Some on Council look to manage methadone clinics, not ban them

Next week, a City Council committee will consider a bill sponsored by Councilman Mark Squilla which would change the zoning code to prohibit new medical and dental offices from being built in the 1st Councilmanic district, which covers portions of South Philly, Center City, Old City, and the River Wards.

If history is any indication, the committee will approve the bill: Council unanimously adopted nearly identical legislation late last year that prohibits new medical offices in Northeast Philly’s 6th and 10th districts, represented by Bobby Henon and Brian O’Neill.

The bans mean that doctors and dentists who want to open small practices will first have to go through neighborhood meetings and get the approval of the Zoning Board of Adjustment, a five-member panel that decides when to grant exceptions to the city’s zoning code.

But doctors and dentists aren’t the real targets of the legislation. The real targets are methadone clinics, which provide treatment to heroin addicts, and which many communities tend to consider nuisances, stains on the neighborhood, blight.

They can be problematic. There are only 14 methadone treatment centers in the city, and each sees hundreds of visitors a day. Patients gather outside, loiter, smoke cigarettes, buy and sell prescription pills.

And yet some city officials say the solution to these problems isn’t fewer methadone clinics, but more, targeted in the areas that need them the most, with each caring for fewer patients.

Last week, Dr. Arthur Evans, commissioner of the Department of Behavioral Health, told the Planning Commission that while residents sometimes claim that new methadone facilities will draw drug addicts from other areas into their neighborhoods, drug abuse and addiction is a citywide problem.

“There is no part of the city that doesn’t have drug addiction or mental health challenges,” Evans said. “We think it’s important to have facilities in those places.”

It’s true. According to data provided by the city’s Office of Addiction Services (OAS), there are at least 4,607 city residents in methadone treatment, spread across Philadelphia, but concentrated in parts of Kensington, the Northeast, and South Philly. According to the data, roughly a quarter of methadone patients reside in zip codes in the 6th and 10th Councilmanic districts, where new clinics are now banned. Another thousand or so live in the 1st district, where a medical-office ban is proposed.

(For two years, residents of Holmesburg have been fighting the placement of a methadone clinic in that neighborhood. According to OAS data, Holmesburg (zip code 19136) has the second-highest concentration of residents in methadone treatment of any zip code in the city. Note: an earlier version of this article neglected to account for the portion of 19136 residents in methadone treatment who are part of the Philadelphia Prison System. Leaving out that portion of the patient population, 19136 is actually tied in 10th place for highest number of residents in methadone treatment.)

Some Council members are now seeking solutions to the problems that accompany methadone facilities without banning them outright.

“I think we have a responsibility and a moral obligation to spread this out all over the city,” said 7th-district Councilwoman Maria Quiñones-Sánchez, “but be obviously cognizant of the public safety issues and the impact of where you locate them.”

Councilwoman Sánchez is supporting Kensington Hospital’s plan to move its 160-patient methadone treatment operation down the street into a now-vacant building at the corner of Diamond and Front streets, under the El. The proposal, which the zoning board will consider on Wednesday, February 19th, has made some neighbors skittish. In November, the East Kensington Neighbors Association voted to oppose the project.

“I don’t say no to these facilities—and I get beat up about it all the time—because there’s a health issue related to this,” Sánchez said. “I like to manage the conversation differently, and I’m OK with some people getting upset with me from time to time because of it.”

Sánchez said communities could spend their time better by working to make the facilities as low-impact as possible, through design elements, security plans and so on.

“I want to know the ‘how,’” Sánchez said. “What is it that you need?”

The City Planning Commission is working on potential solutions as well, specifically related to requiring methadone clinics to have waiting rooms large enough to accommodate their patients, in order to offset some of the loitering problems.

“If you’re going to try to mitigate [clinics’ problems] using zoning, it always has to be tied back to land-use impacts,” said Natalie Shieh, who works for Alan Greenberger, the Deputy Mayor for Economic Development. “… So things like parking capacity, waiting room size, ingress and egress—where are the doors facing in relation to the street?—all of those factor into whether a facility is adequate enough to handle the services that they’re providing.”

Shieh said that while she understood the issues that Councilmen Henon, O’Neill, and Squilla are trying to resolve, the legislative approach they took to resolving them was both disproportionate and legally questionable. Courts have ruled that cities and states can’t use zoning to prohibit methadone treatment centers in all but the least-restrictive zoning districts, and Deputy Mayor Greenberger said last week that if the bills passed in the 6th and 10th districts were passed across the city, the city would be likely to face a federal lawsuit and lose. Shieh said she thinks the zoning prohibitions should be rolled back.

“The medical industry encompasses a lot of different practices—medical, dental, and a lot of different sizes—so you have large institutional hospitals but you also have family-run practices that are on your commercial corridors,” Shieh said. “These are all going to be impacted and these are all now banned in the 6th and the 10th district, and now proposed to be banned in the 1st district. And I think the impact for small businesses, I think the impact for access to healthcare is tremendous. Those consequences should be weighed very heavily.”

A number of district Council offices have been involved in discussions with the Planning Commission as well, including those of Councilwoman Sánchez as well as Council members Cindy Bass and Marian Tasco.

Councilman Curtis Jones, Jr.’s 4th district is home to one of the city’s largest methadone clinics, at 50th Street and Parkside Avenue. Jones said in an interview last month that he had considered introducing a ban like that used by Henon and O’Neill but that he is holding out for the time being. He said that making sure the existing facility is well-managed is his priority.

“Crowd control outside of a facility is one of my pet peeves,” Jones said. “Methadone clinics are within, in my case, 500 yards of two major elementary schools. And I’ve watched, on a number of occasions, parents have to navigate through those outdoor crowds, folks catching a smoke—or some other activities that I won’t go into to paint so negative a picture, but all of those activities aren’t so cool—that little kids have to walk through and figure out, on the way to figure out Sesame Street.”

Jones said that no one should have to know that a methadone clinic is a methadone clinic from a block away. He also said he’d fight for constituents for whom the placement of a door or a waiting area in a new facility could make a major difference in terms of neighborhood impact. But he said he accepts that methadone treatment is a necessary social service.

“Each Council district has a responsibility for taking a bite of the unpopular cause,” Jones said. “Whether it’s day-reporting centers for newly released ex-offenders, whether it’s rehabs, whether it is methadone clinics, we all have a responsibility to service that end of the population as well.”

Many people question whether methadone treatment is a real service to heroin addicts; some claim that is a government-funded substitute addiction. Councilwoman Sánchez said she has mixed feelings about the treatment herself: “It does create this kind of long-term treatment path that you never see an end to,” she said.

Still, the Centers for Disease Control considers methadone the best treatment for opiate addiction.

One morning last week, a 25-year-old man named Nick was standing in the cold at the corner of Franklin and Girard Streets, outside Girard Medical Center, smoking a cigarette and waiting for the bus. He had plastic bags wrapped around his shoes and a magazine rolled up in the pocket of his coat.

Nick, who asked that his last name not be used, said he’d been in daily methadone treatment for four years, since he was 22. Each day, he takes the 15-to-20-minute bus ride from his home in South Philly to 8th and Girard, to get dosed. He can’t get a job or go on vacation, he said, because he’s in an intensive outpatient (IOP) program.

“I can’t get away from this place no matter what I do,” Nick said. Methadone was “liquid handcuffs.”  

Nick said he hoped in the next few months to switch over to suboxone, which can be dosed less frequently and which he said can be slightly easier to kick—he hopes. He said he understood why people wouldn’t want a methadone clinic in their neighborhood: people loitering, vomiting, nodding off, selling drugs. He pointed to a donut shop across the street where he said you could buy any type of prescription pill you could want.

“I can’t walk past this clinic without somebody offering me Xanax” or other pills, he said.

“I don’t want to live this way no more.”

The bus arrived, and as Nick was getting on an older man jumped off, walked into the small crowd gathered near the corner and announced, half-yelling, “Klonopins! Klonopins!”

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