Nancy Falcon ran toward two police officers tending to a stopped car just off Kensington Avenue on a sunny afternoon this week, yelling “Do you need Narcan?”
In the driver’s seat of the car, a woman slumped unconscious — head back, eyes closed, face white, lips blue. Falcon ripped open the plastic packaging and handed the officer the Narcan, a drug that reverses the effects of opioid overdose. One dose of the nasal spray produced no visible effect. Police removed the woman from the car, laid her limp body in the street and tried again with a second dose provided by a woman working across the street at Prevention Point, a local organization that works to reduce harm associated with substance abuse.
This time, it worked. The woman, wearing a black sweatshirt that read “Philly” across the front, jolted up and immediately stood on her own, telling those nearby that she’d go along with medics who recommended professionals check her vitals. But she was alive.
“And that,” Falcon said, “is why you carry Narcan.”
She’s always carrying it. Falcon, a 45-year-old recovering addict herself, said while she didn’t want to see a woman who’d clearly overdosed, she was just doing what she said she does every day: “Passing on the blessing.”
Falcon is a certified peer specialist with Pathways to Housing PA, a North Philly-based nonprofit that addresses chronic homelessness and works to find housing solutions. Since last fall, Falcon’s been a member of the new “Team 7,” a handful of Pathways employees focused exclusively on getting housing for people addicted to opioids and experiencing homelessness.
Since October, Pathways has gotten about 45 participants experiencing homelessness and addiction off the streets and into housing, and they’re working to place at least 10 more in the near future. Some participants have taken significant steps toward sobriety since entering the program. Others have continued to use. Some have thrived in their new homes. Others have struggled with basic community integration.
What they all have in common is clear: They’re not sleeping on the streets anymore.
“I finally have a place to stay. A shower,” Earl Volz, a participant in the program who’s been in housing for two-and-half months, said through uncontrollable sobs of happiness. “It’s like I’m a normal person.”
Why housing is first, not necessarily sobriety
It’s first thing in the morning, and seven people are sitting around a dark, wooden table in a room labeled “Team 7” at the Pathways to Housing PA office, just off North Broad Street in Olney. The team is in the midst of its morning “rounds,” a daily marathon meeting when every member of the team gets caught up on what’s going on with every one of the 54 current Team 7 participants. Nurse Kate Gleason Bachman is sitting at the end of the table, taking notes on a pad that’s next to a set of keys and a bottle of Narcan.
For one participant, the team weighs whether a suboxone treatment or a methadone program might work best, since she’s showed signs of interest in getting help addressing her addiction. Another participant is currently incarcerated, and the team is strategizing an advocacy plan for him. The meeting involved status updates on dozens of participants, some of whom the team is helping with money management. One had been robbed. Some are out of rehab. Others are still in the depths of addiction and are at a high risk for overdose. Every person has an individual plan.
Team 7 started taking on participants last fall and was placing folks in housing by Christmas. The participants get a contract, housing is permanent, and if the participant has income, they’re required to spend 30 percent of that on their housing. Matt Tice, the clinical director at Pathways, said Team 7 currently has a 100 percent housing retention rate.
The Pathways organization, funded largely through federal dollars, launched the seven-person team last year with the hopes of making a dent in the opioid epidemic that’s gripping Philadelphia. Last year, more than 900 people died in the city as a result of a drug overdose, and Philly is on track to record a staggering 1,200 overdose deaths this year.
Today, Tice said the group believes it’s the first team in the country dedicated exclusively to a “housing first” model for people addicted to opioids and experiencing homelessness. “Housing first” is the progressive philosophy Pathways operates on, and it means that the organization will offer housing without any pre-conditions. Participants don’t have to get sober. They don’t have to take medication. They don’t need to agree to treatment.
“If we are pushing them aside or telling them ‘you need to do what we tell you,’” Tice said, “they’re going to be alienated and not want to have anything to do with us, and then be further stigmatized into the margins.”
Keeping substance abuse ‘at the forefront’
The model isn’t universally accepted. Many have questioned whether more “progressive” groups like Pathways are enabling addicts to continue using. The criticism is similar to conversations that bubbled up as part of a task force charged earlier this year by the mayor to find solutions to addressing the opioid epidemic in Philly.
Much of the conversation centered around whether Philadelphia should consider implementing medically-supervised “safe injection sites.” Tice, who is a member of the task force, is in favor of exploring such a move. The group’s full report is to be released today, and a draft report shows the task force didn’t take a position for or against safe injection sites.
Tice said the progressive model used by Pathways is all about “harm reduction.” Though most of their participants have expressed a desire to move toward sobriety, Pathways would rather provide housing and give participants clean needles and a sharps container as opposed to crossing their fingers and hoping the person gets sober and doesn’t relapse.
“Traditional models have said ‘well, you failed our approach, you weren’t conforming to what we say you need to do,’” Tice said. “What we’re saying is: ‘We failed you in what we need to offer, so we need to come up with the best options that will work with you.’ We really treat it as though this is a person in front of us, and not just a problem.”
That doesn’t mean they don’t talk about addiction. Quite the opposite.
“We always try to keep substance abuse at the forefront of our conversation,” said team leader Kristen Hamill, noting that on move-in day, Pathways gives each participant Narcan and trains them on how to use it.
Connecting with addicts
Nancy Falcon’s son David would be 23 years old today. He died at age 6 after spending his short life wheelchair-bound due to epilepsy. It was his illness and subsequent death that sent Falcon spiraling into addiction in the 90s.
“No one wants to be, like, a druggie,” she said. “But the next thing you know, you’re in so deep.”
Falcon, who moved to the United States at age 9 from Puerto Rico and has lived in Kensington for most of her life, has been sober for 17 years. But she still has painful memories from her time in the depths of addiction. She’d already lost her son. Then she lost other relationships. In 1999, her friend got high, beat her with a machete and permanently damaged her nose.
Then she started selling to supplement her habit. What saved her, she says, was incarceration. After spending time in jail and then in a recovery program, Falcon got sober. And her experiences are a critical component of the Pathways team — she and other “certified peer specialists” have the life experience that allows them to connect with participants on a level others simply can’t.
“I’m upfront,” she said. “I tell them I have nothing to hide. Getting clean and passing on the blessing? I’m living proof it can be done.”
Almost every day, Falcon drives through Kensington and makes home visits to check in on the participants who live in the neighborhood (though participants are placed in homes across the city). She takes them grocery shopping, reminds them to make appointments and assists them in filling out paperwork. Sometimes when she gets to the home, the participant isn’t there. Other times, there are people in the apartment she has to kick out. Once, she got to a participant’s apartment and the woman was being beaten by a domestic partner. Falcon called 9-1-1, and never left the woman alone.
When I asked Falcon if she ever gets frustrated working with participants who are struggling to get sober, she brushed off her own feelings, saying the strategy is often that if one member of the team can’t get through to someone, another person tries. Every participant works with the entire team, so when one person is struggling with a participant, there are six others who can step in.
“I just continuously give people different suggestions and different ideas,” Falcon said. “Certain people don’t like change. That’s OK.”
With support, ‘anything is possible’
Edgar Figueroa’s home on Frankford Avenue in Kensington is spotless. His kitchen cabinets are stocked with soup, rice and beans, cereal, crackers and Pop-Tarts, and he repeatedly offers me a bottle of water or a soda. In his living room sits a small TV and a coffee table with a pocket-sized paper book sitting on it. “Auxilio de los Cristianos,” it’s called. It’s a prayer book given to him by Nancy Falcon. And he reads from it daily.
Figueroa is a 52-year-old in recovery, and he’s been in this second-floor apartment for the last month since finishing a 70-day treatment program, thanks to Pathways. When Prevention Point — the Kensington-based nonprofit that partners with Pathways— referred Figueroa for housing, he told Falcon he wanted to go into detox and then to a treatment program. And he did, describing the 48-hour detox process as “my hell.”
Since then, Figueroa says he’s stuck to sobriety, and things have taken a turn for him. He shows me photos of each of his five kids — four daughters and a son — with whom he’s regained contact over the last few months. Every day is hard when you want to change, he says. But with support from his family and the Pathways team? He says “anything is possible.”
At Prevention Point’s Kensington headquarters, Pathways participants often flow in and out. Three quarters of participants being served by Team 7 were referred from there. Philip Rohmer, a 49-year-old participant in the program, was experiencing homelessness and on the streets for three years when he was connected with Pathways. Now, he’s been in his own place for about a month. And, like Falcon, he can’t stop using the phrase “it’s been a blessing.”
“They took me out of a very bad situation,” Rohmer said. “I broke down when I moved in. It went from insanity to normalcy.”
Throughout the day, participants visiting Prevention Point often swing by Falcon’s car just to check in and say hello. Michael Gellock, a 48-year-old participant who has been with Prevention Point for eight years, is one of them. He said since he got housing through Pathways, he’s been eating more. He’s “more responsible.” He likes to cook. And he’s hopeful.
“Everything I have,” he said, “is because of them.”
That was a common refrain coming from the people who have so far been housed by Team 7. Some of them are still in the throes of addiction. And some are well on their way to lasting sobriety.
After visiting with Figueroa earlier this week, I walked out the front door to get back in Falcon’s car, when Figueroa yelled to me with a smile: “Come back again sometime,” he said. “I’ll make you rice and beans.”