When Mayor Kenney announced the resignation of Health Commissioner Dr. Thomas Farley on May 13, due to the Health Department’s mishandling of the remains of victims of the MOVE Bombing, many wondered what this change in leadership meant as Philadelphia continues to fight the coronavirus.
But some have started to wonder what a change in leadership means for those organizations working on one of Philadelphia’s other public health crises: opioid and substance use disorders.
Farley’s resignation came on the heels of a turbulent 2020 for many, including those struggling with substance use disorders in Philadelphia. According to a report by the Philadelphia Department of Public Health, unintentional drug overdoses rose 6% from 2019, accounting for 1,214 deaths in the city.
During his time as health commissioner, Farley was a major supporter of harm reduction as a strategy for mitigating the impacts of substance use. He supported organizations with a harm reduction focus, advocated for safe injection sites, and for increased citizen access to fentanyl test kits and supplies of Narcan.
His absence means that many organizations working specifically on harm reduction are wondering who will lead the Department of Public Health now, and what will their stance on harm reduction organizations be?
Currently the acting health commissioner is Cheryl Bettigole who has served as the Director of Chronic Disease and Injury Prevention for the Department of Public Health since 2015. However, even with an acting health commissioner Farley’s resignation still leaves questions for harm reduction organizations.
“As far as his resignation goes, we do recognize there has been an increase in awareness around opioid use and the need to do sound public health strategies educating people around opioids, and the presence of fentanyl in the drug supply,” Clayton Ruley, director of community engagement and volunteer services at Prevention Point, said.
Prevention Point is a harm reduction organization that works to reduce the negative consequences of risky behaviors by taking a meet them where they are at approach according to Ruley. They offer syringe services, free medical care, housing services, food, and work to reduce the stigma around the people who use their services.
Many organizations continue to speak positively about Farley and his impact on the opioid epidemic in Philadelphia.
“Dr. Farley was certainly a visionary,” Rebecca Richman, from Safehouse Philly, said.
Safehouse Philly is a proposed safe consumption site or overdose prevention site. During visits people would be presented with rehab options, physical and behavioral health assessment, and a range of overdose prevention services would be offered to them. However, Safehouse Philly has not moved forward yet with services due to a lawsuit.
As for what comes next, staff at harm reduction organizations are trying to stay optimistic, but realize a new Health Department leader may not be as open to harm reduction as a strategy as Farley was.
“We are, I would say, optimistic that there’s not going to be major changes in approach,” Ruley said. “But you always have to be cautious because you don’t know.”
It’s a sentiment echoed by staff and volunteers at Operation in My Backyard, which provides harm reduction supplies including Narcan, and safer injection, smoking, and snorting supplies for people that use drugs.
Harm reduction is controversial and some critics see this work as facilitating drug use, Nicole Bixler, the organization’s co-founder, said.
“It’s really scary, because all it takes is one person to change a law that will make our freedom and the freedom of the people that we’re serving in jeopardy,” she said. “So yeah, it’s always a concern.”
Operation in My Backyard also helps people who ask for assistance with getting into treatment and helps individuals connect with aid services, often housing and food, Bixler said.
When reached for comment about the City’s future stance and possible policy shifts due to Farley’s resignation, the mayor’s office said that Dr. Farley’s resignation doesn’t mean a change in the City’s response to substance use disorders.
“Dr. Farley’s resignation does not mean a shift in the City’s response to the opioid epidemic,” Irene Contreras, deputy communications director at the Office of the Mayor, said in a statement.
It was a statement echoed by the Philadelphia Department of Public Health.
“We’re not anticipating any radical shifts in what we’ve been doing under Dr. Farley,” James Garrow, communications director of Philadelphia Department of Public Health, said in an email. “The Substance Use Prevention and Harm Reduction division continues to work apace.”
Both the mayor’s office and the Department of Public Health pointed toward City initiatives continuing to move forward, such as the Opioid Response Unit (ORU), the distribution of naloxone and fentanyl testing strips, free bereavement support resources for Philadelphians who have experienced loss due to substance use disorders, and the April release of the Philadelphia Opioid Response 2021 Action Plan.
Support from the City is a crucial part of many organizations’ harm reduction work.
“We do get our Narcan from the Department of Public Health, which is the only way we can get it,” Bixler said. “We’re a small grassroots organization, and we can’t afford that.”
A supportive health commissioner can also lend legitimacy and credibility to an organization’s work, Ruley said.
“I think having the commissioner who is for the work that we do is obviously a really big deal,” Ruley said. “Having a health commissioner who believes in the work that you do, I think, gives you a stronger force to push the efforts that you have, whatever they are, to a larger audience with, if not total approval, certainly a willingness to give things a try.”
However, for organizations working on harm reduction, there is still uncertainty until the next health commissioner is announced and sets their own action plans. In the meantime, organizations are continuing to focus on day to day operations.
“The period in between feels like, to be honest, we do what we’re doing and we’re going to continue doing it,” Bixler said.
Ruley said the people who Prevention Point helps have been dealing with a range of issues even before the COVID-19 pandemic — housing insecurities, lack of mailing addresses, lack of regular food sources — and will continue to deal with these issues regardless of who runs the Health Department.
“I would say, at this point, it’s very much the same as it’s been prior to Dr. Farley’s resignation,” Ruley said. “I think the good thing about an organization like Prevention Point is it’s very much used to dealing with being under-resourced and making more out of less, or turning lemons into lemonade.”
Ruley also pointed out that contracts with the City and other agencies are set ahead of time for upcoming fiscal years, so programs that are currently set will continue.
For the future, both Bixler and Ruley stressed the importance of the new Health Commissioner supporting harm reduction efforts in Philadelphia.
“We can’t do it alone,” Bixler said. “We got a grant a couple of years ago, and we just were approved for another one.”
For Ruley and Bixler, a change of leadership means an opportunity to deepen the work that had been started under Farley. They are calling for larger coordinated efforts to get to the root problems of the opioid epidemic.
“There needs to be a larger — whether it’s federal, state, and certainly city — effort to work to eradicate those issues,” Ruley said. “So, you don’t have many people gravitating toward risky behaviors and activities to get by, to survive, to feel good about themselves, to get away from a circumstance that is haunting them, or is troubling them.”
A strategy focused on building compassion for those dealing with substance use should be a priority for everyone involved in public health, Bixler said.
“I feel like, as outsiders, it’s really easy to see the behaviors which are the symptoms of the drug use, which is a symptom of trauma, abuse, poverty, all of these other things,” she said.
Ruley noted that strong, vocal leadership is necessary to bring the situation in specific neighborhoods to the public’s attention, or else the public health issues that accompany widespread substance use will only continue to worsen.
“I think it’s important that we continue or start doing things that make long term sense preventively,” he said. “Stop being as reactive and waiting for a pandemic or epidemic to happen to start actually trying to do something.”
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