This story originally appeared on Spotlight PA.
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In December 2017, Gov. Tom Wolf signed legislation to increase oversight for drug and alcohol recovery houses — a measure that lawmakers said was needed to fight the opioid epidemic and protect vulnerable people from being exploited.
The action by lawmakers came after years of complaints from local government leaders and some recovery advocates, who said profit-driven owners packed people into homes, provided few rules and little support, and put residents at greater risk of relapsing.
But more than three years later, recovery homes — believed to number in the thousands — continue to operate without state oversight, Spotlight PA has found. The state’s Department of Drug and Alcohol Programs missed a June 2020 deadline to, for the first time, create a certification or licensing process for them.
People often move into these homes after going through a treatment program, and they agree to rules, like following curfews, to help them avoid using drugs and alcohol.
Department officials said earlier this month they were completing an internal review of draft regulations and planned to send them to the attorney general’s office by the end of January, but couldn’t commit to a timeline for when licensing and oversight will begin.
“I’m saddened by that because the longer it takes to set that up, the more individuals could pass away in these unstructured recovery homes,” said Amber Longhitano, a former council member in Bristol Township, Bucks County, who pushed state lawmakers to create oversight for recovery homes.
Beyond the delay, there’s a more fundamental problem with the oversight effort: It’s voluntary, though there are incentives.
Homes that receive or want to receive state or federal money, as well as ones seeking referrals from state agencies and state-funded facilities, will have to follow the licensing rules. And judges will have to first consider a licensed home when approving housing for people under court supervision.
Some advocates for higher standards believe poorly run or predatory homes might simply opt out of the licensing process. Jason Sabol — an attorney for the city of York in south-central Pennsylvania, which several years ago estimated it had about 80 recovery homes — said he appreciated the effort, though he doubted it would bring the relief residents are looking for.
“They think that help is coming,” Sabol said. “Unfortunately, it’s really not.”
And many in the recovery home industry fear proposed regulations requiring fees, background checks, training, and annual audits could make it almost impossible for good homes to obtain a license.
“There was a cost to the operator that a lot of people had problems with, especially if it was a mom-and-pop recovery house,” said Fred Way, executive director of the Pennsylvania Alliance of Recovery Residences.
Even a Republican state representative who helped write the 2017 recovery house law — Frank Farry of Bucks County — warned that regulations proposed by the Wolf administration go too far, telling the department that he heard from “local recovery house owners who support having their industry regulated but fear these regulations cannot be met and are unmanageable.”
Officials with the department have adjusted the draft regulations based on feedback. But they are defending the proposal and said the latest version — which they haven’t made public — keeps the audit requirement and others the industry opposes, according to Jennifer Smith, secretary of the Department of Drug and Alcohol Programs.
“I think we may still hear some of those same concerns,” Smith told Spotlight PA. “In fact, I think we probably won’t hear the concerns die a little bit until we actually start implementing.”
The lack of action on recovery homes comes as the opioid crisis continues to kill thousands of people in Pennsylvania each year. More than 4,400 people died of a drug overdose in Pennsylvania in 2018 — a rate that ranked fourth in the nation, according to the U.S. Centers for Disease Control and Prevention. Drug overdose deaths were similar in 2019, and some parts of Pennsylvania are reporting a record number of drug overdose deaths for 2020, in tandem with the outbreak of the coronavirus pandemic.
COVID-19 has contributed to the delay, but the Department of Drug and Alcohol Programs was already behind on its plan before the pandemic began. Smith said the department faced other priorities as it responded to the opioid epidemic, including expanding access to naloxone, which can rapidly reverse a narcotic overdose.
“It’s just a matter of kind of juggling priorities and making sure that we’re continuing to keep everything moving,” she said.
‘The wild, wild, west’
As a council member in Bristol Township, Longhitano championed a local ordinance regulating recovery homes.
These homes — which don’t offer formal treatment, such as medical prescriptions or counseling— can provide important support early in someone’s recovery, as they are starting new jobs and taking on new responsibilities, industry officials and addiction advocates said.
“If we don’t provide them a way to do that, people end up homeless, or back in prison, or back in treatment,” said William Stauffer, executive director of the Pennsylvania Recovery Organizations Alliance.
Longhitano agreed that communities need these facilities, some of which “are set up wonderfully” and “are helping people by the hundreds recover.”
But she said too many unregulated homes hurt the whole community. When Longhitano served on council, residents told her they wouldn’t take their kids to parks because they found “needles all over the ground.”
And sometimes tragic things happen to the people inside.
In 2016, The Philadelphia Inquirer described how pastors and others in Puerto Rico sent people to Philadelphia, where recovery house operators took advantage of them, forced them to hand over food stamp benefits, and generated money by referring residents to treatment centers.
An investigative statewide grand jury report, released in 2019, alleged that a Bucks County-based treatment provider, the now-closed Liberation Way, used recovery homes as part of an elaborate and complex insurance fraud scheme in which patients were cycled through the treatment process as many times as possible to maximize billing. Some housing staff and employees had sexual relationships with patients who were actively receiving treatment, and some homes were located in areas “known for nefarious activity,” which made it easier for residents to relapse, the grand jury said.
“It was like the wild, wild west,” said state Rep. Tina Davis (D., Bucks), one of the lawmakers who turned their attention to recovery homes as the opioid epidemic surged.
In 2014, Stauffer and Way served on a task force, alongside others in the recovery community and state officials, to study recovery houses and make recommendations for safety standards. Some of those recommendations, released in 2016, were incorporated into legislation that came up for a vote the following year.
“It has been a long time coming,” Davis said on the House floor at the time.
Smith said the department used input from the recovery house task force to influence its proposed regulations. But three members of the group — Way, Stauffer, and Denise Holden, CEO of the recovery home operator the RASE Project — told Spotlight PA they had concerns about the draft released in 2019.
Way’s organization, the Pennsylvania Alliance of Recovery Residences, is in favor of oversight. In fact, his organization inspects and certifies homes for owners that want to meet national standards. The goal, he said, is to make the homes better.
But the cost of implementing the proposed requirements — from a $250 license and renewal fee to hiring an independent certified public accountant to conduct annual financial audits — would make it prohibitive to get a license in the first place, he said.
Stauffer said some of the proposed changes are welcome. That includes safety requirements for the property, as well as measures to protect residents financially. The draft regulations would ban recovery house operators from forcing residents to sign over public assistance benefits, and it would ban them from requiring residents to attend a specific treatment facility.
But like Way, he’s concerned about the additional financial burden. He’s glad the state hasn’t introduced the regulations during the coronavirus pandemic, at a time when many are already struggling and the homes are desperately needed.
“Any kind of change at this point would make that housing less stable.”