September 24, 2023

PHILADELPHIA — Shaun Anderson hasn’t slept this late within the day in years. He nonetheless wakes up a couple of occasions all through the night time — a behavior he’s developed making an attempt to guard himself from being jumped whereas at his most susceptible. This morning, nonetheless, he slept so deeply he didn’t hear his doorbell ring. He wasn’t used to even having a doorbell, or a daily place to sleep — housing is one in all many issues he’d misplaced to a decades-long battle with opioid use dysfunction. “I hate you heroin — you ruined my life,” he writes in his journal. “You took every little thing from [me]: my home, automobile, children, and my spouse.”

Anderson’s story is emblematic of what 1000’s of Individuals fighting opioid dependancy undergo day-after-day. For a lot of like Anderson who resolve to give up, it’s far simpler stated than finished. Even for individuals trying to enter therapy, and who discover assist programs keen to assist, fundamental obstacles like housing, security, and cash could make restoration all however unattainable. “I simply really feel like I’m caught. I really feel like life’s passing me by,” Anderson, 44, laments. “All I ever needed was to be husband and father. … Heroin mess[es] with you. I overlook who I’m — which is an effective, sincere, humorous man.”

Anderson, who had been unhoused in the Kensington neighborhood of Philadelphia, sits on the porch of his new apartment in southwest Philadelphia.
Anderson, who had been unhoused within the Kensington neighborhood of Philadelphia, sits on the porch of his new condominium in southwest Philadelphia. Rachel Wisniewski for STAT
Anderson (left) draws with artist Lisa Kelley, who co-hosts a biweekly art lesson at Prevention Point in Kensington, in May 2023.
Anderson (left) attracts with artist Lisa Kelley, who co-hosts a biweekly artwork lesson at Prevention Level in Kensington, in Might 2023. Rachel Wisniewski for STAT
A letter that Anderson wrote to the Prevention Point staff in February 2023.
A letter that Anderson wrote to the Prevention Level employees in February 2023. Rachel Wisniewski for STAT

STAT frolicked with Anderson over the course of a number of months in Philadelphia’s Kensington neighborhood, which is alleged to be the most important heroin market on the East Coast. About 300,000 people in Pennsylvania are coping with a substance use dysfunction, in line with authorities estimates. The state has the third highest charge of overdose deaths within the nation, with 15 lives misplaced to overdoses every day.

Anderson speaks with a friend who is without housing while taking the subway in Philadelphia. Anderson had just purchased breakfast for himself but quickly gave the food to his friend.
Anderson speaks with a good friend who’s with out housing whereas taking the subway in Philadelphia. Anderson had simply bought breakfast for himself however shortly gave the meals to his good friend. Rachel Wisniewski for STAT
Anderson picks up his buprenorphine prescription, a drug that treats dependancy to narcotics, from a pharmacy in Kensington in June 2023. Rachel Wisniewski for STAT

Pennsylvania is one in all solely 10 states the place syringe service packages are illegal. Some packages, although, function underneath native municipal ordinances. Based in 1991, Prevention Point is the oldest needle trade program within the metropolis, and is a every day stopping level for Shaun Anderson. Prevention Level presents outreach packages, main care, psychological well being companies, meals, housing case administration, and extra. The companies couldn’t be extra wanted by the neighborhood. “[Kensington] is among the extra closely hit areas. It’s been like this for years,” admits Sarah Carroll, Anderson’s case supervisor at Prevention Level. Nonetheless, Carroll is keen on the neighborhood. “It’s an exquisite neighborhood. It’s various; it’s accepting,” she says. “And all people from america comes to go to!” she quips.

It’s in Kensington the place xylazine, an animal sedative generally known as “tranq,” most likely began gaining floor within the unlawful drug provide nearly a decade in the past. Though Prevention Level provides drug testing kits, tranq is virtually unavoidable, present in over 90% of the town’s drug provide. Heroin is already extremely addictive by itself, and is made much more addictive by fentanyl and tranq. In 2021, fentanyl was present in 94% of accidental opioid overdose deaths in Philadelphia, and tranq was present in 44% of deaths. Tranq additionally causes extreme wounds together with necrosis: the rotting of tissue. Anderson as soon as skilled a sore from xylazine that was so deep “I may put two fingers in my leg,” he says.

A Delaware native, Anderson moved to Philadelphia 5 years in the past seeking heroin. His life in Delaware had been troublesome. When he was a toddler, his father would beat his mom; when Anderson would intervene, he’d get hit as nicely. Later in life, he says, each of his youngsters and one in all his sisters died and he needed to determine their our bodies — an expertise that also offers him nightmares. Anderson’s mom used medicine, usually encouraging him to affix her. It helped, he says, to boring the trauma. “Lots of people received psychological well being issues. That’s why lots of people use,” Anderson says. “I’ve been utilizing for like 20 years.”

Anderson sweeps the sidewalk in entrance of his condominium in Might 2023. Rachel Wisniewski for STAT

After years of housing insecurity, Anderson signed the lease to an condominium in southwest Philadelphia in Might. He was in a position to lease the condominium on account of constant advocacy from Carroll. Carroll is in restoration herself, and couldn’t be happier to assist. “[Housing] could make a person, particularly Shaun, really feel full,” she says. Her efforts don’t go unnoticed. “I like Sarah. Sarah’s superior, man,” Anderson gushes. “Sarah cares, she actually does. She’s saving my ass.”

Anderson receives an air mattress from Sarah Carroll, his built-in medical case supervisor at Prevention Level, shortly after transferring into a brand new condominium. Rachel Wisniewski for STAT
An image of Anderson and Carroll displayed on Carroll’s cubicle at Prevention Level. Rachel Wisniewski for STAT

To Prevention Level, “Housing is well being care; housing is wellness,” states Silvana Mazzella, interim lead govt officer of Prevention Level. “Possibly any person shouldn’t be but prepared for restoration, however that doesn’t imply that they don’t deserve security and peace and relaxation.” So far as outcomes, Mazzella says, “[Some] individuals have gotten into our program, gotten housed, they usually flourish. They’re self-sufficient and have a top quality of life. We even have individuals who — possibly they don’t turn out to be employed or handle each difficulty they’ve or each want they’ve relayed to us. However they’ve turn out to be housed. What’s unsuitable with that?”

The demand, although, is way greater than the provision. “There are particular tips that need to be met to qualify for housing, and at occasions it may be very troublesome,” Carroll says. “And there’s not sufficient.”

Earlier than getting the condominium, Anderson says, he was robbed or jumped nearly every day. Nonetheless, he has been stolen from and beat up a number of occasions previously a number of months. In June, he needed to spend the night time within the hospital emergency room after making an attempt to cease an tried sexual assault at McPherson Sq. Park. “Nobody else even tried to assist,” he sighed. The next day, his physique ached from head to toe: discomfort he attributed to being beat up within the park. It turned out, although, that the supply of ache was truly an abscess subsequent to his coronary heart — a standard affliction of power IV drug customers. “My good friend died of this,” he cries from his room at Temple College Hospital.

“I’m used to giving, not receiving,” Anderson explains about himself. Mere hours after being launched from the hospital in June, Anderson picked up a rainbow-colored teddy bear he discovered on the road and, a couple of blocks later, handed it to a lady who was in a heated argument along with her boyfriend. Receiving the bear prompted the couple to cease their combating for a second. The girl regarded shocked however happy by the sudden reward. “I do know the individuals — they’re good individuals,” Anderson explains of Kensington residents. They might be tousled on medicine, “however they’ll provide the shirts off their backs, ?”

Anderson buys espresso at a store near his new condominium. Rachel Wisniewski for STAT

Later in the identical day, whereas strolling to obtain his weekly provide of Suboxone — a drugs that helps deal with opioid use dysfunction — Anderson overheard a younger girl who was experiencing withdrawal signs comment that she was chilly. With out hesitating, he unzipped his black jacket and handed it over to her. Withdrawal is a sense that Anderson can relate to. “Like, now I’m going via withdrawal and my physique’s actual scorching. … You would get diarrhea, upset abdomen … I get a chill up my backbone — identical to this icky feeling, I can’t clarify it. I get like, mind zaps.” Although Anderson needs to give up utilizing heroin, the withdrawal signs weaken his conviction; when he’s sick, utilizing heroin is the one factor that makes him really feel higher. “I haven’t used the entire time within the hospital, so my tolerance is approach down. One bag may kill me,” he worries. When requested if he’s usually involved about unintentionally overdosing, he solutions: “That’s what all people’s anxious about.”

Anderson rests within the cardiology unit of Temple College Hospital in Philadelphia in June 2023. Whereas he sought look after ache after being attacked, an abscess subsequent to his coronary heart was found — a standard affliction of power IV drug customers. Rachel Wisniewski for STAT
A good friend helps Anderson to clear the crust from his eye. Anderson was concerned in a combat the night time earlier than when he says he tried to cease an tried assault in McPherson Sq. Park; one in all a number of accidents Anderson sustained was an an infection attributable to particles in his eye. Rachel Wisniewski for STAT

It’s been a halting course of, however Anderson is slowly working to realize restoration. He’s had a considerably constructive expertise with methadone, a medicine used to deal with opioid use dysfunction. “It’s a piece in progress,” Carroll summarizes. “I meet Shaun wherever he’s. And no matter he chooses to finish, I’ll be there,” she says. “There’s no methadone clinic in Kensington, although. So that could be a massive barrier.”

Shifting into the brand new condominium has proved a more durable adjustment for Anderson than he anticipated. Although he had lastly began to sleep higher in his condominium, he lately selected to maneuver in with a good friend again in Kensington as a substitute. Anderson was jumped once more in late August, his eye socket damaged within the course of. He individually was hospitalized and underwent surgical procedure to have his spleen eliminated. Resulting from his declining bodily and psychological well being, he didn’t really feel he may dwell alone any longer. He additionally felt that spending an excessive amount of time alone elevated his probability of utilizing. “I come residence to nothing however my ideas … that’s why I’m by no means residence. I’ll be caught by myself all day, after which I’ll begin utilizing actual dangerous,” he says.

In early September, Anderson lastly felt able to ask Carroll for Sublocade — a month-to-month injection that manages opioid cravings and withdrawal signs. However there’s so much at stake: If opioids are used whereas receiving the therapy, it will increase the prospect of respiratory issues, coma, or loss of life. Anderson is optimistic, although; even earlier than the therapy begins, he’s proud to announce that he hasn’t used heroin in 12 days.

“I don’t wish to use ceaselessly,” he says. “That is my life, and I’m gonna take it again.”

Anderson within the kitchen of the condominium he lived in till lately, when he moved in with a good friend in Kensington. Rachel Wisniewski for STAT

STAT’s protection of power well being points is supported by a grant from Bloomberg Philanthropies. Our monetary supporters usually are not concerned in any selections about our journalism.