhill, Port Richmond and Olde Richmond, is often referred to as “Kensington.”) As the white population fled for the suburbs, Hispanic and African-American people moved in, and with few investments from the city, the drug market filled the economic vacuum. Houses transformed into drug dens, factories into spaces to shoot up, rail yards into homeless encampments. Most residents, many of them immigrant families who had come to Kensington for a better life, did not have the means to move.

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. Kensington’s decentralized market kept competition high and prices low. Most corners were run by small, unaffiliated groups of dealers, making the area difficult to police; if a dealer was arrested, there was always someone there to replace him. The Philadelphia prison system has become the largest provider of drug treatment in the city. The police have realized that they can’t arrest the problem away, and they spend many of their calls reviving drug addicts with Narcan, an overdose-reversal spray. The D.E.A. focused on the high-level drug traffickers, not the guys working the streets, but the arrests did little to curb the growing demand.

“They call this the Badlands,” Elvis Campos, 47, said about Kensington. “Good people are held hostage in their homes.” Campos, who moved to the neighborhood 22 years ago, lives on a small, crumbling block next to a demolished crack house. “I didn’t know about the drugs when I came,” he said. “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. “I tell them to leave,” Campos said. “I served in Iraq, and I think that’s why I’m good at telling drug dealers to get off the block.”

Like Campos, many residents had come to Kensington simply because they couldn’t afford housing anywhere else, and though many expressed empathy for the users, they also wanted them to leave. People cleared needles off their lawns, their front steps and the sidewalks where their children played. Some wouldn’t go anywhere unless they were in a car, but a lot of families were too poor to afford a car. They organized cleanups, lobbied City Council members and state representatives and asked for help from church groups, but the problem seemed insurmountable. The drug market, institutional racism, joblessness and the ravages of the war on drugs in the ’80s left the community struggling. “You see everything here,” one female resident told me. “Overdoses, shootings, killings. We are exposed to trauma every day just living here. It’s constant.”

Dealers fought for territory and intimidated police informants. The area has one of the highest rates of shootings and murders in the city. Less than two-thirds of the residents have a high school diploma, and only a fraction have a bachelor’s degree. Nearly half the residents live below the poverty line. And yet parts of the neighborhood were solidly working-class, and the edges of the neighborhood were gentrifying. “The narrative of the opioid crisis is focused on big-pharma greed,” Zoë Van Orsdol, a public-health specialist, told me, “but in Kensington the reality is far more complicated.”

Early one morning, I found Crystal, 34, a mother of three, going into withdrawal near the intersection of East Somerset Street and Kensington Avenue, the area’s largest drug corner. Car stereos boomed, and the elevated train screeched to a stop. The train doors opened, and buyers spilled onto the walkway, heading down two flights of stairs before dispersing into the streets.

Crystal’s ankle was fractured, and her hair was damp with rainwater. She grew up just a few blocks away, and many of her relatives were addicted to heroin. Crystal started shooting up after her husband lost his job. They had split up, but she still wore her wedding ring. Narcan kept bringing her back. “It’s like playing Russian roulette with your life,” she told me. Crystal sobbed and folded her body over her knees while people walked by her.

A lot of people first came to Kensington because a car accident or surgery had left them addicted to painkillers. Later, when they could no longer afford them, they switched to heroin. Those deep in addiction were using 10 or more times a day. People cycled in and out of Kensington’s recovery houses, treatment centers and shelters. After years of this, women often ended up as prostitutes. They offered oral sex for $25 so they could buy a few bags. They had been raped, tied up and held up. They had nowhere to go to shower. They feared telling the cops about the abuse because they had already been busted on drug or prostitution charges. They slept curled with their purses between their knees and their chests.

When I met Jax, a prostitute with curly blond hair, she apologized about her appearance. She had smoked crack and scratched up her face. It was speckled with wounds. Jax started using opioids in college and ended up in Kensington shooting heroin. She had checked herself into a lot of rehab centers, but she couldn’t stay sober. Her boyfriend tried to help, but he got fed up. In 2009, she became pregnant and used heroin the whole nine months. Recently she spent 24 days in jail, then went right back to the streets and overdosed nine times in two weeks. “Sometimes I just don’t ever want to survive,” she said. “Just let me die.”

“What about your son?” I asked.

“He’s better off without me.”

At the bottom of the station steps, I met John, a 55-year-old man who lived with his parents. John was a “guide”: He guided customers from the train to the drugs. He could help you find heroin, cocaine, PCP, marijuana, Xanax, Percocet virtually any time of day or night. He could help you shop around, compare prices and quality. His own drug of choice was heroin, which he sniffed. John carried a grocery bag filled with clean needles. He got them from Prevention Point, a nonprofit on Kensington Avenue that exchanged dirty needles for clean ones. Needle exchanges helped stop the spread of H.I.V. and hepatitis C. But John was smart and made a small business out of it. He sold clean needles for $2. “You don’t come from our world,” he told me, “and we don’t come from your world.”

A few steps away, I met Shiz, a redhead dressed all in blue. Like most everyone else, Shiz was in Kensington to buy heroin. He was with his friend Kevin, a short man with a wild beard. Opioids often make people itch, and Kevin wouldn’t stop scratching his arms. There was so much dead skin it looked as if his arm were foaming.

“I only do about 20 bucks a day,” Shiz told me. He worked as a cook, making Philly cheesesteaks, and commuted into Kensington to buy drugs. Sometimes he ended up in jail and got clean. He always wanted to stay clean, but it was too hard. He tried locking himself in his house and not talking to anyone, but the boredom drove him crazy. It drove him right back to the drugs.

“Do you wish you could stop?” I asked.

He and Kevin laughed.

“Everybody wishes they could stop,” he said. “You’re always in this web. You’re in the web for the rest of your life.”

When Philadelphia’s progressive mayor, Jim Kenney, took office in 2016, he soon made it a priority to tackle the city’s opioid crisis. His administration wanted to focus on getting heroin users into treatment rather than arresting them. In late 2016, Kenney created a task force of addiction experts, doctors, social workers and agents from the D.E.A. to come up with a plan to curb overdose deaths in the city. In May 2017, they offered 18 recommendations, including a media campaign about the risks of opioids, wider distribution of Narcan and support for medically assisted treatment, which uses opioid-replacement drugs like Suboxone to help users manage withdrawal.

The first order of business was to clear the railroad gulch. For decades, a mile-and-a-half-long stretch of tracks in a ravine had been a magnet for heroin users, with 300 or so people using the tracks to shoot up every day. Near a bridge over the gulch, an encampment of dozens of homeless addicts had grown up. There were mattresses piled beneath the bridge, along with tables where users cut, snorted and cooked drugs together. A Hispanic addict known as the Doctor worked behind a folding table in a shack called “the hospital.” He charged a couple of dollars to shoot up those who couldn’t do it themselves. People sometimes pushed the bodies of users who had overdosed and died into the bushes instead of calling the police. Residents complained about the smell.

The plan was ambitious: El Campamento, as the encampment was known, would be bulldozed, the trees removed and the tracks sealed with fences. The cost was more than $1 million. Conrail, the company that owned the tracks, agreed to dispose of used needles, clear the vegetation from around the tracks and remove trash, including televisions, recliners, mattresses and hundreds of tires. The city would contribute funds for waste removal, some fences and security. It would also remove all the homeless heroin users from the site and offer them medical care and drug-treatment services.

Months before the official cleanup in August 2017, the Office of Homeless Services and the Department of Behavioral Health began sending daily outreach teams to the encampment. They wanted to get as many users into treatment and supportive housing as were willing to go. Kensington Hospital expanded its treatment facilities. Housing and treatment slots opened up for those removed from the encampment. Transportation was provided for those who were willing to accept treatment, and the Office of Homeless Services paid for ID cards for those who didn’t have them. Social workers and community groups set up trailers on a corner, right outside El Campamento, ready with volunteers who would help connect the homeless heroin addicts to treatment.

“It’s not an easy issue,” Kenney had told The Philadelphia Inquirer. “It’s going to take many years and a ton of money, so that may have been why it hasn’t been addressed in the past — but that’s not an excuse.”

That August, just before the demolition was scheduled to begin, I walked along the edges of the tracks and could hear people moving around in the vegetation below. Streams of users walked to and from the tracks to buy and use drugs. Two cops patrolled the area, as drug-dealing kids on trick bikes looped around to run their own surveillance. A man with thick hair and camo pants came up the street and started waving his arms. “Never see this in Texas, man,” he said. “This place is crazy.”

“Are you homeless?” I asked.

“Nah, I’m down here for the summer,” he said.

He had traveled from Texas to sniff the heroin. After two tours in Iraq and Afghanistan, he said, he started taking painkillers recreationally. He said he learned about Kensington from the National Geographic docu-series “Drugs Inc.,” in its 2013 episode “Philly Dope.” At first he threw up because the heroin was so strong. “I’m fine, I’m fine,” he said. “Don’t worry about me. I won’t end up like these people. I do other things with my life. I race dirt bikes. I do jujitsu. I take a shower every day.”

A few days later, Conrail’s team started clearing El Campamento. On a bridge overlooking the encampment, crowds of spectators gathered to watch the destruction. Machines ripped trees from the ground and pulverized them on the spot. Cars honked in celebration. An avalanche of garbage stretched from the top of the slope to the bottom of the ravine.

Two E.M.S. workers chatted about the addicts who overdosed. “If you were on the street having a heart attack and you were dying, and I left you and you died, that’s on me,” one said. “I come and wake you up from an overdose, and you walk away, and I get you again three hours later? That is insanity. I’m like: Make them go to rehab.” He nodded toward a machine that scooped up trash. “Sometimes you need to take a different approach.”

The city offered treatment, but most of the displaced heroin addicts didn’t accept it. They moved into crumbling churches, abandoned buildings, vacant lots. They pitched tents on the grass at McPherson Square, where library staff regularly rushed outside with bottles of Narcan to save the overdosed. The police told the users to be on their way. Some of them moved to the abandoned and boarded-up Ascension of Our Lord Church, on a windswept corner of Westmoreland Street about a mile northeast of the tracks. They gathered in pews, beneath light raining through stained-glass windows. They left needles in the holy-water basin.

In October, outside the Rev. Billy Cortes’s trailer church, a bin overflowed with trash, and the ground was covered with syringes. Homeless men pushed grocery carts, and addicts shuffled up and down the sidewalk. None of the neighbors were out playing dominoes as they usually did. “People are afraid to go outside,” Cortes said. He blamed the city for working too quickly to clear El Campamento. There were more drunk people, more needles in front of his house and on the street. Every day, for weeks, he saw someone overdose. Every corner of his block was littered with trash.

“Look at all these people,” he said. “Look at my neighborhood. See all this trash. Trash everywhere. It’s all dirty now! You think this is fair? This is the reality of this neighborhood. The job the city made is not good. These people don’t have a plan. The cleanup is good for the future, but at the moment it’s not a good thing.”

Winter arrived, and the addicts took shelter in four railroad underpasses beneath elevated sections of Conrail’s railroad tracks, at Kensington Avenue, Emerald Street, Frankford Avenue and Tulip Street. These new encampments were all within a half-mile corridor, just a short walk from where El Campamento had been. In general, the cleanup had pushed the market and the users east toward Olde Richmond and Port Richmond, where the population tended to be less Hispanic and more white. Areas that hadn’t seen a lot of activity in the past were now busy with drug use.

Desiree Gilman, a 34-year-old nurse with shoulder-length blond hair, lived in a rowhouse with her children about a block away from the Tulip Street underpass. Gilman was raised in the neighborhood and did everything she could to stay away from heroin. She focused on her career and raising a family. “But still,” she told me, “about 80 percent of my friends are either in jail or dead.”

Since the cleanup, her car’s battery had been stolen three times, and she had found a man sleeping in the back seat. She pointed at the tracks across the street. “I see people up there sleeping. I see clothes in the trees. You just see people crunching through the leaves. It’s creepy.” In the mornings, she got her 5-year-old son ready for school and waited with him until the school bus came. “I feel bad for them,” she said about the users. “I really do, but I can’t have them shooting up on my steps. I don’t want my kids to see it.”

At the Frankford underpass, the users were all smashed together beneath piles of blankets and clothes. The ceiling dripped. Used syringes lay in puddles and buckets. Trash was everywhere — office chairs, a pleather love seat, plastic crates, trash bags stuffed with clothes. No one slept soundly. Traffic rushed by at all hours of the night. Users were injecting one another in the neck, sometimes because their arm veins had collapsed, but also because the neck was quicker and yielded a more potent high.

A 40-year-old man who went by the nickname Country looked at me with blue eyes and droopy brows. He used to be at the Kensington underpass but moved to Frankford after people found out he had H.I.V. They didn’t want him around. Country slept on two flattened boxes. In the middle of the tunnel, where it was dark, I watched Country try to inject a man in the neck. Country was high and missed the vein. He kept going unconscious with the needle still in his hand.

A man named George sat on a soggy mattress, next to a rug with a tiger on it. He was a new arrival from South Philly. His eyes looked as if someone had scooped them out and filled them with mud. The night before, he said, two cars collided outside the underpass and a man was ejected through the windshield.

“Why come up here?” I asked.

“It’s easier to be homeless here,” George said. “You get help up here. You get food. Everything I have I was given from somebody. The drugs are here — they are closer and cheaper.” George wiped his nose with his sleeve. “People think we are having fun down here. Are you insane? I live under a bridge.”

I didn’t go to Kensington at night on Code Blue days in December, when the temperatures were dangerously cold. But the addicts were still there. They set up burn barrels to keep fires going, and the city opened emergency warming rooms. Even when the temperatures dropped to single digits, many of the addicts refused go to a shelter. For some users, opioid withdrawal was worse than the possibility of freezing to death.

This January, Gov. Tom Wolf signed a statewide disaster declaration, the first of its kind for a public-health emergency in Pennsylvania. There had been more than 1,200 overdose deaths in Philadelphia in 2017 — a 34 percent rise from 2016. Wolf pushed the state to roll back regulations that might be stopping users from getting help, like ID and sobriety requirements for shelters and treatment facilities. Instead of sending overdosed people back out onto the street, the city hired recovery specialists in the E.R. to talk to them about treatment. It handed out tens of thousands of doses of Narcan. It sent a van into the neighborhood to offer recovery services. It gave residents blue light bulbs for their porches, because the light seemed to make it harder for heroin users to find a vein.


Shanta Schachter, a community development consultant who was hired by Conrail during the cleanup as a liaison between the company and neighborhood organizations, watched the new encampments grow throughout the winter. Months before the Conrail cleanup began, she attended community meetings and chatted with neighbors. She had encouraged residents to take control of Kensington by planting trees in vacant lots, building fences, painting abandoned buildings, installing streetlights. During the cleanup, she was hopeful, but after she drove through the tunnels, she was worried about the addicts living there. “It’s just such an incredible amount of suffering,” she told me. “It’s not like people are getting better. There aren’t resources to help the people who are addicted now. I don’t think anybody really knows how to get the addicts off the streets. It can’t just be new beds, or recovery services, or anything else. It has to be everything.”

The city was willing to try almost anything. In January, the 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 and inject under the care of a medical team. There are roughly 120 of these injection sites around the world — although none in the United States — and research has shown that they reduce overdose deaths, connect addicts to long-term care and help keep neighborhoods clean of needles. There has never been a fatal overdose at an official safe-injection site. The Justice Department made it clear that it would view any such place to be in violation of federal drug laws, but Ed Rendell, the former Pennsylvania governor and Philadelphia mayor, threw his support behind a nonprofit group trying to establish one.

At one community meeting this March, city officials explained the idea to residents. The clinic would be located where the most overdose deaths occurred, and that very likely meant Kensington. Many of the overdose victims were white men, though, and some of the minority residents didn’t think it was fair. They worried that establishing a supervised-injection site in the neighborhood would condemn it to a permanent future of drug use. Brooke Feldman, a social worker, had planned to bring a homeless user named Johnny to the meeting, but when she went to the Tulip Street underpass that morning, he had already died of an overdose. “He said he would use the site and wanted to be a part of the conversation,” Feldman told me. “He didn’t even live to be able to do that.”

Dan Martino, a community organizer who put together a march for overdose awareness, had been lobbying for a supervised-injection site for years. “We already have unsafe injection sites on every street corner in the city, and it’s not working out,” he told me. “It has to be easier to get help than heroin.”

In February, on a concrete stoop on East Tusculum Street near the Kensington Avenue tunnel, two sisters, Nancy and Dawn, watched the addicts. Dawn wore a green T-shirt that read, “Dawn’s drinking club,” and her blond hair was high in a ponytail. “Almost everybody I grew up with is either an addict or dead,” she said. “I’m like the only one.”

From the stoop, the Kensington underpass looked dark, like the opening to a rat hole. “The screaming at all hours of the night is way out of control,” Dawn said. “It basically sounds like they are killing each other.”

Nancy’s nephew was an eighth-grade student at Visitation Blessed Virgin Mary, a Catholic school just on the other side of the tracks. Every day he walked back and forth through the tunnel, along with hundreds of other schoolchildren, while the addicts continued to shoot up beneath the dim lights. Some children avoided the tunnel by walking north to the B Street bridge and then swinging back around to Kensington Avenue.

The sisters’ family had lived on Tusculum Street for five generations, and the kids had always been able to play on the street. The underpass used to be empty, and they took care of the vacant lot to make sure it didn’t turn into a dumping site. Now they woke up to find feces and urine on their stoops. They swept needles off their steps, and they took their plants inside because the pots filled with syringes. They wouldn’t let the children play in the snow because of the buried needles.

Dawn lived one door closer to the tunnel than Nancy. “In all the years we have been here, it was never like this,” she said. “They lived on the railroad, like way up that way, where there are no houses. But you know, we don’t count, so whatever.”

“They eat, like, six times a day,” Nancy said. “They eat more than I do. They get coffee and doughnuts in the morning. They brought them tents and blankets. Their drug dealer is two blocks away.”

“They have no reason to go when everyone is giving them absolutely everything,” Dawn said. “The only thing we wish they had is a bathroom.”











“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. I can’t deal with it anymore. We were thinking about opening that fire hydrant and letting that water go. Just flood them out.” She looked east. “Tulip is already starting to fill up. If the addicts migrate to Port Richmond, the neighbors are going to riot.”

With pressure from the neighborhood, the city agreed to remove the homeless addicts from the Tulip Street and Kensington Avenue tunnels. A deadline was set for the end of May. In a news release about the removals, the city’s managing director said the camps “pose a health and safety threat to those who stay there as well as to the neighbors.” As for the other two encampments, the city didn’t have the resources. The residents would have to wait.

Liz Hersh, the director of the Office of Homeless Services in the city, described the underpass encampments as one of the most complex and challenging aspects of Philadelphia’s opioid crisis. The city wanted to respond to the needs of the residents, she told me, “in a way that was also humane for those suffering from addiction,” even when those needs were not always one and the same. The goal was to get as many people as possible into treatment or a shelter by the end of May, but a new approach was needed.



The city realized it needed to help get people into treatment more quickly. Outreach workers began evaluating people for treatment in the tunnels and on the streets, ushering them into vans for privacy. They were able to dose some users immediately with Suboxone and transport them to care. In just two weeks, more users agreed to go into treatment than had in the previous six months. “At the Conrail cleanup,” Hersh told me, “we all thought everyone should go into treatment, and it turned out that offering them homeless services, and specifically low-barrier housing, gave us better results.”

But as the city worked to clear the encampments, the drug dealers seemed to become more aggressive. On a small block off Kensington Avenue, someone threw a Molotov cocktail through a resident’s window. Dealers were looking for turf, but residents were demanding that they stay off their blocks. “That’s the level of danger and violence we face,” Eduardo Esquivel, a resident, told me. His wife was threatened by a panhandler, and his neighbor was surrounded in his car with a young child when users swarmed his block for free samples. “My worry,” Esquivel said, “is we are being asked to face this epidemic as a neighborhood, but the threat of violence is very high and very real, and it’s only getting worse.”

On the day of the removals, protesters — a mix of outreach workers and activists — marched through the streets. They plastered the underpasses in signs that read “Eviction = Death.” They wrote, “Who is human?” on the sidewalk in green chalk. Homeless Services workers carried clipboards and continued to try to get people into treatment or shelters. Police officers stood guard about every 10 feet. Volunteers handed out sanitary wipes and bottles of Gatorade. Sanitation workers threw heaps of trash into the mouth of a garbage truck.



At Tulip Street, two men dragged a tent into the trees on top of the viaduct. The younger man started popping his boils in a side mirror of a school bus while the other man called his mother. “Hey Mom, it’s Nathan,” he said.

“Just letting you know I’m alive. I love you. Bye.”

Nathan put down the phone. “I’m going to rehab,” he told me. “If there is anytime to go, then now is the time.”

“Will this be your first time?” I asked.

“No,” he said. “This is the ninth time.”

Another homeless man came out of the trees behind us. He looked down at himself. “Please don’t take my photo,” he said. “My family would be devastated.”

Nancy, Dawn and a neighbor pulled out butterfly chairs to watch the removals unfold at the Kensington Avenue tunnel. “I have two children in addiction, and this is ridiculous,” the neighbor said. “That’s a life choice.”

In a lot in front of their homes, the police dragged a shirtless man off a mattress. A young woman with a pink backpack kept going unconscious with a cigarette in her mouth. On the other side of the tunnel, people waited in line at One Pound Cheese Steaks while users shot up in the adjacent lot. Next to the counter, a man lay unconscious. “We are trying to keep it together for the community,” an employee told me, “and it’s not working out.”



Mark and Sarah, the couple who stopped in Kensington to buy drugs and never left, were being removed from the Tulip underpass. Mark wore an American-flag tank top and his sandy-colored hair curled beneath a baseball hat. “Sapper school,” he said, referring to the Army training course for combat engineers, “was probably the hardest thing I did in life. I don’t know how I did something like that but I can’t get my [expletive] together out here.” He and Sarah filled a shopping cart with damp clothes and a moldy sleeping pad tied with a bungee cord. They were going to push the shopping cart to a shelter. “It’s kind of a hike from here,” he said, “but that’s where we go to cop drugs anyway.”



Country was out wandering the avenue. He was almost unrecognizable, with thin limbs and sunken cheeks and a shaved head. “I don’t know what I’m going to do,” he said.“Where’s your stuff?” I asked.“This is my stuff.” He had a pocketful of syringes. He turned his back to me and began to cry. He cried for a minute, until the train rushed overhead and drowned him out.

By noon, the Kensington Avenue underpass was empty. Dark clouds made the early afternoon feel like twilight. Dawn waited on her stoop with her arms crossed. She pointed to the empty lot behind a factory just east of her block. “They are building a new camp right over there,” she said. “They told me they are going to come right back.”

There were already about 30 people in the lot, injecting, defecating and sleeping. One of them, Krista, 30, told me she started using heroin after she was raped in college. She was crouched over a lavender purse cleaning a crack pipe and wore a T-shirt that said “Perfect is Boring.” “If I’m a little further away, I have this nervous feeling that I need to come back to Kensington,” she said. “It’s like a big dysfunctional family. I guess this is the one place I belong.”

A portion of the factory, on the corner of East Somerset and Ruth Streets, was being converted into a $17.8 million office building with low-income housing. Residents were already living there. It was supposed to be a sign of hope. But Country had told me it was one of his new favorite places to shoot up. Someone had spray-painted “Gentrification Is Genocide” on the wall.

More than 100 people from the tunnels accepted shelter or treatment. Others were incarcerated or moved away or died. Some of them joined the encampments at Emerald Street and Frankford Avenue or pitched tents in abandoned lots. Others just disappeared.

In a single weekend over the summer, 173 people overdosed from the same bad batch of heroin. It was called Santa Muerte, or Saint Death, and witnesses said people were responding in ways they hadn’t seen when waking up from an overdose. They were agitated and scratched the air in pain.




The city plans to clear the other two encampments in the coming months. This time, activists are worried that the users will go deeper into hiding, that more of them will die alone. “We are still not done,” Devin Reaves, who participated in the mayor’s opioid task force, told me. “Until we see a decrease in overdose deaths year after year, I don’t know if you can say we have done enough,” he said. “How can we say we made an impact if people are still dying?”

Sometimes addicts died in Kensington and no one claimed the bodies. Investigators searched for loved ones, but if none could be found, the remains were buried without a funeral. Some residents mourned in their own way. They wrote the names of the dead on walls or sewed patches with portraits onto a quilt. Small memorials began appearing on land near the railroad tracks and in gardens along Kensington Avenue, close to the place the addicts had called home.

The post Trapped By The ‘Walmart Of Heroin’ appeared first on Reach Out Recovery.

10 Ways You’re Adulting

They call being responsible and truly grown up “adulting.” I see people who think of themselves as adults everyday, but sometimes they are only emotional toddlers stomping around demanding others make their life easier.

The 10 signs I look for are small and often overlooked, but as far as I am concerned they tell me a great deal about an individual’s maturity level. Here are my top ten signs someone is an adult:

1. Adults Make Their Bed Every Day

I know this sounds silly, but it starts the day off with an accomplishment and as an added bonus it rewards us at the end of our day with a made up bed. Our Intern wrote a article about the importance of making your bed. Making your bed everyday may not be easy, but nothing adults do is easy.

2. Adults Finish What They Start

From putting the clean clothes away to painting the baseboard. “Children start projects, but adults finish them.” I have heard it said, “When you are stuck for an answer find the nearest finish line and cross it.” It can be anything from wiping the fingerprints off the front door to returning a DVD to the RedBox to  putting your grocery cart back. Once some of my grown-up kids discovered the good feeling of crossing finish lines they started looking for them everywhere. They stopped starting a new project every weekend and started looking instead for projects to complete.

3. Adults Are On Time

Ask any boss what is important to them. Simple stuff, like being on time every day. Yes, life is busy and we can all over schedule ourselves. That is one reason I love the slogan, “Keep It Simple.” If I can’t make it to places on time it is often a sign for me to stop trying to please too many people. Being on time, every time, to everything, will put someone miles ahead of someone who is constantly “running late.”

4. Adults Don’t Come Empty Handed

Even if they have little to offer,  adults will find a  way to share something. I often look to see if my children remember to bring something when they are invited to a celebration. For Thanksgiving one year my daughter was flat broke, but she stopped and bought an off-brand of soda to share. It costs her $.50, but showed that she was thinking of others even during her own hard times. She was only 19 years old, and her siblings were impressed that she contributed what she could. I have seen adults stop and pick flowers if they had nothing else to bring. Adults think of others and reflect that with their actions.

5. Adults Pick Up After Themselves And Others

My kids were like so many others when they were teens, just close the door and hope for better days. Well, they aren’t kids anymore and how they keep their places tells a lot about their ability to manage their life. While cleaning up after ourselves makes sense to most people, even harder is the idea of picking up after someone else. Walking down a beach and finding litter left by a total stranger is fairly common. My friend is great about picking up litter others have thrown down. I try hard to adopt his attitude of remembering the higher good is to have a cleaner environment. Messes are a part of life. Cleaning up after ourselves and others is a big part of being an adult. Our town has a clean up day every year. It was where I first learned the importance of cleaning up after others.

6. Adults Know How To Manage Money

Adults understand the concept of delayed gratification. I like to think  my children are in control of their money and not panicked because they forgot to look before buying an item they felt they “had to have.” Adults keep track of where the money goes and more than that they tell their money where to go. I am still trying to be better with my money, but I know starting with a goal of knowing where it is keeps me in touch with my limitations and helps me avoid financial drama.

7. An Adult Know How To Argue

Grown Ups find ways to compromise with each other. Adults allow others to finish what they are saying. Adults don’t always agree, but they know it is important that everyone feels heard. To avoid a heated argument they can say, “You may be right.” With this attitude, adults look for common ground and focus on finding solutions. Being level headed, tolerant,  and calm is a welcome characteristic in today’s world.

8. Adults Know How To Entertain Themselves

Children fuss when life is boring. Adults enjoy the opportunity to let their brain decompress. Adults don’t need constant stimulation and understand that quiet is a rare gift in our often over-stimulated culture. They embrace the quiet and are simply patient or find something to occupy themselves with until the situation changes.

9. Adults Return The Things They Borrow

Adults return things they borrowed in better condition than when they received them. How many times in my youth did I return something I had accidentally broken while using and thought an apology was sufficient. Eventually I learned if I broke it I would need to buy a replacement. Adults take borrowed clothes to the dry cleaners before returning them. They wash the car and fill it with gasoline before returning it. They know the owner risked trusting them and want to show appreciation for that trust. This also helps get a yes the next time you need to borrow something from a friend.

10. Finally, Adults Don’t Constantly Complain

They accept life on life’s terms. Adults have survived bad teachers, bad bosses, and bad days. They have learned words of gratitude can pause their desire to bitch and moan about everything that doesn’t go their way. I pay close attention to what my children do when they have a job or college class they don’t like. It can be a real marker of where they are on the road to maturity.

I would like to think my adult children are making progress toward becoming fully developed adults, but only time will tell. Too many times in our culture today there seems to be a  disconnect between being of service to our fellow man and being served. The good news is it is never too late to grow up.

 

Save

Save

 

Follow our life in recovery on Instagram!

The post 10 Ways You’re Adulting appeared first on Reach Out Recovery.

Stigma Breaker Carrie Fisher

The actress spoke out on mental illness many times during her life ― something almost unheard of in Hollywood at the time she began sharing publicly.

She gave honest testimonies of the trials and triumphs of battling addiction and bipolar disorder, displaying a no-holds-barred attitude when it comes to discussing the realities of mental health conditions.

We want to salute the original Princess Leia for her groundbreaking stance on mental health in the public eye. Below are few times Fisher stood up against stigma:

When she owned what was happening with her mental health.

GETTY IMAGES

“I have a chemical imbalance that, in its most extreme state, will lead me to a mental hospital … I am mentally ill. I can say that. I am not ashamed of that. I survived that, I’m still surviving it, but bring it on.”

The time she had this great response to being called the “poster child” of bipolar disorder.

“Well, I am hoping to get the centerfold in Psychology Today. … Now, it seems every show I watch there’s always someone bipolar in it! It’s going through the vernacular like ‘May the force be with you’ did. But I define it, rather than it defining me.”

When she offered sound advice on pursuing dreams despite mental illness.

GETTY IMAGES

”Stay afraid, but do it anyway. What’s important is the action. You don’t have to wait to be confident. Just do it and eventually the confidence will follow.”

The time she got real about how it feels to go through manic episodes.

“You can’t stop. It’s very painful. It’s raw. You know, it’s rough … your bones burn … when you’re not busy talking and trying to drown it out.”

When she explained the only real way to manage a mental health condition.

“The only lesson for me, or for anybody, is that you have to get help. It’s not a neat illness. It doesn’t go away.”

And finally, when she shut down the shamers by explaining just how strong you have to be to deal with a mental health condition.

GETTY IMAGES

”One of the things that baffles me (and there are quite a few) is how there can be so much lingering stigma with regards to mental illness, specifically bipolar disorder. In my opinion, living with manic depression takes a tremendous amount of balls. … At times, being bipolar can be an all-consuming challenge, requiring a lot of stamina and even more courage, so if you’re living with this illness and functioning at all, it’s something to be proud of, not ashamed of.”

Nailed it.

The post Stigma Breaker Carrie Fisher appeared first on Reach Out Recovery.

Different Forms Of Higher Power In Recovery

From Psychology Today:

Alcoholics Anonymous (AA) has helped millions of people to stop using alcohol and drugs. The 12 steps of AA remains the primary model in most in- and outpatient treatment centers. For as many as AA and its 12 Step model have helped, perhaps just as many have avoided or left AA or a 12 Step treatment program because of the Christian conception of God that undergirds the 12 Steps. For those people who are not Christian but identify with another faith tradition or who identify as a humanist or as an agnostic or atheist, turning our wills and lives over to what seems to be a Supernatural and paternalistic deity is not an option. When and where we try, we might feel as if we are being untrue to some of our core beliefs and being dishonest with other people in the Program. Since the Program demands “rigorous honesty,” and its absence may make recovery that much more difficult, failure may seem inevitable to some.

The co-founders of Alcoholics Anonymous, Bill W. and Dr. Bob, wrote the 12 Steps in a way that assumed a Christian notion of God. They themselves were Christians or had been raised as such, which means Christianity comprised their “overbeliefs.”  Overbeliefs are propositions, values, and even worldviews that an individual holds habitually or without rigorous reflection. Overbeliefs may themselves lack rational grounds, but they provide the grounds for other beliefs and values. Had they paid attention more to their own overbeliefs, Bill W. and Dr. Bob may not have enshrined them in the 12 Steps. How might they have avoided this mistake? By paying more careful attention to the work of William James, whom Bill W. regarded as another co-founder of AA even though James had died decades earlier.

When Bill W. was in the Charles B. Towns hospital in 1934 undergoing “the belladonna cure” and probably suffering from delirium tremens from withdrawal, he had what he later called a conversion experience. He felt he was on a mountain and that a wind of spirit was blowing. It was at that point he felt a free man. Not long after this experience, afraid he was losing his mind, a friend gave him a copy of William James’s The Varieties of Religious Experience (VRE), published in 1902, to help him understand his experience. In VRE, James is concerned with spiritual experiences of individuals and how such experiences are radically transformative. People become regenerated, rejuvenated, or as James says, “reborn.” James assembled an extraordinary set of examples of spiritual experiences from a wide range of sources, which is amazing to consider, as he was doing so in the late 1890s and early 1900s. It is true that many of the examples he discusses are Christian, but there are also examples from Buddhist, Muslim, and Hindu traditions. Just as important, James offered examples that had no basis in faith but rather in moral commitment.

James also offers several accounts of “reformed drunkards” who had similar experiences to Bill W. The men claim it was God who removed the desire to drink. Small wonder that those examples spoke volumes to Bill W. These experiences involved a great external force moving through them and removing the desire to drink. These men were powerless over a force that had an origin outside themselves. With these examples, however, come several cautions from James.

James argues that these “sudden conversions” may feel as if they are driven by an outside force, but may, in reality, be driven by one’s subconscious mind breaking through the rigid borders the rational mind maintains. Such experiences, however, easily fit within Christian doctrine of an infinite God who exercises causal power over humans and intervenes in human life. In fairness, James does concede if there is a God of this sort, it enters through the subconscious. But note the “if”: the experience doesn’t constitute proof of God.

It is in VRE that Bill W. encounters the term “higher power.” Here, too, James offers many examples from Christian traditions right alongside other non-Christian examples. One of the best examples of “higher and friendly power” James borrows from Henry David Thoreau walking in the mist at Walden Pond feeling a sense of connection to pine needles. Other examples of “higher power” include moral principles, patriotism, civic engagement, and quite importantly, a higher or better self. James is quite clear that higher power is a very personal conception. It may be simply the belief that you can be or have been in the past a better person.

Individuals have spiritual experiences, while religions may be founded on those experiences. Religions are more like corporations and tend to traffic in “second-hand experiences,” James might say. A religion is both a doctrine and the people who live by that doctrine. It is entirely understandable and laudable that Bill W. and Dr. Bob and others wanted to create a program to help others achieve sobriety. Bill’s experience worked for him; he lived a very different life with respect to his relationship with alcohol. The issue is when an individual’s experience, along with all the overbeliefs, comes to undergird a program for others. Though Bill W. and Dr. Bob were clear the Steps are suggestions, they do function more strongly than that, even to the point of being doctrine for some. The Steps suggest turning our lives and wills over to the care of God (even with the proviso “as we understood Him”), becoming ready to have God remove our defects of character, asking Him to do so, and praying for knowledge of His will for us and the power to carry it out.  Some people will be able to “work the Steps,” by finding enough latitude in the “God as we understood him” qualification. Perhaps some others will be like the atheists and agnostics who appear in the chapter, “We Agnostics,” in the Big Book aka Alcoholics Anonymous. These atheists and agnostics might pivot, and God will come to those who honestly seek Him.

Some people are neither willing nor able to square themselves with a Christian God, which means they will have a difficult time “working the steps” and staying in the fellowship. One’s honesty rather than dishonesty may be the reason why one leaves the fellowship. This is truly unfortunate because AA—both the program and many of the people—can be helpful in the right circumstances.

The post Different Forms Of Higher Power In Recovery appeared first on Reach Out Recovery.